Sometimes you pull on a thread and all you get is a hole. Other times …

Of all the concepts in this month’s issue, the one I least suspected I’d be coming back to was from our superb Medicare expert, Donna McCune. In this month’s column, she offers sage advice that may not strike you as earth-shaking at first glance but could save you quite a bit of money: Be very careful with those macros and other automated chart-filling helpers on many EHR systems. See p. 16 for a further discussion of why all this may matter mightily to you.

I pulled the EHR thread a little further. Remember 2004 when that visionary George Bush set 2014 as the goal for all Americans to have an EHR? OK, not there yet, but we passed a milestone this month with a Health and Human Services report confirming that we have passed the halfway mark: 50 percent of physicians have received Medicare or Medicaid incentive payments for adopting or meaningfully using EHRs, and HHS has met and exceeded its goal for 50 percent of doctor offices and 80 percent of eligible hospitals to have EHRs by the end of 2013, a rate more than double that of 2012.

I gave it another tug. Perhaps in celebration of the milestone, Farzad Mostashari, MD, the national coordinator for health information technology at HHS, was out and about winning lots of press coverage. In one interesting exchange, Dr. Mostashari told a Washington gathering, “We’re about halfway through the process of computerizing and digitizing America’s hospitals and doctor’s offices,” but “we’re about 5 percent of the way through changing workflows and redesigning care to take advantage of those technologies.”

Dr. Mostashari revealed his Bushian vision of the as-yet unrealized potential of EHR systems by citing three ways an effectively integrated EHR system can impact care of diabetic patients: by truly engaging patients in the process and reducing the rate of patients lost to follow-up; by streamlining and automating communication about such matters as cholesterol tests, freeing the doctor from having to remember everything in an eight-minute visit; and by using protocol-based defaults for choices about care options, such as what steps come next after a diabetic patient has tried unsuccessfully to reduce blood pressure and cholesterol with diet and exercise.

While he was talking about diabetic patients, I couldn’t help but think—patients with poor or lost follow-up, with an inadequate knowledge base about their disease, and a myriad of treatment choices and options for their physicians—glaucoma! Which brings us back to this month’s issue.

Thanks, Donna!