- Email: [email protected]
Health information technology resources for optometrists
MOVING TOWARD THE PAPERLESS PRACTICE Health information technology resources for optometrists Francis McVeigh, O.D., Mark Swan, O.D., Rex Ballinger, O.D., Jerry Cavallerano, Jr., O.D., and Phil Gross, O.D.
B
y now most optometrists are probably aware that American health care is entering the era of health information technology (HIT). Most have heard that the U.S. Department of Health & Human Services (HHS) is moving toward the Bush administration’s goal of providing all Americans access to electronic health records (EHRs) by the year 2014 through a Nationwide Health Information
The AOA Health Information Technology & Telemedicine Committee offers resources for optometrists who are pursuing a paperless practice through the adoption and implementation of electronic health records and e-prescribing in their offices. Network (NHIN). Increasingly, optometrists realize that the electronic health records movement is part of a larger effort to increase the quality and reduce the cost of health care through an overall reform of the entire American health care system—a reform that will probably entail concepts such as quality measurement, pay-for-performance, and valuebased purchasing. Most important, optometrists increasingly realize that this movement has the potential to profoundly impact the practice of eye and vision care in any number of respects. The problem is: most optometrists have not yet determined exactly what to do about all of this. The American Optometric Association (AOA) Health Information Technology & Telemedicine Committee (HITT Committee) was established by the AOA Board of Trustees in 2006 as an AOA project team and recently transitioned to committee status to help guide the profession of optometry into the new age of health information technology. The Francis McVeigh, O.D., is the chair of the AOA Health Information Technology & Telemedicine Committee. Mark Swan, O.D., Rex Ballinger, O.D., Jerry Cavallerano, Jr., O.D., and Phil Gross, O.D., are members of the committee. Correspondence to the committee may be sent in care of staff person Kelli Tate-White ([email protected]). Opinions expressed are those of the authors and not necessarily those of the American Optometric Association.
committee suggests optometrists (and their staffs) adopt a 4-point strategy: ● Understand the basics of HIT ● Begin planning for EHR implementation in their practices ● Prepare now for e-prescribing, which will probably be the first aspect of HIT implemented in most practices ● Become involved in the regional health information organization (RHIO) or health information exchange (HIE) that will ultimately serve their practices on a state/local level To assist, the AOA HITT Committee has launched a Web page to provide optometrists a compendium of HIT information and resources. Because much of the best HIT information (as one would expect) is being made available electronically, a new Health Information Technology Resources for Optometrists page has been established on the AOA Web site, offering direct links to reliable information that optometrists can use to learn about HIT and begin planning for EHR implementation in their practices. The Web site can be accessed at www.aoa.org/HIT.xml.
Getting the office ready The AOA New Technology Survey notes that optometrists consistently implement the latest eye and vision care technology in their practices (http://www.aoa.org/x9088.xml). Electronic patient record systems of one type or another are already found in 25.9% of AOA member optometric practices, according to the association’s most recent New Technology Survey conducted in 2007. This figure is up from 17.7% 2 years earlier. In addition, some 28.5% of survey respondents report they can already interface 1 or more practice management technologies (e.g., billing, claim filing, bookkeeping) with electronic patient records in some fashion. However, EHR technology certainly has not yet found the same level of acceptance as management software, used (in one way or another) in up to 85% of practices. There are certain preparatory actions that optometrists can do now to begin laying the groundwork for the implementation of EHRs in their practices. For a more detailed discussion see “Time to Get Serious About Electronic Health Records” (Optometry 2008;79:9-17) and other Optometry: Journal of the American Optometric Association and AOA News articles on HIT, available on the AOA
1529-1839/08/$ -see front matter © 2008 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2008.05.006
