The complexities of HIPAA and administration simplification.

BACKGROUND: The Health Insurance Portability and Accessibility Act (HIPAA) was signed into law in 1996. Although focused on information technology issues, HIPAA will ultimately impact day-to-day operations at multiple levels within any clinical setting. Optometrists must begin to familiarize themselves with HIPAA in order to prepare themselves to practice in a technology-enriched environment. METHOD: Title II of HIPAA, entitled "Administration Simplification," is intended to reduce the costs and administrative burden of healthcare by standardizing the electronic transmission of administrative and financial transactions. The Department of Health and Human Services is expected to publish the final rules and regulations that will govern HIPAA's implementation this year. RESULTS: The rules and regulations will cover three key aspects of healthcare delivery: electronic data interchange (EDI), security and privacy. EDI will standardize the format for healthcare transactions. Health plans must accept and respond to all transactions in the EDI format. Security refers to policies and procedures that protect the accuracy and integrity of information and limit access. Privacy focuses on how the information is used and disclosure of identifiable health information. Security and privacy regulations apply to all information that is maintained and transmitted in a digital format and require administrative, physical, and technical safeguards. CONCLUSIONS: HIPAA will force the healthcare industry to adopt an e-commerce paradigm and provide opportunities to improve patient care processes. Optometrists should take advantage of the opportunity to develop more efficient and profitable practices.

Evidence-based medicine.

BACKGROUND: Evidence-based medicine has emerged as a new paradigm for the practice and teaching of clinical medicine. This new paradigm places greater emphasis on procurement and interpretation of clinical research in order to choose the most efficacious diagnostic procedures and therapies. This will enable optometrists to apply state-of-the-art clinical practices and keep pace with the ever-changing health care environment. METHODS: The process of evidence-based medicine involves five steps: (1) convert the problem to a clinical question; (2) find the evidence; (3) evaluate the evidence; (4) apply the evidence; and (5) evaluate the process. The educational prescription is presented as a tool to teach and practice evidence-based medicine in various clinical settings that is based on this 5-step process. RESULTS: The definition of the clinical question includes three key concepts: the characteristics of the patient, the intervention being considered, and the desired outcome. Finding the evidence requires knowledge of the hierarchy of information products, which includes Medline, secondary journals, electronic collections of systematic reviews, and clinical practice guidelines. After accessing of the appropriate information, the clinician must still interpret the evidence and apply it to a specific patient care encounter. When performed appropriately, the process has the potential to enhance patient care quality and healthcare outcomes. CONCLUSIONS: Information technology has become the cornerstone of evidence-based practice. As bandwidth is enhanced and the electronic medical record is more widely adapted, evidenced-based medicine will become more integrated into clinical practice. Significant resources will be required to develop educational programs and research into the impact of evidence-based medicine on healthcare outcomes.

A yearly summary of quality assessment and improvement in the optometric pediatric clinics of the SUNY College of Optometry.

BACKGROUND: Each clinic within the University Optometric Center (UOC) of the State University of New York (SUNY) College of Optometry develops a Quality Management (QM) Plan for each calendar year. The vehicle for implementation is a Quality Assessment and Improvement (QA&I) committee. The clinical adherence to the objectives are reviewed each year. The following article is a review of the QA&I reports of the Pediatric Vision Clinics within the College for the year 1996. METHODS: Clinical records were concurrently and retrospectively reviewed for completeness and appropriateness of care. One hundred percent of the records were concurrently reviewed, and 10% of each doctors' total records were retrospectively reviewed. In addition, records with specific diagnoses--chosen as clinical indicators--were reviewed for a specified period of time. RESULTS: Patient satisfaction exceeded predetermined threshold values. On general review, the clinical faculty performed at a 95% efficiency level. The pediatric population yielded only minimal major pathologies. In our strabismic sample, patients with esotropia exceeded those with exotropia (61% vs. 39%). Strabismic amblyopes were more prevalent than refractive amblyopes (80% vs. 20%). Preschool vision therapy appeared to be successful in most cases. CONCLUSION: Quality assessment and improvement is an ongoing process that can provide an overview of case management and type. The process serves to monitor quality of care, provide a modality for improvement, enhance outcomes, and guide future QM plans.

Biosocial consequences of poverty: associated visual problems.

