Many optometric offices have already incorporated practice management software (PMS) and find it an indispensable part of the modern optometric practice. Such software allows users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks and generate reports. While the majority of O.D.s have embraced these programs for administrative functions, electronic systems havent made the same impact in the clinic. There, paper charts are still widely used.
But, an electronic medical records (EMR) system provides a host of benefits to a practice, and its not as hard to convert to EMR as you might think.
Simply defined, EMR is the digital documentation of a patients medical history and care. While some information overlaps, such as patient and provider data, EMR is primarily used in clinical processes, and PMS is used for administrative and financial matters.
Converting from paper charts to electronic medical records is not a matter of if; it is a matter of when. Current federal legislation mandates that physicians and hospitals utilize electronic records systems by 2014. Dont wait until the last minute to adopt this technology. Some of the most progressive health-care practitioners have already taken the plunge, and they now enjoy the benefits of EMR.
Benefits of EMR
Besides the upcoming mandatory change, there are several compelling reasons to implement an EMR system now.
It saves countless man-hours by eliminating the need to pull and re-file charts each day. Electronic charts are stored on a server and are available to any staff member at any time, so lost charts and wasted time while hunting for them becomes a relic of the past. Legibility is another big benefit of electronic chartingit allows for easy reading by both your staff and outside personnel.
EMR also provides more efficient and accurate documentation. A well-designed program aids an assistant in taking a thorough history by logically linking appropriate and specific follow-up questions to a patients presenting complaint.
For example, when a patient presents complaining of red eye, a good EMR program automatically prompts specific questions about the history of the patients present illness and requires the assistant to record which eye is affected (location); other symptoms, such as pain, itching or discharge (associated signs and symptoms); how long it has been present (duration); whether the problem manifested suddenly or gradually (onset); and how many other episodes have occurred (frequency). Likewise, when a patient presents complaining of floaters, the software automatically guides the assistant to ask about other symptoms, such as flashing lights.
Some programs even allow patients to complete their own history electronically, which is then downloaded directly into their electronic medical charts. This history can even be given at a remote computer via the Internet. True, these programs are in their infancy and are still somewhat cumbersome, but they will improve. They may even become the standard method of obtaining a medical history.
But, patient history is not the only information that can be input into an EMR system. Diagnostic data can also be integrated seamlessly into most programs, and modern instrumentation allows technicians to gather data quickly and accurately. An EMR program can import this information into the patients record before the doctor even enters the exam room, providing more time to analyze the case, design treatment plans and educate the patient.
Nearly all new diagnostic technology is designed to export data electronicallyincluding automated refracting systems, digital imaging systems, visual fields systems and laser scanning instruments. In my office, a technician performs the refraction in a remote pre-testing room using the Marco Epic 2100. When I enter the exam room, the habitual spectacle prescription, K readings, uncorrected and corrected visual acuities, phorias, pupil distance and final prescription are waiting at my desktop. Doesnt that sound better than taping that little adding machine paper to your paper chart?
After entering information into an electronic chart once, follow-up exams are simple. An EMR system allows you to review and select from pre-existing data to modify only those items that have changed. This has obvious implications for medications, allowing for a quick review of the patients current drug prescriptions. But, virtually any prior finding can be easily traced with the click of a mouse. This is especially useful in tracking things like patients IOP history, and it replaces the glaucoma flow chart that many clinicians currently use.
EMR also greatly facilitates communication with other professionals. Since moving to EMR six years ago, I have been able to send reports on behalf of my patients with diabetes and other high-risk conditions to their primary-care physicians. Additionally, school nurses even receive reports on all their students. Besides providing excellent patient care, these letters demonstrate the breadth of optometric care, and foster inter-professional relationships and referrals.
Creating such a letter takes nearly no time and can be finished before the patient leaves the exam room. At my practice, reports are created and saved throughout the day, and then faxed as a group each night. In the future, this correspondence will likely be delivered via e-mail or other digital means.
Also, EMR has revolutionized and simplified the prescription process. Spectacle and contact lens prescriptions are available to anyone in the office at any time, increasing efficiency and accuracy. Eyeglass prescriptions are generated in the exam room and instantly become available to the frame stylist or optician, saving time and eliminating the possibility of transcription error.
Computerized contact lens prescriptions make it easy to comply with the Federal Trade Commissions Fairness to Contact Lens Consumers Act. All prescriptions can be printed and given to the patient immediately upon completion of the exam. Each one has an expiration date, which makes it easy for staff to verify and fill a request for a prescription from an outside retailer. And, since the prescription is in digital format, it can be faxed or e-mailed directly from the computer.
In addition to the advantages of efficiency and legibility, there are other benefits when using an EMR system to generate medication prescriptions. Medications are saved in a drop-down list that includes the most common dosages and directions for each one. This both saves time and acts as a built-in reference source. (I find it especially helpful for medications that I need to use only occasionally, such as oral antibiotics.) Simply click on the drug, and its dosage regimen is automatically available. Another advantage that many EMR packages offer: the ability to check for potential drug interaction complications and allergies.
