Eyeworld

DEC 2014

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/422211

Contents of this Issue

Navigation

Page 18 of 90

EW NEWS & OPINION 16 December 2014 by J.C. Noreika, MD, MBA The sound and the fury D on't like typing on a keyboard? Blame the 2007 housing bubble and the 2008 collapse of Lehman Brothers. Reputed to have caused the most serious economic crisis since the Great Depression, they engendered legislation with far-reaching consequences. The American Recovery and Reinvestment Act of 2009 (ARRA), euphemistically called the Stimulus, was passed by a sharply divided Congress and signed into law by President Barack Obama. It cost taxpayers more than $850 billion or more than $10,000 per American household. But it didn't start with President Obama—the original mandate, an executive order from President George W. Bush in 2004, was designed to have all doctors on electronic health records (EHR) within 10 years. ARRA included the Health In- formation Technology for Economic and Clinical Health (HITECH) Act, which provided more than $25 bil- lion to realize President Bush's and a bipartisan congressional coalition's vision to bring doctors, hospitals, and health plans into the digital age. A three-stage program, it has been fraught with changes and delays. Health Data Management (October 2014) reported that as of August, only "1,898 eligible professionals had attested to Stage 2." The term Meaningful Use (MU) has become an expletive-deleted oxymoron in medical lexicon. Electronic health records are not new. In the early 1990s, I and other miscreants spent a weekend on Massachusetts's Route 128 to conceive a computerized record for eye surgeons. Datamedic Inc. would then produce ophthalmology- specific software for the world's first Windows-based EHR. Far removed from today's hardware, cloud data storage and computing speeds, it failed spectacularly. DICOM was then a dream, and graphical user interface was associated with Apple's iconoclastic product. There was no demand, no incentive, no need to change. The tipping point? America could no longer pay for its citizen- ry's sense of healthcare entitlement. IT was the answer; "we're from the government and here to help you." Compared to tragedy, an expense is merely a problem. Bureaucrats view the EHR as a cost of doing business, albeit one extending beyond the checkbook. Lowered efficiencies and productivi- ty, IT glitches, the stark comparison between a smartphone's intuitive- ness and the Orwellian mandates of the health record, and the unloved technology's opportunity costs are not inducements for adoption. The absurdity of government's MU apparatchiks is exemplified by their decreeing offices be penalized if their patients don't initiate contact through a patient portal. Let the games begin! EHR is here to stay and no amount of rancor will change that. Consider this: There's a real proba- bility that today's pre-med, medical student, and house-officer may never handle a paper chart. These Gen-Xers and Millennials grew up on screens. Cursive is no longer taught in schools. Today's EHR is merely a first step—the Space Invad- ers—of medicine's digital age. For us, the pre-screeners, I offer the following advice. Remember the transition from extracap to phaco? Traumatic for most, many surgeons proved adequate, a few excelled. The same holds true of this technology. Vari- ance isn't due to intrinsic talent but to effort, practice, and perseverance. You can do this. Ponder the input device. The art of medicine is incompatible with keyboard or mouse. Optical character recognition (OCR) may someday permit No. 2 pencil users to write on a pad. For me, voice recognition is the solution. Skep- tical? Have you talked to your car lately, called American Airlines, or conversed with Siri? Much-maligned Dragon has come a long way since Ray Kurzweil's earliest offerings. I've used voice to document clinical encounters since 1998. Face time? Integrated into EHR since 2002, I dictate a SOAP note as I examine the patient. I document testing, satis- fy compliance requirements, and reinforce the therapeutic covenant in real time. The dictation includes assessment and plan and becomes a letter emailed from the exam lane. In the October 2014 issue, Healthcare Informatics extolled the virtues of today's Dragon and its utility in a busy clinical setting. Interconnectivity is huge. Collecting megadata and sharing siloes of information are the Af- fordable Care Act's holy grail; the AAO has been laboring to estab- lish standards for ophthalmology. Recently, the Office of the National Coordinator for Health IT published its outline of the "interoperability roadmap." It is projected to take 10 years. But intra-office connectivity is here now. MU's patient portal is one example. Zeiss's slick Forum is a model of industry's attempt to bring testing results, trend analysis, and correlative data to the point of care. Clinical decision support code reduces medical error. Our jobs are safe; software will not replace the perceptive practitioner. But, a Coumadin patient may never again be prescribed tetracycline, a hydroxychloroquine patient won't miss a HVFT 10-2 and macular OCT, and a Flomax patient's cataract may be better managed. Neuroscience teaches that the brain's key to remembering something is to externalize it. Finally, ICD-10 is an impending challenge. My EHR has a dropdown coding crosswalk simplifying the changeover. Even a Luddite can do it. The Bard again has the last word. All this noise emanating from ether, print and podium may ultimately prove to be "a tale told by an idiot, full of sound and fury, sig- nifying nothing." We can hope. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com Insights J.C. Noreika, MD, MBA

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - DEC 2014