Although the impact of poverty on the health and development of children is readily acknowledged, the extent of accompanying visual functional and perceptual-motor disorders has not received very much attention. These visual disorders are shown to be linked with poverty. In particular, research studies to support the notion that neurointegrative and concomitant visual problems can be the result of malnutrition, low birthweight, teenage pregnancy, and maternal complications of pregnancy are cited and discussed. The association between perceptuocognitive functioning in children and sociodemographic factors are examined and related to central nervous system maturation in a hostile environment. The role of the optometrist in diagnosing and treating children with visual and neurointegrative problems is reviewed. Special emphasis is placed on the potential for optometric intervention to improve the ability of disadvantaged children to respond more effectively to classroom learning and enable them to make fuller use of the intelligence they possess. The authors recommend that optometrists play a vital role in their communities to ensure the rendering of appropriate professional treatment for economically impoverished and socially disadvantaged children.

Attitudes about women in optometry.

A survey was conducted to examine attitudes that affect women in optometry. Most respondents felt that women have greater difficulty than men entering private practice. On the other hand, the majority felt that female optometrists do not find it more difficult to be employed by other ODs, MDs, or to work in corporate settings, HMOs/health institutions, or academic settings. Examining the results of the survey can help establish programs of professional development that will enable women to practice in the environments that they find most suitable. In addition, an open and honest discussion of these issues can raise the sensitivity of the optometric community to these issues.

Vision screening of an adolescent inner city population: a high failure rate and low compliance on follow-up care.

625 inner city high school students were screened. Some 45.8% of this sample were designated as special education students. The referral rate was 52.3% for all students screened. Detailed failure rate by group and category are reported. Special education students had a higher incidence of uncorrected hyperopia and binocular dysfunction. Intervention strategies to improve a poor compliance rate for follow-up care are discussed.

Prognostic value of laser interferometric visual acuity in amblyopia therapy.

There has been no simple clinical test which accurately predicts post-therapy visual acuity in amblyopic eyes. Since grating test patterns generally yield optimal visual acuity in amblyopic eyes, the authors sought to determine if pre-therapy laser interferometric grating visual acuity would predict conventional post-therapy visual acuity in functional amblyopia. In 90% of the patients who completed therapy, the pre-therapy laser visual acuity was within two lines of the post-therapy Snellen visual acuity. Thus, pre-therapy laser visual acuity is a good prognostic indicator of conventional post-therapy visual acuity in amblyopic eyes.

The correlations of perceptual-motor maturation to readiness and reading in kindergarten and the primary grades.

This study lends further support to the additive nature of perceptual-motor skills and their correlation with reading. Using multivariate analysis, the investigation quantifies the extent to which success in readiness and reading in kindergarten and grades one and two is related to perceptual-motor organization. In addition to establishing concurrent validity, the results support the hypothesis that perceptual skills in kindergarten predict reading proficiency at the end of grade one. Perceptual skills play a significant role in learning to read in the primary grades. Beyond grade two, however, when cognitive and language skills appear to have a greater influence in normal children, perceptual organization remains a necessary but not a significant condition for learning.

Selected perceptual norms and their relationship to reading in kindergarten and the primary grades.

This study provides standardized procedures and norms for four perceptual-motor tests and their correlations with readiness/reading in grades K-2. Theoretical constructs and cognitive implications underlying these tasks are discussed. One hundred forty-four normal children in grades K-2 were tested with the Tachistoscope, Divided Form Board, Grooved Pegboard, and Auditory-Visual Integration Test (AVIT), using standardized procedures. Norms including means, standard deviations, ranges of scores, and percentiles were established for each test at each grade level. Except for the AVIT, the correlations between the perceptual tasks and readiness or reading were not only strong in kindergarten, but remained significant in grades 1 and 2. The data suggests that as reading becomes more dependent upon language skills, cognition gradually becomes more dominant. Beyond grade 2, it appears that perception remains a necessary but not a sufficient condition for learning.

The auditory-visual integration test: intersensory or temporal-spatial?

Forty-two children, twenty-one boys and twenty-one girls, were tested at the beginning and end of grade one using Birch's auditory-visual integration test (AVIT) and a parallel visual-visual integration test (VVIT). Reading tests were administered at the end of grade one. No significant differences between the means of the two integration tests were observed at the beginning of the year. A differential development of the AVIT and the VVIT resulted in a significant difference between the means at the end of the year when a common variance of 58% was observed between the two tests. At the conclusion of the school year each function correlated significantly with reading (decoding), with the correlation between AVIT and reading being significantly larger than the correlation between VVIT and reading. Implications for the optometric treatment of children with learning disabilities are discussed.