Practice Strategies HIT Web page. The AOA HIT Web page also provides links to 2 online HIT education programs: ● Alliance for Health Reform Health Information Technology Toolkit—The Alliance for Health Reform’s latest toolkit is designed to help health care providers understand how health information technology is slowly changing health care and how analysts disagree about the value of some technologies (http://www.allhealth.org/ publications/Health_information_technology/Toolkit_ Health_Information_Technology_78.asp). A version suitable for viewing on a Blackberry or similar handheld device can be accessed at http://www.allhealth.org/ publications/health_information_technology/health_ information_technology_bb.asp. ● DOQ-IT University—The Centers for Medicare & Medicaid Services’ (CMS) Doctor’s Office Quality Information Technology University (DOQ-IT or DOQ-IT U) is an interactive, Web-based education tool designed to provide solo and small-to-medium– sized physician practices with the information necessary for successful HIT adoption. Lessons cover culture change, vendor selection, and operational redesign along with clinical processes. The nationally available e-learning system is available at no charge (http://elearning.qualitynet.org). Optometrists who would prefer to learn about EHRs in a more traditional classroom setting may wish to attend the new AOA Electronic Health Records Seminar: Building the Paperless Practice. The 2-day program features in-person presentations by EHR experts and optometrists who have successfully implemented EHRs in their practices as well as opportunities to personally try out programs offered by most of the nation’s major optometric EHR vendors. The AOA Electronic Health Records Seminar: Building the Paperless Practice was presented to full-capacity audiences in January. Check the AOA HIT Web page for information on upcoming seminars.
E-prescribing Although all Americans may not have access to electronic health records until 2014, health care providers may be required to begin prescribing pharmaceuticals electronically much sooner. E-prescribing is not simply faxing or e-mailing prescriptions to a pharmacy, it requires software that allows prescriptions to be sent through a network that provides medicine reconciliation. As this issue of Optometry went to press, Congress was considering legislation that would require the electronic transmission of pharmaceutical prescriptions for Medicare patients through e-prescribing networks. In April, Medicaid implemented rules requiring all paper pharmaceutical prescriptions to meet tamper-resistance standards, giving health care providers a reason to file prescriptions electronically. For that reason alone, optometrists should begin giving serious thought to e-prescribing now. A new AOA White Paper, E-Prescribing: What Optometrists Need to Know, provides an overview of what e-prescribing is, how it works, and what optometrists must
481 know to implement it in practice. The document can be accessed on the AOA HIT Web page. For a more in-depth look at the specifics of e-prescribing and some assistance in the selection of an e-prescribing system, practitioners may wish to access the Electronic Prescribing Readiness Assessment Web site (www.GetRxConnected.com). Developed by the Center for Improving Medication Management, this comprehensive site (with specialized sections for those practitioners who already have, and those practitioners who do not have, electronic health records systems in their practices) outlines the benefits of e-prescribing, “peer perspectives” from practitioners who are e-prescribing, a listing of the 40,000 pharmacies that accept e-prescriptions, a roster of national and state e-prescribing initiatives, and the benefits e-prescribing can hold for patients. A Customized Guide to Selecting Technology can be generated for the practice by entering information on a practice’s current use of HIT and prescribing volume in an interactive Web tool. Optometrists may also wish to become familiar with the e-prescribing networks they may soon be using. Among them: ● The Pharmacy Health Information Exchange™, operated by SureScripts (and often referred to simply by that name), is the largest network to link electronic communications between pharmacies and physicians, allowing the electronic exchange of prescription information. SureScripts was founded in 2001 by the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) to improve the quality, safety, and efficiency of the overall prescribing process. For additional information see the SureScripts Web site (http://surescripts.com/). ● The RxHub National Patient Health Information Network™ provides secure access to more than 200 million Americans with prescription coverage. Prescription eligibility, benefit, formulary and medication history information for consenting patients is made available to authorized physicians at the point of care. The information is then used by physicians to prescribe the most clinically appropriate and cost-effective medication for patients. Prescriptions can then be sent electronically to the patient’s choice of pharmacies. Details are available on the RxHub Web site (www.rxhub.net/index.html). ● MedAvant (also known as ProxyMed) is an information technology company that facilitates the exchange of medical claim and clinical information among doctors, hospitals, medical laboratories, and insurance payers. MedAvant also enables the electronic transmission of laboratory results. Details are available on the MedAvant Web site (www.medavanthealth.com).
