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 ophthalmolog ists to incorpora te electronic medical re- cords (EMR) into their practices. Lately, some of the leading academic ophthalmological centers have realized import ance of incorporating EMR into their practice for efficient record keeping, patient care, education and conducting of ad- vanced 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 pat ients. It is hoped that with implementation ofEMR, communication with others by printed letters, personal phone calls and e-mails may become things of the past.

Historically, ophthalmologists have been reluctant to em- brace and implement EMR in their practice as compared toother medical specialties.2 Severa l factors had contributed to their lagging behind others, not to mentio n cost, lack ofany cook-book approach to start EMR and the lack of re- quired training for all personal workin g in the practice. Fur- ther, most ophthalmologist are visually-orient edpractitioners 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, upgrade s can also provide addi- tional 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 alarge group, all physicia ns share the same system and each patient has a single chart while every physician having full ac- cess to the pat ient’s test results and the kind of treatmen trendered. Since patient care, education and research are in- ter-dependent, all diagnostic and surgical procedures can betracked and outcomes can be evaluated. Clinical trials can beconducted and patients fitting certain criteria can be easily selected from the EMR by click of few buttons. The office staff and physicia n can perform electronic chart review for re- search 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 documenta- tion, 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 pa- tients over time allowing for comprehensive evaluation ofchronic 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 pa- tients. Further, in the large multi-specialty practices, EMR can offer a comprehensive and expanded level of intera ction between ophthalmologists and the other clinicians. For example, a patient with chronic disease such as diabetes may benefit from the expertise of an intern et, endocrino lo- gist, cardiologist and an ophthalmologist without having tohave multiple tests ordered by each physician individually.In the EMR, patient’s medication record includes prescribed medications, both active and inactive with appe arance ofwarning signs of potential drug-drug interactions and their allergies. EMR maintains a real-time history of the patient’s medication recor d avoiding omissions and duplications. Bythe use of e-prescription, orders for new medications and re- fills can be sent electronically to the patient’s pharmacy.

Obviously, there are many drawbacks for major eye cen- ters 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 somany 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 experienc e has proven that the centers had to decrease their patient flow to allow them integration ofthe 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 cen- ters have done well during their conversion.

Diagnos tic tests from various imaging solutions and diag- nostic devices can be integrated into the patient’s EMR along-with their demographic information. Some of the diag- nostic tests and reports that can be stored and displayed within the current EMR include ophthalmic photography,angiography, visual fields, OCT and measurements for cata- ract surgery.1,2 Imaging obtain ed prior to the implementa- tion of EMR can be scanned and stored and utilized tocompare with newly obtain ed 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 en- hances workfl ow, opportunity for the practitioner to interpret

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72 Editorial

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 summarize d referral letter.2 One needs to work clo- sely with IT personal, office staff, COTs, nursing staff and the ophthalmologist in the customization of an EMR for the par- ticular specialty.

EMR enables ophthalmolog ists to enhance practice pro- ductivity by streamlin ing the entire set of operatio nal proce- dures and by integratin g 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 compli- ance and proper documentation mandated by the govern- ment regulatory agencies while increasing practice’s surveillance of billing.1,2 Overall, the billing process can be- come more efficient and standardized by capturing charges and enhanced income. The bill can be autom atically 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, providin g them a sense of empowerment. The pa- tients can set-up their appointmen ts and have their questions answered on timely basis. EMR can streamlin e billing cycle from weeks to few days allow ing review of the indication and necessity of the diagnostic procedures or thera peutic 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 onthe tests and level of care provided. Electroni c practice man-

agement (EPM) component of the EMR can help track all the charges based on the diagnostic tests and the level of care hence improve d billing compliance and reimbursement ofprofessional and testing fees.

In conclusion, EMR can enhance the lives of our pat ients by providin g early, accurate diagnosis and treatment in effi- cient 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 med- ical and provide additional information needed to create acomprehensive vision and eye health surveillance system.Starting as an independent new sub-specialty practice, incor- poration of the EMR was an easy step into my practice. Be- fore 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 tobeing seen by the doctor. EPM has also helped in ease ofcommunication between different providers for proper pa- tient 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. Pediatrics2003;111:626–32.