MAY 2019

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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I TECHNOLOGY & INNOVATION N FOCUS 50 | EYEWORLD | MAY 2019 way applied to decide whether an OCT or visual field is appropriate. He added that none of these systems presently have built-in algorithms to report to providers how they're doing compared to col- leagues to apply clinical benchmarks. Precious few practices use this digitized data to inform their own pathways, he said. "I would say that the profession has gotten over the hump," Mr. Pinto said. "It used to be that every practice was throwing rocks at its EHR vendor and unhappy with the cost or the slowdown in the pace of patients." Clearly, however, we're still at baby steps for extracting the value for the cost of these systems, he added, and not just the cost for the vendor but also the staff cost. For example, Mr. Pinto said that the average ophthalmologist using EHR is spending an extra 500 hours a year in lay labor to provide scribing and other services. There are also internal and external IT costs associated with the systems. There are other issues associated with EHR, like how it affects the patient experience. There are doctors who have shared concerns that they are now talking to patients over their shoulders while looking at the patient records instead of face to face. Mr. Pinto said he likes to the use the analo- gy of early automobile production. "Back in the early days when the automobile was invented, there were hundreds of companies," he said. Similarly, in the early days of EHR, there were a large variety of companies. In the automobile world, there are fewer and fewer producers making more and more cars, and that's the same arc we've traversed with EHR, Mr. Pinto said. "Now we have half a dozen or so in the oph- thalmic space who are the leaders." Mr. Pinto added that his observations relating to EHR technology can be mirrored on the practice management side. These systems have been in place much longer, around 30–35 years. If you look at where the world is right now, practices capture all kinds of demographic data on patients, however, they're still "fairly primitive [in] harnessing that data to automat- ically benchmark." He added that a practice's I ntegrating software like electronic health records (EHR), scheduling tools, and other technologies can help doctors im- prove the overall experience for patients and office efficiency for their staff and themselves. Practice perspective John Pinto spoke about his observations of the evolution of EHR. "I visit practices all over the country and the world, see what's available and being used in real time, and I listen to what staff and providers say about it," he said. "Elec- tronic health records are the most prominent shift in the last decade to 15 years. We've gone from about a 5% utilization to about a 95% utilization." EHR have a lot of positive attributes, Mr. Pinto said, and they make for more complete and legible records. EHR also make it easier to pass the records back and forth among collabo- rators inside and out of practices. Additionally, they can help free up physical space in offices where records used to be stored. Mr. Pinto noted that there is still some untapped potential with EHR, like improving care pathways, assessing provider competency, looking at utilization, and trying to optimize coding. "Unfortunately, a lot of the potential of gathering and filling in all the fields [is not being recognized], and the profession is still not using that data for what it could do," he said. Mr. Pinto noted the differences he sees among practices in how dry eye is treated, in utilization of YAG postop, and in the care path- At a glance • EHR can help in a number of ways, including providing more complete and legible records. • EHR make it easier to pass records among collaborators inside and outside practices and ease the transfer of records to others. • There are a number of products available to help with key activities like patient education and appointment reminders. Software to help improve surgery and practice experience by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor Contact information Hovanesian: drhovanesian@harvardeye.com Pinto: pintoinc@aol.com

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