Understanding the basics Plans to implement a national HIT infrastructure over a 10-year period were announced by President George W.
482 Bush in 2004. With both Republican and Democratic presidential candidates calling for health care reform, development of the system is expected to continue despite next year’s administration change, and may be further defined by congressional legislation next year. The NHIN will be a “network of networks” joining a series of regional health information exchanges around the nation. The key to the system will be the adoption of standardized electronic health records, with uniform specifications, that can be used by all health care providers across the country. Detailed histories of NHIN development to date, future plans for the system, and in-depth discussions of HIT’s potential impact on optometry are provided in a library of Practice Strategies articles compiled on the AOA HIT Web page (www.aoa.org/HIT.xml). The development of the NHIN has entailed the development of numerous specialized terms and acronyms, many of which are destined to become common terminology in optometric practices. A glossary of the most important HIT terms will appear in a future issue of Optometry: Journal of the American Optometric Association. A more complete listing is provided in a special section of the AOA HIT Web page (www.aoa.org/ x9947.xml). The development of the nation’s electronic health records system involves numerous public and private entities. Optometrists should be aware of the roles they play and how their work can impact the practice of optometry. Among the most important are: ● The U.S. Department of Health & Human Services (HHS) is the federal agency charged with developing the NHIN. The department’s Health Information Technology homepage is a good place to find basic information on the developing EHR system and links to the major government-chartered entities charged with developing various aspects of the system. The site provides information on health IT certification, data and technical standards, case studies, privacy and security issues, initiatives, and answers to frequently asked questions (www.hhs.gov/healthit/). ● The American Health Information Community (AHIC) is a federally chartered committee established in 2005 to advise the HHS on ways to accelerate the development and adoption of health information technology. The AHIC makes recommendations on how to make health records digital and interoperable, encourage market-led adoption, and ensure that the privacy and security of those records are protected. The planned transition of the AHIC to a “public-private partnership based in the private sector”—referred to as AHIC 2.0—is scheduled to be completed by autumn 2008, providing a permanent independent advisory body for the NHIN (www.hhs.gov/healthit/community/ background). ● The Office of the National Coordinator for Health Information Technology (ONC) is the agency specifically established within the HHS to oversee the development and nationwide implementation of an
Practice Strategies
●
●
interoperable health information technology infrastructure. The ONC also provides management of and logistical support for the American Health Information Community. Sometimes referred to as the “HIT Czar,” the National Coordinator serves as the HHS’s principal adviser on the development, application, and use of health information technology; coordinates HHS health information technology policies and programs internally and with other relevant executive branch agencies; develops, maintains, and directs the implementation of HHS’ strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors to the extent permitted by law; and provides comments and advice at the request of the Office of Management and Budget regarding specific federal health information technology programs (www.hhs. gov/healthit/onc/mission/). The State Alliance for e-Health was established by the National Governors Association’s Center for Best Practices under a contract with the Office of the National Coordinator. The consensus-based, executivelevel body of elected and appointed state officials (governors, state legislators, attorneys general insurance commissioners) was developed to collectively address state-level health information technology issues and challenges to interoperable electronic health information exchange. These include issues related to state regulation of health care providers and the insurance industry. Issues are being addressed through a Health Information Protection Taskforce, Health Care Practice Taskforce, and Health Information Communication and Data Exchange Taskforce (www.nga.org/ center/ehealth). The eHealth Initiative and The Foundation for eHealth Initiative are independent, nonprofit-affiliated organizations (representing more than 100 healthrelated entities including the Centers for Disease Control and Prevention, the CMS, public health agencies, clinician groups, consumer and patient groups, employers and purchasers, health plans, health care information technology organizations, HIT vendors and manufacturers, public