Thanks for the 'update'

I don't know how many of you were able to tune in to yesterday's Electronic Clinical Template Open Door Forum, but here's my take: I'd have to say it was kind of a mixed bag.

First, Melanie Combs-Dyer gave a brief history of why CMS is looking into creating a template and what has been done so far. Not necessarily a bad idea, since the template has been off the radar since�hm�Looks like the last ODF I can find in my datebook was July 10. We were supposed to have one in November, but it was inexplicably cancelled.

And what's the big update?  “We're in a little bit of a holding pattern.”

Yep, CMS is still working to get together with the Office of the National Coordinator for Health IT to start nailing down how we're going to get those template questions into the electronic health record. Pretty much where we were� in July.

It's true that CMS has updated its draft template since July. The newest version is dated 11/2/2012.

But for now, we're still waiting to really move forward. Apparently, certain stakeholders will—at some point—get an email invitation to take part in weekly/biweekly phone calls to hash out details as we get closer to the IT/technical aspect of getting this template off the ground.

While we may not have gotten an earth-shattering update, I don't think the call was a waste of time. Listeners obviously had a lot of questions, filling almost the whole call with concerns and issues (some old, some new). There were still people in the queue waiting to ask questions when the call ended.

One caller question that really hit home for me: Is there going to be some sort of beta testing for this template before we invest a bunch of time running ahead with something that may have issues?

Combs-Dyer says doctors are welcome to print out the template, use it and provide feedback, but I'd like to see a real, concentrated pilot.

Don Clayback and I were talking about the ODF this morning, and he mentioned something that's a real concern with this template: “As we get further down the road, it'll be harder to change it.”

One thing I was glad to hear: Combs-Dyer said she'd include prompts in the template to remind physicians they can bring in a PT/OT to help evaluating the patient. I can't imagine how doctors who only need to evaluate a few potential wheelchair users each year get through this process without a PT/OT, to be honest.

The end of the call was a discussion that I expect to continue for a while: should the template be CMS-only, or universal. I know the Clinician Task Force is worried if we focus on what CMS is looking for, doctors won't document what other payers accept, like a patient needed a PMD outside the home. Current practice has physicians documenting all of a person's mobility needs, but if doctors follow the template, that complete evaluation might disappear.

I'm not sure how complex it would be to make a template that meets all—or most—payers' needs. Combs-Dyer says other payers can use the CMS template as a base and alter it to make their own templates. Doctors could then choose the template that coincides with the patient's coverage. But what incentive do these other payers have to create their own templates? As far as I've heard, they're not having the documentation difficulties CMS is having.

We'll have to keep an eye on how that one shakes out. They're supposed to address the issue in the next ODF—no word yet on when that will be.