Not all electronic medical record (EMR) systems are suited for a retinal practice.
"I recommend a system with drop-down screens, which most EMR systems do not offer," says David J. Browning, MD, PhD, who practices at Charlotte Eye, Ear, Nose, and Throat Associates in North Carolina. Dr. Browning and his colleagues have settled on a system made by Medflow, of which they share a minority fraction of ownership.
"A system such as Medflow allows you to customize drop-downs," he says. "Some physicians prefer free-form typing by scribes. This makes you dependent on a speed typist with great accuracy."
EMR Purchasing Tips
When shopping for an EMR system, Randy Dhaliwal, MD, of the Retina Eye Center, Augusta, Ga., and Dr. Browning recommend visiting practices where different EMR systems have succeeded and failed and finding out the causes of these outcomes. They say not to be afraid to ask colleagues about costs. When selecting vendors, diversify as much as possible. For example, your hardware vendor should be different from the company that sells you the EMR. Using multiple vendors will ensure that you receive balanced information and cause less dependence on pricing and offerings of a single company.
Dr. Browning suggests that you look for the following functionalities and capabilities:
- E-prescribing
- Ability to fax notes to referral sources
- Drawing tool
- Procedure flow screen
- OCT flow charts
- Image processing
- Ability to enter and modify medication names easily
- Billing module
- Patient tracker
- Analytics (data mining) based on codes, words, MDs using the system, procedures, etc.
- Excellent MD sign-off function, including ability to edit
- Pre-population of diagnosis module from the exam findings, offering the ability to prune later
"Pick an EMR vendor that has at least 4 to 5 years experience with retina," says Dr. Dhaliwal. "Also, consider ergonomics. You shouldn't have to drill down multiple levels to get to menus."
After adopting EMR, productivity will decrease, he adds. "You should be able to recover productivity within a few months. By having a system that requires only a few keystrokes, you should, at a minimum, be able to maintain productivity and meet the compliance standards of Medicare, as well as 'meaningful use' standards for EMR. But it's a fallacy and a misleading sales pitch to say EMR will increase productivity."
Frequent Reporting Needs
"Drop-down screens work well with the frequent reporting required by our many diagnostic imaging tests," says Dr. Dhaliwal. "I can easily create over 45 reports on the fly during a clinic day. Standardized drop-downs also help in the event of an audit. Secondarily, your system should generate disease-specific consent forms, such as those needed for the different diagnoses associated with a focal laser."
Dr. Dhaliwal notes that most retinal physicians perform surgery in hospitals, where patients are generally more ill and the need to record detailed histories and physician examination findings is greater. "The EMR should efficiently address these needs without requiring too much of the physician's time," he says.
Another consideration, according to both doctors, is an EMR's drawing function. "Look for a system that allows you to freehand draw or use preloaded icons (for retinal tears, lattice, etc.,)," Dr. Browning says. "Renderings of detachments and peripheral tumors are important."
Adapt EMR to Your Style
Keep in mind that EMR, even when customized to the highly specific needs of a retina practice, can be used in varying ways.
"Use scribes with your EMR," advises Dr. Browning. "Never type yourself. Talk to the patient and let the scribe do the EMR charting."
Dr. Dhaliwal uses a different approach. "I input data directly into the EMR instead of having a scribe perform this task," he says.
Dr. Dhaliwal says he and other retinal specialists have been perfecting EMR for 10 years. "Now I'm working to develop a cloud-based system, free of wired networks," he says. "Eventually, this is the direction it will go for all of us."
In order for the entire practice to be on board with EMR adoption, you need to conduct extensive research on the different EMR offerings and involve as much of your staff as possible in your decision-making process.
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