health agencies, academic and research institutions, and standards organizations) established to define and then implement specific actions that will address the quality, safety, and efficiency challenges of the health care system through the use of interoperable information technology. Although not officially chartered by government, the e-Health Initiative, as a powerful proponent group, is playing a role in shaping the implementation of the electronic health records system. Its eHI Blueprint sets down a detailed timetable for the implementation of the NHIN. The e-Health Initiative’s Connecting Communities Toolkit provides a 7-step plan for the organization of an HIE. It has provided a number of development grants for health information exchanges around the
Practice Strategies
●
country. In the wake of continuing concern over the long-term financial viability of health information exchanges, the e-Health Initiative recently developed a Value and Sustainability ModelSM. Especially valuable to optometrists seeking to understand HIT is the e-Health Initiative’s Connecting Communities Toolkit, which was developed to explain HIT to interested stakeholders. The Connecting Communities Toolkit can be downloaded free on the eHealth Initiative Web site (http://toolkit.ehealthinitiative.org/). The Certification Commission for Health Information Technology (CCHIT) is an independent, voluntary, private-sector initiative established to set standards that will ensure the interoperability of electronic health records. Products designated as “CCHIT CertifiedSM” meet all basic criteria for functionality, interoperability, and security. A Physician’s Guide to CCHIT Certification (recently updated to help health care providers understand the ambulatory EHR criteria approved last year) is designed to explain the benefits of certification and the factors providers should consider when selecting EHRs (www.cchit.org).
Finding local RHIOs All optometrists should be familiar with the RHIOs or HIEs being developed in their respective practice areas. The AOA HITT Committee also encourages optometrists to become actively involved in the planning and development of their local RHIOs to ensure inclusion of eye and vision care. Fortunately, there are information sources that can be used to help optometrists identify functioning RHIOs in their areas. The Healthcare Information and Management Systems Society (HIMSS), the health care information technology industry’s trade association, offers current data on RHIOs and state HIT initiatives through online services. The HIMSS State Dashboard provides free information on: ● RHIOs both in operation and under development (with updates every 6 months) ● Grants awarded to communities, hospitals, providers, and health care systems for HIT developments ● State Legislation related to HIT (updated annually)
483 The HIMSS State Dashboard can also be used to obtain new listings as well as detailed information on the RHIOs’ functions, development timetables, and contact information. This can be accessed on the HIMSS Web site at www. himss.org/ASP/topics_rhio.asp. Those wishing more insight on a particular RHIO may wish to consult the RHIO Wiki. Modeled on the popular Wikipedia Web encyclopedia site, the RHIO Wiki is an interactive Web site on health information exchanges and RHIOs. The Wiki allows users to access information on local and regional data exchange programs as well as share their own experiences or ask questions. The site is maintained by the Center for Health Transformation, the College of Healthcare Information Management Executives, and the eHealth Initiative (www.rhiowiki.com).
Looking toward the future The transition to the new world of health information technology promises to rival in importance optometry’s transition from vision care to full-scope diagnostic and therapeutic vision care. As the AOA New Technology Survey notes, optometrists have helped ensure their place as America’s primary eye care providers by regularly incorporating new eye care technology into their practices. Adopting and taking full advantage of emerging health information technology could well prove just as critical in maintaining optometry’s position in eye care. The Health Information Technology and Telemedicine Committee takes very seriously its charge to inform AOA members of the relevance and benefits of HIT, promote bidirectional electronic communication between optometrists and other health care stakeholders, and monitor federal activities, policies, and laws. The committee’s new HIT Web page represents an important step in informing AOA members on topics relevant to HIT. The Web page provides convenient links to all of the resources cited in this article. However, with so much of the NHIN infrastructure being developed at the regional or local level, it will be up to optometrists to stay abreast of developments in their areas and take part in shaping those efforts. And it will ultimately be up to optometrists and their staffs to implement HIT in their offices in a timely manner. The time to start thinking seriously about it is now.
