Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

Are you a primary care member of a health care system?

The delivery models for health care are in a rapid stage of growth and development to meet the challenges of health care reform. Hospital systems have been part of the landscape for several decades, but in more recent years, they have expanded to include primary care physicians.

The fuel that has moved this from a theory and a concept to an operational model has been the advent of electronic health records (EHR) and the current initiative of creating the connectivity of the doctor’s EHR with the hospital and pharmacy.

As eye care providers, many of us are out of this loop and not sure how we can find a bridge to mainstream medical care. Most of us that believe our future will be as a primary health care provider have made the transition to EHR but remain, with our nice neat charts, on the side of the road.

To make the connection, you must become part of a health care system. There are a number of networks of eye care providers in various stages of development and sophistication around the country. These groups are organized in several ways such as eye care independent practice associations (IPAs), university networks or referral center networks.

To move from a network or IPA to a health system, the group must be able to exchange patient information (Protected Health Information or PHI) among the providers of care within the network.

The first packet of health information is the Consolidated- Clinical Document Architecture document. This is a universal document generated out of any EHR that is certified by the Office of the National Coordinator for Health Information Technology.

Creating the document is easy; it is done with the push of a button within your EHR. Finding a way to use the document is a much more difficult task.

The individual provider cannot achieve this alone and must rely on the development of a community of other health providers. The development of an effective, secure exchange of this health information is the core role of an ophthalmic health care system.

There are of number of levels of patient care data communication that define the goals and objective of a health system. Organizations such as eye care IPAs are often composed of a group of primary care optometrists using a variety of different EHRs. Their health system should work to create the interconnectivity of their health care data to develop and refine a quality assurance program. Systems that can provide actual data-based reports on care points such as diabetic eye exams, vital signs or early diagnosis of hypertension, hyperlipidemia or chronic medical problems will be able demonstrate great value as they develop relationships with various comprehensive health systems and third party payers.

Other health networks that include optometrists and ophthalmologists and perhaps the specialty eye services of a university platform will need to evolve their health system for vertical integration with secure communication of PHI for referrals back and forth between different provider types and specialty care units.

The most experienced and well-developed eye care systems will interface with the larger, more comprehensive health systems via state or private Health Information Exchange programs. This is the final step in process of achieving the true integration of optometry with the health care system and the environment where optometry can have a real role in primary health care.

Eye care delivery systems are a new trend and a break from the tradition of eyeglass- and hardware-based optometry plans. The building blocks are out there with a number of good EHRs and the technology available for interconnectivity. Optometrists must find the right network or group to develop these programs.

The existing networks and IPAs must work to develop and evolve as health care systems by building the infrastructure of secure communication. As the large health systems grow and lock in insurance and managed care contracts, we must be ready to interface with these programs with comparable technology and organization. Without the effort on our part, the delivery systems will evolve without us and we may just get tacked on at the end as the vendors of ophthalmic hardware.