Lions and tigers and bears. Oh my. Yes, three scary beasts are invading our exam rooms this year. They are called Meaningful Use Stage 2, ICD-10, and the Affordable Care Act. But don't fear, we can safely navigate this troubled yellow brick road. I hope.

Take a deep breath. Roll up your sleeves. Learn to meditate in your “free time.” It's going to be a tough year.

Meaningful Use Stage 2. Hopefully you are using an electronic health record (EHR) vendor that has been able to upgrade your EHR to meet the more stringent 2014 Edition EHR Certification Criteria. If you aren't, you are either anxiously awaiting for them to do what they promised to do (stay certified) or you are in the arduous process of changing vendors. If your EHR vendor does have a 2014 Edition (Stage 2 compatible) version, you either recently went through an EHR upgrade, are scheduled to do so soon, or are tearing your hair out because your vendor still hasn't given you a “go-live” date.

Now you will have to learn the new features of this upgrade, learn the new Stage 2 criteria, and change your workflows in order to get your smaller EHR incentive payments this year and avoid the penalties that go into effect in 2015 for not complying with the Meaningful Use criteria. You will need to send electronic referrals, order labs and imaging electronically, and somehow convince your patients to sign up for your patient portal and actually use it.

And you need to be ready to do all this by Oct. 1 at the latest. (For more on the Stage 2 requirements, see "Making Sense of Meaningful Use Stage 2: Second Wave or Tsunami?" in this issue.)

ICD-10. I hope you do have an EHR, because if you don't, switching to ICD-10 will be an even bigger struggle. The number of codes will increase five-fold, you will need to be more specific in your coding, and most likely you will need to improve your documentation to support those more specific codes. Why? More specific coding and better documentation will help you in risk adjustment – proving that your patients really are sicker. If your reimbursement isn't affected by risk adjustment yet, it will be soon.

You will need to take an ICD-10 class. Those seven character alphanumeric codes are going to look pretty strange, at least at first. But if you do have an EHR, picking those new codes should be a lot easier.

And ICD-10 goes into effect starting Oct. 1 too. (For more on the ICD-10 transition, see "10 Steps for Preparing Your Office for ICD-10 – Now.")

Affordable Care Act. Many of your patients are anxious about the Affordable Care Act, which could make you anxious as well. Some have new plans they don't really understand. Some have insurance for the first time, but they have big deductibles. Many couldn't afford to pay cash before, so they won't be able to afford those deductibles. Who will get left with unpaid bills? Accept the fact that confusion will reign, at least for a while.

I realize all this may sound negative, and I don't mean to bring you down. However, I believe in being honest and realistic. This is going to be a challenging year.

Yet, despite the scary beasts, I believe we can make it to the Emerald City. I'm optimistic that in a few years we'll look back and say these were good changes, for the most part. Our health care system will improve with them. But we have a lot of work to do before we can sit back, relax, and say, “Yeah, I remember 2014. That was a hell of a year.”