Saudi Journal of Ophthalmology (2013) 27, 71—72
Editorial
Electronic medical records in ophthalmology
The purpose of this editorial is to offer essential benefits for ophthalmologists to incorporate electronic medical records (EMR) into their practices. Lately, some of the leading academic ophthalmological centers have realized importance of incorporating EMR into their practice for efficient record keeping, patient care, education and conducting of advanced clinical research.1–3 Clinicians who understand the benefits of EMR implementation have realized advantages which include, sharing of information with other colleagues in the same specialty and with others involved in the care of these patients. It is hoped that with implementation of EMR, communication with others by printed letters, personal phone calls and e-mails may become things of the past. Historically, ophthalmologists have been reluctant to embrace and implement EMR in their practice as compared to other medical specialties.2 Several factors had contributed to their lagging behind others, not to mention cost, lack of any cook-book approach to start EMR and the lack of required training for all personal working in the practice. Further, most ophthalmologist are visually-oriented practitioners who like drawings of their observations. For ophthalmologists who like to draw their observation, several platforms can allow insertion of drawings and graphics into patient’s EMR.2 Further, upgrades can also provide additional level of customization for the sub-specialties and even for technical staff and billing and coding personal. Patient calls can be entered into the system and answered quickly, efficiently and above all on timely bases. Letters can be faxed directly from the EMR to the recipient anywhere needed. In a large group, all physicians share the same system and each patient has a single chart while every physician having full access to the patient’s test results and the kind of treatment rendered. Since patient care, education and research are inter-dependent, all diagnostic and surgical procedures can be tracked and outcomes can be evaluated. Clinical trials can be conducted and patients fitting certain criteria can be easily selected from the EMR by click of few buttons. The office staff and physician can perform electronic chart review for research purposes and staff development in matter of hours rather than days or weeks.1,2 Ophthalmologists who have added EMR to their practice find significant advantages which include proper documentation, accurate billing and above all security of patient medical data.1,2 Once entered, data becomes available anywhere needed for any desired purposes not to mention audit for
Peer review under responsibility of Saudi Ophthalmological Society, King Saud University
the insurance purposes. EMR also can permit trending of patients over time allowing for comprehensive evaluation of chronic diseases such as glaucoma and diabetic retinopathy progression as well as determining of practice efficiencies and clinical performance of technical staff in the care of patients. Further, in the large multi-specialty practices, EMR can offer a comprehensive and expanded level of interaction between ophthalmologists and the other clinicians. For example, a patient with chronic disease such as diabetes may benefit from the expertise of an internet, endocrinologist, cardiologist and an ophthalmologist without having to have multiple tests ordered by each physician individually. In the EMR, patient’s medication record includes prescribed medications, both active and inactive with appearance of warning signs of potential drug-drug interactions and their allergies. EMR maintains a real-time history of the patient’s medication record avoiding omissions and duplications. By the use of e-prescription, orders for new medications and refills can be sent electronically to the patient’s pharmacy. Obviously, there are many drawbacks for major eye centers with large residency and fellowship teaching programs to convert from paper work to EMR that may include, added initial cost, selection of state-of-the art system among so many in the market, incorporation of previous paper records to the electronic format, staff training, maintenance of high speed internet connections and ability to keep a backup system.1,2 But experience has proven that the centers had to decrease their patient flow to allow them integration of the various aspects of functioning of the system. After full implementation and overcoming of the potential downtime due to unexpected bugs and technical issues, most eye centers have done well during their conversion. Diagnostic tests from various imaging solutions and diagnostic devices can be integrated into the patient’s EMR along-with their demographic information. Some of the diagnostic tests and reports that can be stored and displayed within the current EMR include ophthalmic photography, angiography, visual fields, OCT and measurements for cataract surgery.1,2 Imaging obtained prior to the implementation of EMR can be scanned and stored and utilized to compare with newly obtained images and hence document progress of the disease process especially in cases of diabetic eye diseases, glaucoma and AMD. Incorporation of these tests into the patient’s EMR provides an interface that enhances workflow, opportunity for the practitioner to interpret
Production and hosting by Elsevier
Access this article online: www.saudiophthaljournal.com www.sciencedirect.com
