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.

BLOG: A bump on the road to health care reform

As part of my traditional December activity, I review the work of 2014 and try to make plans for the New Year. Looking forward, I see a number of clouds over the road to health care reform. A road that seemed like a clear path to the future last summer now may be facing some bumps and detours. 

Although technology is sure to be a big part of our future, the movement through the stages of meaningful use of our electronic health records (EHRs) and onto a fully integrated, comprehensive health delivery system may take a little longer than what was highlighted in the play book.

The first cloud in the sky is a sudden lack of confidence in web-based security in general. The year 2014 has seen several large companies become the victims of either Internet hackers or at least poor electronic information policies. These issues have exposed the private information of many American citizens. These companies include Target, Home Depot and, even within our own industry, Davis Vision.  The most recent hacker attack to Sony has experts baffled by the sophistication of the attack and has led these experts to ponder publicly if anything is really secure on the Internet.

A second “cause for pause” happened in our own office with a hardware problem of our cloud-based EHR. When you have a totally paperless office and are dependent on a computer, the Internet and a cloud server, and suddenly one of these fails, the entire office grinds to a full stop. Patients sit in the chairs and shoot the breeze with our doctors about the weather or current events, the front desk cannot check in or out, no appointments can be made, no orders can be placed, and no billing or accounting can be done. It is a health care disaster.

As the minutes tick by, everyone sits and wonders what would happen if it did not come back. What if an Internet hacker wiped the servers of our EHR? Fortunately, it all came back in a few minutes, but the seed was planted.

Our office has made the painful leap to a cloud-based EHR. Several of my key optometrists have attested to stage 1 meaningful use. We have already enjoyed the bulk of the stimulus money. The amount of work and the risk of getting everything correct to attest to stage 2 is not justified by the minimal amount of the remaining stimulus payment. The other health care providers, whom with we share patients and would be our candidates for care collaboration, are not even to stage 1. The prudent decision at this point is to sit tight and see how things unfold.