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Six Tips for Choosing an EMR System for Your Retina Practice
Keep these points in mind when evaluating a system.
By Virginia Pickles, Contributing Editor |
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The retina subspecialty presents several unique challenges for an electronic medical records (EMR) system. Patients are generally older, with multiple medical problems, and physicians must document findings with clarity and a high degree of specificity. "Often these high-pathology patients have more abnormal findings than normal findings, and EMR systems that were developed for a more general medical practice can really struggle in that environment," says Clearwater, Florida, retina specialist Dan P. Montzka, MD. How do you determine which system is best for your practice? Dr. Montzka offers these tips.
- Be involved
Although your practice administrator and other key personnel may be involved in selecting an EMR system, no one is better equipped to determine if a system will meet the needs of a retina surgeon than the surgeon. "The primary function of an EMR system is to replace the paper chart, which is why the doctor must be involved in evaluating the software from the very beginning," Dr. Montzka says. "Some of the biggest mistakes occur when the doctor isn't driving the decision." Checking an EMR company's references in the retina community is also a must.
- Watch your language
Many EMR systems use terminology from standardized knowledge bases, such as the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) or Systematized Nomenclature of Medicine (SNOMED), to describe clinical problems and findings, which may be inadequate for a retina practice. "We need to document with state-of-the-art clinical terminology," Dr. Montzka says. "The EMR should then translate this into standard terminology for billing or reporting purposes. If you use an EMR with a standardized knowledge base, you won't be able to describe a clinical problem with the specificity required, and you'll need to dictate a lengthy addendum after each encounter."
- Consider the cloud
Typically, EMR can be housed on a practice's server, on a server hosted by the EMR company, or the EMR system may be cloud-based with access via a Web browser. Dr. Montzka prefers a cloud-based system for several reasons. "From a technology standpoint, a cloud-based system is less costly to maintain," he says. "You only need to manage your desktop computers and your Internet connection; whereas with a client-server system, the server resides and must be maintained in the practice." In addition, cloud-based systems enable physicians to collaborate on clinical studies or individual cases, and software updates are easier to load via the cloud.
A potential downside to a browser-based system is the need to compress large images, which, when opened, may result in slow Internet speeds. "You may want to combine a local network imaging solution with a cloud-based EMR if you want to review large images at your work stations," Dr. Montzka says.
- Be flexible
It can take up to 3 or 4 months before physicians start feeling comfortable with an EMR. "If you've been working on paper for 15 years, you need to be flexible when you first start working with an EMR system," Dr. Montzka advises. "Try to learn the system the way it is, and then as you become more facile with it, you can offer constructive feedback to the EMR company."
- Invest in a second monitor
Because retina specialists must process a tremendous amount of information very quickly, a second monitor is a wise investment. "With two monitors, you don't have to flip back and forth between screens so often," Dr. Montzka says. "An extra monitor is a minor additional cost, but with it, you'll have a much more efficient system."
- Stay focused
A simple, one-size-fits-all, plug-and-play EMR system may seem like an attractive option, but Dr. Montzka warns that such a system may not be the best fit for a retina practice. He advises staying focused on the core task. "It's really about how well an EMR system replaces the paper chart," he says. "A system may have a lot of bells and whistles, but when it comes right down to running an efficient retina practice, we must be able to review information and document each patient's examination with a high degree of efficiency and specificity."
Dan P. Montzka, MD, practices in Clearwater, Florida. He is founder and CEO of MDIntelleSys, an EMR company.
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