With EMR, your records can follow you anywhere you go. Copying your records to a laptop greatly simplifies seeing patients outside your office, such as nursing home or hospital inpatient visitsnot to mention the convenience and security of having your records available to you at home. Yet another advantage of moving your records from paper to computer is that available floor space increases. We converted our old chart room to a business workstation, so the problem of finding space to file new charts no longer exists.
Using an EMR program can even help with marketing by allowing you to extract specific patient records, sorted by virtually any diagnostic search criteria. By filtering for patients with high minus prescriptions, for example, you could target that group with information regarding a new lightweight lens material. Likewise, information about a new ophthalmic drop could be sent to those diagnosed with allergic conjunctivitis.
But of all the reasons to use an EMR system, the most important is improved coding. As you know, there are very specific requirements for the level of history-taking, examination procedures and decision-making necessary for proper evaluation and management coding. Many programs keep track of all these components and guide you in determining the correct code for each. Some also keep track of face to face time between doctor and patient, which can be the determining factor to code at a certain level. (In my experience, computer-generated codes are irrefutable, and will be upheld in any audit.)
Drawbacks of EMR
But, as with any new system, implementing EMR is not without its challenges. A paperless environment requires the staff to become highly computer literate. (Besides keyboarding skills, all job applicants in my office must demonstrate proficiency at file management tasks and basic spreadsheet use.) In an office with multiple practitioners, realize that each practitioner has different comfort and skill levels with the computer; so, the system should accommodate everyone.
Perhaps the biggest challenge is the never-ending hardware and software glitches that seem to plague any office dependent on technology. Even the smallest computer networks require professional IT (information technology) experts to keep them running smoothly.
And, while all the hardware, software, and support are not cheap, consider the expense as a necessary cost of business. A well-designed system more than pays for itself by increasing productivity through improved efficiency.
Choose the Right Software
Remember: EMR is a big business, with lots of companies vying for the market share. How do you know which system is right for you? For most practitioners, especially those that are techno-phobic, a PMS suite package may be the solution; these include EMR. Typically, these all-in-one packages also include a document management system that permits high-speed scanning of paper documents into the digital chart. These program suites give you one source for technical support and are designed to allow every program within the suite to share information.
With these systems, however, you are at the mercy of one company, and invariably, you find that you like certain parts of the program better than others. For example, you might love the way a product files insurance, but dislike the way that it stores scanned documents.
For this reason, more technologically-adept practitioners may choose separate EMR and document scanning programs and integrate them with a different PMS system. While there are some challenges to integrating programs from different vendors, this best of breed concept allows you to shop for the best product in each specific category.
Increasingly, companies are realizing the importance of making their product compatible with others, so the technology that facilitates seamless integration is improving. I have had the same PMS in my office since 1992 for demographics and billing, but it now interfaces with outside programs for my EMR, document scanning, online appointment scheduling, automated appointment reminder phone system and electronic claims submission.
Regardless of which system you choose, research the company who designs and provides it. For example, small startup companies may have a good product, but may be too small to provide comprehensive IT support or may have less financial stability. The company you choose should be poised for future growth, including the ability to interface with other programs and utilize the latest Internet technology, such as Web-based automatic updates and patches. Make certain that the program you choose has an efficient way to scan and incorporate paper documents. Last, but certainly not least, choose a company that offers reliable customer service and support.
Also, trade shows are a good starting point when shopping for software, but never make a final decision without visiting the practice of a colleague who uses the software youre interested in. Salesmen are great at showing their products bells and whistles, but the only way to really evaluate a program is to see it in action. Find a practice that is similar in size and philosophy to yours and observe the staff in action to get the true picture of how the program will work for you. Talking to the O.D. is important as well, but it may be even more important to talk to the staff about their likes and dislikes.
Get Started!
Once you have chosen your software, youll have to close your office for a minimum of two days for training. Give the trainer your undivided attention; do not allow any interruptions. (In my office, I put up a closed sign and covered up all our windows.) Ideally, the trainer should first observe at least one day while you are seeing patients, which enables him or her to troubleshoot problems on the spot. The trainer should also return about four weeks later for follow-up and to address problem areas that may have been identified by your staff.
Conversion to paperless technology can progress gradually by initially using both paper and electronic charts side-by-side. While setting up your EMR system, save patients paper charts until the end of the day and convert them to electronic after hours. Over time, the number of electronic charts completed in real time will increase as your office gets more comfortable with the process, and eventually you will reach a point where it doesnt make sense to continue with paper anymore. In our case, this process took approximately three months.
All medical offices must incorporate EMR eventually. Why not be proactive and start now? Instead of searching for charts, search for a better way to practice optometry. Todays technology exists to increase your productivity and efficiency and improve your level of patient care.
Dr. Scibal is in private practice in coastal