B
y now most optometrists are probably aware that American health care is entering the era of health information technology (HIT). Most have heard that the U.S. Department of Health & Human Services (HHS) is moving toward the Bush administration’s goal of providing all Americans access to electronic health records (EHRs) by the year 2014 through a Nationwide Health Information
The AOA Health Information Technology & Telemedicine Committee offers resources for optometrists who are pursuing a paperless practice through the adoption and implementation of electronic health records and e-prescribing in their offices. Network (NHIN). Increasingly, optometrists realize that the electronic health records movement is part of a larger effort to increase the quality and reduce the cost of health care through an overall reform of the entire American health care system—a reform that will probably entail concepts such as quality measurement, pay-for-performance, and valuebased purchasing. Most important, optometrists increasingly realize that this movement has the potential to profoundly impact the practice of eye and vision care in any number of respects. The problem is: most optometrists have not yet determined exactly what to do about all of this. The American Optometric Association (AOA) Health Information Technology & Telemedicine Committee (HITT Committee) was established by the AOA Board of Trustees in 2006 as an AOA project team and recently transitioned to committee status to help guide the profession of optometry into the new age of health information technology. The Francis McVeigh, O.D., is the chair of the AOA Health Information Technology & Telemedicine Committee. Mark Swan, O.D., Rex Ballinger, O.D., Jerry Cavallerano, Jr., O.D., and Phil Gross, O.D., are members of the committee. Correspondence to the committee may be sent in care of staff person Kelli Tate-White ([email protected]). Opinions expressed are those of the authors and not necessarily those of the American Optometric Association.
committee suggests optometrists (and their staffs) adopt a 4-point strategy: ● Understand the basics of HIT ● Begin planning for EHR implementation in their practices ● Prepare now for e-prescribing, which will probably be the first aspect of HIT implemented in most practices ● Become involved in the regional health information organization (RHIO) or health information exchange (HIE) that will ultimately serve their practices on a state/local level To assist, the AOA HITT Committee has launched a Web page to provide optometrists a compendium of HIT information and resources. Because much of the best HIT information (as one would expect) is being made available electronically, a new Health Information Technology Resources for Optometrists page has been established on the AOA Web site, offering direct links to reliable information that optometrists can use to learn about HIT and begin planning for EHR implementation in their practices. The Web site can be accessed at www.aoa.org/HIT.xml.
Getting the office ready The AOA New Technology Survey notes that optometrists consistently implement the latest eye and vision care technology in their practices (http://www.aoa.org/x9088.xml). Electronic patient record systems of one type or another are already found in 25.9% of AOA member optometric practices, according to the association’s most recent New Technology Survey conducted in 2007. This figure is up from 17.7% 2 years earlier. In addition, some 28.5% of survey respondents report they can already interface 1 or more practice management technologies (e.g., billing, claim filing, bookkeeping) with electronic patient records in some fashion. However, EHR technology certainly has not yet found the same level of acceptance as management software, used (in one way or another) in up to 85% of practices. There are certain preparatory actions that optometrists can do now to begin laying the groundwork for the implementation of EHRs in their practices. For a more detailed discussion see “Time to Get Serious About Electronic Health Records” (Optometry 2008;79:9-17) and other Optometry: Journal of the American Optometric Association and AOA News articles on HIT, available on the AOA
1529-1839/08/$ -see front matter © 2008 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2008.05.006