72 and ability to see these results at any location anytime. Other specific features and capabilities can be incorporated with the help of IT personal. Customized EMR can also allow boxes where plain-text can be added for entry that can show up in the summarized referral letter.2 One needs to work closely with IT personal, office staff, COTs, nursing staff and the ophthalmologist in the customization of an EMR for the particular specialty. EMR enables ophthalmologists to enhance practice productivity by streamlining the entire set of operational procedures and by integrating financial information in the patient encounter. The system is embedded with all current ICD and CPT codes, allowing clinicians to capture, submit and track charges electronically. EMR system can increase compliance and proper documentation mandated by the government regulatory agencies while increasing practice’s surveillance of billing.1,2 Overall, the billing process can become more efficient and standardized by capturing charges and enhanced income. The bill can be automatically created when physician signs off and the system allows the billing personal visualize charts on a real-time basis while seeing everything performed for the patient. Patient can also view and monitor progress of their care by logging-onto a secure network, providing them a sense of empowerment. The patients can set-up their appointments and have their questions answered on timely basis. EMR can streamline billing cycle from weeks to few days allowing review of the indication and necessity of the diagnostic procedures or therapeutic interventions. Further, EMR prevents miscoding of billing charges not related to the services provided. Accurate billing automatically goes out to the insurance or payers based on the tests and level of care provided. Electronic practice man-
Editorial agement (EPM) component of the EMR can help track all the charges based on the diagnostic tests and the level of care hence improved billing compliance and reimbursement of professional and testing fees. In conclusion, EMR can enhance the lives of our patients by providing early, accurate diagnosis and treatment in efficient and state-of-the-art care which mirrors 21st century technology. By automating collection of data elements, EMR simplifies the process of measuring the quality of medical and provide additional information needed to create a comprehensive vision and eye health surveillance system. Starting as an independent new sub-specialty practice, incorporation of the EMR was an easy step into my practice. Before going live with the EMR system, I started incorporation of EPM which helped with patient scheduling, assigning tasks for particular staff and above all billing. EPM also helped with reducing the problems with unclear plans to planned visits which included getting desired diagnostic tests prior to being seen by the doctor. EPM has also helped in ease of communication between different providers for proper patient scheduling and appointment with other doctors.
References 1. Elliott AF, Davidson A, Lum F, Chiang MF, Saaddine JB, Zhang X, et al. Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States. Am J Ophthalmol 2012;154:S63–70. 2. Electronic medical records: ophthalmology update, special ed. Cleveland Clinic Cole Eye Institute; 2012. 3. Adams WG, Mann AM, Bauchner H. Use of an electronic medical record improves the quality of urban pediatric primary care. Pediatrics 2003;111:626–32.
Editorial
Electronic medical records in ophthalmology
The purpose of this editorial is to offer essential benefits for ophthalmologists to incorporate electronic medical records (EMR) into their practices. Lately, some of the leading academic ophthalmological centers have realized importance of incorporating EMR into their practice for efficient record keeping, patient care, education and conducting of advanced clinical research.1–3 Clinicians who understand the benefits of EMR implementation have realized advantages which include, sharing of information with other colleagues in the same specialty and with others involved in the care of these patients. It is hoped that with implementation of EMR, communication with others by printed letters, personal phone calls and e-mails may become things of the past. Historically, ophthalmologists have been reluctant to embrace and implement EMR in their practice as compared to other medical specialties.2 Several factors had contributed to their lagging behind others, not to mention cost, lack of any cook-book approach to start EMR and the lack of required training for all personal working in the practice. Further, most ophthalmologist are visually-oriented practitioners who like drawings of their observations. For ophthalmologists who like to draw their observation, several platforms can allow insertion of drawings and graphics into patient’s EMR.2 Further, upgrades can also provide additional level of customization for the sub-specialties and even for technical staff and billing and coding personal. Patient calls can be entered into the system and answered quickly, efficiently and above all on timely bases. Letters can be faxed directly from the EMR to the recipient anywhere needed. In a large group, all physicians share the same system and each patient has a single chart while every physician having full access to the patient’s test results and the kind of treatment rendered. Since patient care, education and research are inter-dependent, all diagnostic and surgical procedures can be tracked and outcomes can be evaluated. Clinical trials can be conducted and patients fitting certain criteria can be easily selected from the EMR by click of few buttons. The office staff and physician can perform electronic chart review for research purposes and staff development in matter of hours rather than days or weeks.1,2 Ophthalmologists who have added EMR to their practice find significant advantages which include proper documentation, accurate billing and above all security of patient medical data.1,2 Once entered, data becomes available anywhere needed for any desired purposes not to mention audit for
Peer review under responsibility of Saudi Ophthalmological Society, King Saud University
