EHR brings tangible benefits

Take-home

For one ophthalmology practice, implementing an electronic health record system has increased the workflow productivity of the office and enabled the practice to operate at a more efficient level.

Dr. BerdyBy Gregg J. Berdy, MD, FACS, Special to Ophthalmology Times

My associates and I contemplated implementing an electronic health record (EHR) system for our practice more than a decade ago.

However, we did not seriously consider it until the passing of the Health Information Technology for Economic Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, physicians were required to implement an EHR technology.

Accordingly, we began interviewing EHR companies to determine the best fit for our practice.

Deciding on an EHR system

We wanted an EHR system specific to our ophthalmic practice. None of the systems seemed to make sense to us, until we met with certified EHR specialists from our chosen vendor (ManagementPlus).

The vendor’s staff was approachable and took the time to decipher what we needed as ophthalmologists.

We had many questions about the challenges inherent in developing templates, as well as the regulations required by Medicare and Medicaid. Although this vendor does provide generic, template-style formats, its specialists were able to guide our software implementation and help customize the EHR system to our practice’s unique workflow and examinations.

The specialists helped develop templates with specific dropdown menus that allow us not only to communicate to our scribes in an organized manner, but also to interpret data better and print it out in a narrative form for sending referral letters.

Customizing the EHR

We purchased our ophthalmology-specific EHR software in 2011 and began to upgrade our practice with new computers and video monitors.

During the course of the following year, my colleagues and I-along with the EHR specialists-went through the database templates, section by section. Our physicians, technicians, front-desk staff, and optometrists invested hundreds of hours in customizing dropdown menus for external eye disorders, glaucoma, corneal, and retinal diseases, and added images for drawing capabilities, diagnosis codes, and verbiage specific to our practice.

The finished product is the result of a collaborative process and more than a year’s worth of work among physicians, front-desk staff, and technicians.

Our practice has been established for more than 20 years, with 51,000 patients in the database and about 16,000 active patients. My colleagues and I decided that we were not going to cut back temporarily on patient flow and suffer a loss of income when we implemented the EHR system.

At first, its implementation slowed us down, and patients were not receptive. We explained how the implementation is a meticulous process and the system would be back to speed shortly. Fortunately, most patients understood what we were trying to accomplish and they accepted prolonged wait times.

Initially, we were only adding new patients’ records to the EHR, but now we are entering all patient records in the system.

Benefits

As a cornea specialist, I like to use photographs to demonstrate patients’ diseases of the cornea or anterior segment. Each of our 10 exam lanes has dual 27” diagonal high-definition screens-one is used for our scribe, and the other is used for patient data (e.g., visual fields) and pictures.

Each physician uses a tablet (iPad, Apple) to access patient narratives for the day. Being able to display a retinal or corneal photograph or a visual field on a large-screen display provides the opportunity to discuss with the patient diseases, such as glaucoma, diabetic retinopathy, age-related macular degeneration, corneal ulcers, meibomian gland dysfunction, and dry eye.

Patients are impressed by the technology and the ability to see their problem-it is a great educational tool. Instead of flipping through sheets of paper, we now can present data effectively to and communicate with patients and their families. When a patient can see lissamine green staining of the conjunctiva, purulent secretions from meibomian glands, retinal hemorrhages, or a visual field defect, it is much easier for the patient to understand the effect of the disease.

The EHR system has also saved time spent on dictating letters to referring physicians. I used to dictate 10 letters a day. Dictating for each patient took 4 to 5 minutes, so I spent about 1 hour a day dictating.

We have developed our narrative to read like a letter, which prints out on our letterhead. We can send the letter via a secure electronic facsimile program to referring doctors at the conclusion of the patient’s examination.

We used to employ a transcriptionist who had a 1-week turnaround time. At best, I would be able to send a letter 7 days after seeing a patient. Now, the letter is sent and received before the patient has checked out from our office.

Conclusion

I never expected that implementing an EHR system would mean the practice would become completely paperless. As a busy surgical practice, we probably will continue to print copies of surgical patient notes, including refractions and astigmatism axes, printouts of topographies (Orbscan, Bausch + Lomb), and calculations from the biometer (IOLMaster 500, Carl Zeiss Meditec) to have when we are in the operating room.

Ultimately, EHR has increased the workflow productivity of the office and allowed us to operate the practice at a more efficient level.

Gregg J. Berdy, MD, is in practice with Ophthalmology Associates and is an assistant professor of clinical ophthalmology, Department of Ophthalmology and Visual Science, Washington University School of Medicine, both in St. Louis, MO. He acknowledged no financial interest in the products or companies mentioned. Dr. Berdy may be reached at gregg.berdy@youreyedoc.com.

Subscribe to Ophthalmology Times to receive the latest clinical news and updates for ophthalmologists.