Practice Strategies HIT Web page. The AOA HIT Web page also provides links to 2 online HIT education programs: ● Alliance for Health Reform Health Information Technology Toolkit—The Alliance for Health Reform’s latest toolkit is designed to help health care providers understand how health information technology is slowly changing health care and how analysts disagree about the value of some technologies (http://www.allhealth.org/ publications/Health_information_technology/Toolkit_ Health_Information_Technology_78.asp). A version suitable for viewing on a Blackberry or similar handheld device can be accessed at http://www.allhealth.org/ publications/health_information_technology/health_ information_technology_bb.asp. ● DOQ-IT University—The Centers for Medicare & Medicaid Services’ (CMS) Doctor’s Office Quality Information Technology University (DOQ-IT or DOQ-IT U) is an interactive, Web-based education tool designed to provide solo and small-to-medium– sized physician practices with the information necessary for successful HIT adoption. Lessons cover culture change, vendor selection, and operational redesign along with clinical processes. The nationally available e-learning system is available at no charge (http://elearning.qualitynet.org). Optometrists who would prefer to learn about EHRs in a more traditional classroom setting may wish to attend the new AOA Electronic Health Records Seminar: Building the Paperless Practice. The 2-day program features in-person presentations by EHR experts and optometrists who have successfully implemented EHRs in their practices as well as opportunities to personally try out programs offered by most of the nation’s major optometric EHR vendors. The AOA Electronic Health Records Seminar: Building the Paperless Practice was presented to full-capacity audiences in January. Check the AOA HIT Web page for information on upcoming seminars.
E-prescribing Although all Americans may not have access to electronic health records until 2014, health care providers may be required to begin prescribing pharmaceuticals electronically much sooner. E-prescribing is not simply faxing or e-mailing prescriptions to a pharmacy, it requires software that allows prescriptions to be sent through a network that provides medicine reconciliation. As this issue of Optometry went to press, Congress was considering legislation that would require the electronic transmission of pharmaceutical prescriptions for Medicare patients through e-prescribing networks. In April, Medicaid implemented rules requiring all paper pharmaceutical prescriptions to meet tamper-resistance standards, giving health care providers a reason to file prescriptions electronically. For that reason alone, optometrists should begin giving serious thought to e-prescribing now. A new AOA White Paper, E-Prescribing: What Optometrists Need to Know, provides an overview of what e-prescribing is, how it works, and what optometrists must
481 know to implement it in practice. The document can be accessed on the AOA HIT Web page. For a more in-depth look at the specifics of e-prescribing and some assistance in the selection of an e-prescribing system, practitioners may wish to access the Electronic Prescribing Readiness Assessment Web site (www.GetRxConnected.com). Developed by the Center for Improving Medication Management, this comprehensive site (with specialized sections for those practitioners who already have, and those practitioners who do not have, electronic health records systems in their practices) outlines the benefits of e-prescribing, “peer perspectives” from practitioners who are e-prescribing, a listing of the 40,000 pharmacies that accept e-prescriptions, a roster of national and state e-prescribing initiatives, and the benefits e-prescribing can hold for patients. A Customized Guide to Selecting Technology can be generated for the practice by entering information on a practice’s current use of HIT and prescribing volume in an interactive Web tool. Optometrists may also wish to become familiar with the e-prescribing networks they may soon be using. Among them: ● The Pharmacy Health Information Exchange™, operated by SureScripts (and often referred to simply by that name), is the largest network to link electronic communications between pharmacies and physicians, allowing the electronic exchange of prescription information. SureScripts was founded in 2001 by the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA) to improve the quality, safety, and efficiency of the overall prescribing process. For additional information see the SureScripts Web site (http://surescripts.com/). ● The RxHub National Patient Health Information Network™ provides secure access to more than 200 million Americans with prescription coverage. Prescription eligibility, benefit, formulary and medication history information for consenting patients is made available to authorized physicians at the point of care. The information is then used by physicians to prescribe the most clinically appropriate and cost-effective medication for patients. Prescriptions can then be sent electronically to the patient’s choice of pharmacies. Details are available on the RxHub Web site (www.rxhub.net/index.html). ● MedAvant (also known as ProxyMed) is an information technology company that facilitates the exchange of medical claim and clinical information among doctors, hospitals, medical laboratories, and insurance payers. MedAvant also enables the electronic transmission of laboratory results. Details are available on the MedAvant Web site (www.medavanthealth.com).