the insurance purposes. EMR also can permit trending of patients over time allowing for comprehensive evaluation of chronic diseases such as glaucoma and diabetic retinopathy progression as well as determining of practice efficiencies and clinical performance of technical staff in the care of patients. Further, in the large multi-specialty practices, EMR can offer a comprehensive and expanded level of interaction between ophthalmologists and the other clinicians. For example, a patient with chronic disease such as diabetes may benefit from the expertise of an internet, endocrinologist, cardiologist and an ophthalmologist without having to have multiple tests ordered by each physician individually. In the EMR, patient’s medication record includes prescribed medications, both active and inactive with appearance of warning signs of potential drug-drug interactions and their allergies. EMR maintains a real-time history of the patient’s medication record avoiding omissions and duplications. By the use of e-prescription, orders for new medications and refills can be sent electronically to the patient’s pharmacy. Obviously, there are many drawbacks for major eye centers with large residency and fellowship teaching programs to convert from paper work to EMR that may include, added initial cost, selection of state-of-the art system among so many in the market, incorporation of previous paper records to the electronic format, staff training, maintenance of high speed internet connections and ability to keep a backup system.1,2 But experience has proven that the centers had to decrease their patient flow to allow them integration of the various aspects of functioning of the system. After full implementation and overcoming of the potential downtime due to unexpected bugs and technical issues, most eye centers have done well during their conversion. Diagnostic tests from various imaging solutions and diagnostic devices can be integrated into the patient’s EMR along-with their demographic information. Some of the diagnostic tests and reports that can be stored and displayed within the current EMR include ophthalmic photography, angiography, visual fields, OCT and measurements for cataract surgery.1,2 Imaging obtained prior to the implementation of EMR can be scanned and stored and utilized to compare with newly obtained images and hence document progress of the disease process especially in cases of diabetic eye diseases, glaucoma and AMD. Incorporation of these tests into the patient’s EMR provides an interface that enhances workflow, opportunity for the practitioner to interpret
Production and hosting by Elsevier
Access this article online: www.saudiophthaljournal.com www.sciencedirect.com
72 and ability to see these results at any location anytime. Other specific features and capabilities can be incorporated with the help of IT personal. Customized EMR can also allow boxes where plain-text can be added for entry that can show up in the summarized referral letter.2 One needs to work closely with IT personal, office staff, COTs, nursing staff and the ophthalmologist in the customization of an EMR for the particular specialty. EMR enables ophthalmologists to enhance practice productivity by streamlining the entire set of operational procedures and by integrating financial information in the patient encounter. The system is embedded with all current ICD and CPT codes, allowing clinicians to capture, submit and track charges electronically. EMR system can increase compliance and proper documentation mandated by the government regulatory agencies while increasing practice’s surveillance of billing.1,2 Overall, the billing process can become more efficient and standardized by capturing charges and enhanced income. The bill can be automatically created when physician signs off and the system allows the billing personal visualize charts on a real-time basis while seeing everything performed for the patient. Patient can also view and monitor progress of their care by logging-onto a secure network, providing them a sense of empowerment. The patients can set-up their appointments and have their questions answered on timely basis. EMR can streamline billing cycle from weeks to few days allowing review of the indication and necessity of the diagnostic procedures or therapeutic interventions. Further, EMR prevents miscoding of billing charges not related to the services provided. Accurate billing automatically goes out to the insurance or payers based on the tests and level of care provided. Electronic practice man-
Editorial agement (EPM) component of the EMR can help track all the charges based on the diagnostic tests and the level of care hence improved billing compliance and reimbursement of professional and testing fees. In conclusion, EMR can enhance the lives of our patients by providing early, accurate diagnosis and treatment in efficient and state-of-the-art care which mirrors 21st century technology. By automating collection of data elements, EMR simplifies the process of measuring the quality of medical and provide additional information needed to create a comprehensive vision and eye health surveillance system. Starting as an independent new sub-specialty practice, incorporation of the EMR was an easy step into my practice. Before going live with the EMR system, I started incorporation of EPM which helped with patient scheduling, assigning tasks for particular staff and above all billing. EPM also helped with reducing the problems with unclear plans to planned visits which included getting desired diagnostic tests prior to being seen by the doctor. EPM has also helped in ease of communication between different providers for proper patient scheduling and appointment with other doctors.
References 1. Elliott AF, Davidson A, Lum F, Chiang MF, Saaddine JB, Zhang X, et al. Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States. Am J Ophthalmol 2012;154:S63–70. 2. Electronic medical records: ophthalmology update, special ed. Cleveland Clinic Cole Eye Institute; 2012. 3. Adams WG, Mann AM, Bauchner H. Use of an electronic medical record improves the quality of urban pediatric primary care. Pediatrics 2003;111:626–32.