Understanding the basics Plans to implement a national HIT infrastructure over a 10-year period were announced by President George W.
482 Bush in 2004. With both Republican and Democratic presidential candidates calling for health care reform, development of the system is expected to continue despite next year’s administration change, and may be further defined by congressional legislation next year. The NHIN will be a “network of networks” joining a series of regional health information exchanges around the nation. The key to the system will be the adoption of standardized electronic health records, with uniform specifications, that can be used by all health care providers across the country. Detailed histories of NHIN development to date, future plans for the system, and in-depth discussions of HIT’s potential impact on optometry are provided in a library of Practice Strategies articles compiled on the AOA HIT Web page (www.aoa.org/HIT.xml). The development of the NHIN has entailed the development of numerous specialized terms and acronyms, many of which are destined to become common terminology in optometric practices. A glossary of the most important HIT terms will appear in a future issue of Optometry: Journal of the American Optometric Association. A more complete listing is provided in a special section of the AOA HIT Web page (www.aoa.org/ x9947.xml). The development of the nation’s electronic health records system involves numerous public and private entities. Optometrists should be aware of the roles they play and how their work can impact the practice of optometry. Among the most important are: ● The U.S. Department of Health & Human Services (HHS) is the federal agency charged with developing the NHIN. The department’s Health Information Technology homepage is a good place to find basic information on the developing EHR system and links to the major government-chartered entities charged with developing various aspects of the system. The site provides information on health IT certification, data and technical standards, case studies, privacy and security issues, initiatives, and answers to frequently asked questions (www.hhs.gov/healthit/). ● The American Health Information Community (AHIC) is a federally chartered committee established in 2005 to advise the HHS on ways to accelerate the development and adoption of health information technology. The AHIC makes recommendations on how to make health records digital and interoperable, encourage market-led adoption, and ensure that the privacy and security of those records are protected. The planned transition of the AHIC to a “public-private partnership based in the private sector”—referred to as AHIC 2.0—is scheduled to be completed by autumn 2008, providing a permanent independent advisory body for the NHIN (www.hhs.gov/healthit/community/ background). ● The Office of the National Coordinator for Health Information Technology (ONC) is the agency specifically established within the HHS to oversee the development and nationwide implementation of an
Practice Strategies
●
●
interoperable health information technology infrastructure. The ONC also provides management of and logistical support for the American Health Information Community. Sometimes referred to as the “HIT Czar,” the National Coordinator serves as the HHS’s principal adviser on the development, application, and use of health information technology; coordinates HHS health information technology policies and programs internally and with other relevant executive branch agencies; develops, maintains, and directs the implementation of HHS’ strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors to the extent permitted by law; and provides comments and advice at the request of the Office of Management and Budget regarding specific federal health information technology programs (www.hhs. gov/healthit/onc/mission/). The State Alliance for e-Health was established by the National Governors Association’s Center for Best Practices under a contract with the Office of the National Coordinator. The consensus-based, executivelevel body of elected and appointed state officials (governors, state legislators, attorneys general insurance commissioners) was developed to collectively address state-level health information technology issues and challenges to interoperable electronic health information exchange. These include issues related to state regulation of health care providers and the insurance industry. Issues are being addressed through a Health Information Protection Taskforce, Health Care Practice Taskforce, and Health Information Communication and Data Exchange Taskforce (www.nga.org/ center/ehealth). The eHealth Initiative and The Foundation for eHealth Initiative are independent, nonprofit-affiliated organizations (representing more than 100 healthrelated entities including the Centers for Disease Control and Prevention, the CMS, public health agencies, clinician groups, consumer and patient groups, employers and purchasers, health plans, health care information technology organizations, HIT vendors and manufacturers, public health agencies, academic and research institutions, and standards organizations) established to define and then implement specific actions that will address the quality, safety, and efficiency challenges of the health care system through the use of interoperable information technology. Although not officially chartered by government, the e-Health Initiative, as a powerful proponent group, is playing a role in shaping the implementation of the electronic health records system. Its eHI Blueprint sets down a detailed timetable for the implementation of the NHIN. The e-Health Initiative’s Connecting Communities Toolkit provides a 7-step plan for the organization of an HIE. It has provided a number of development grants for health information exchanges around the
Practice Strategies
●
country. In the wake of continuing concern over the long-term financial viability of health information exchanges, the e-Health Initiative recently developed a Value and Sustainability ModelSM. Especially valuable to optometrists seeking to understand HIT is the e-Health Initiative’s Connecting Communities Toolkit, which was developed to explain HIT to interested stakeholders. The Connecting Communities Toolkit can be downloaded free on the eHealth Initiative Web site (http://toolkit.ehealthinitiative.org/). The Certification Commission for Health Information Technology (CCHIT) is an independent, voluntary, private-sector initiative established to set standards that will ensure the interoperability of electronic health records. Products designated as “CCHIT CertifiedSM” meet all basic criteria for functionality, interoperability, and security. A Physician’s Guide to CCHIT Certification (recently updated to help health care providers understand the ambulatory EHR criteria approved last year) is designed to explain the benefits of certification and the factors providers should consider when selecting EHRs (www.cchit.org).
Finding local RHIOs All optometrists should be familiar with the RHIOs or HIEs being developed in their respective practice areas. The AOA HITT Committee also encourages optometrists to become actively involved in the planning and development of their local RHIOs to ensure inclusion of eye and vision care. Fortunately, there are information sources that can be used to help optometrists identify functioning RHIOs in their areas. The Healthcare Information and Management Systems Society (HIMSS), the health care information technology industry’s trade association, offers current data on RHIOs and state HIT initiatives through online services. The HIMSS State Dashboard provides free information on: ● RHIOs both in operation and under development (with updates every 6 months) ● Grants awarded to communities, hospitals, providers, and health care systems for HIT developments ● State Legislation related to HIT (updated annually)
483 The HIMSS State Dashboard can also be used to obtain new listings as well as detailed information on the RHIOs’ functions, development timetables, and contact information. This can be accessed on the HIMSS Web site at www. himss.org/ASP/topics_rhio.asp. Those wishing more insight on a particular RHIO may wish to consult the RHIO Wiki. Modeled on the popular Wikipedia Web encyclopedia site, the RHIO Wiki is an interactive Web site on health information exchanges and RHIOs. The Wiki allows users to access information on local and regional data exchange programs as well as share their own experiences or ask questions. The site is maintained by the Center for Health Transformation, the College of Healthcare Information Management Executives, and the eHealth Initiative (www.rhiowiki.com).
Looking toward the future The transition to the new world of health information technology promises to rival in importance optometry’s transition from vision care to full-scope diagnostic and therapeutic vision care. As the AOA New Technology Survey notes, optometrists have helped ensure their place as America’s primary eye care providers by regularly incorporating new eye care technology into their practices. Adopting and taking full advantage of emerging health information technology could well prove just as critical in maintaining optometry’s position in eye care. The Health Information Technology and Telemedicine Committee takes very seriously its charge to inform AOA members of the relevance and benefits of HIT, promote bidirectional electronic communication between optometrists and other health care stakeholders, and monitor federal activities, policies, and laws. The committee’s new HIT Web page represents an important step in informing AOA members on topics relevant to HIT. The Web page provides convenient links to all of the resources cited in this article. However, with so much of the NHIN infrastructure being developed at the regional or local level, it will be up to optometrists to stay abreast of developments in their areas and take part in shaping those efforts. And it will ultimately be up to optometrists and their staffs to implement HIT in their offices in a timely manner. The time to start thinking seriously about it is now.