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73 August 2014 EW MEETING REPORTER Speaking at the same session, Pannet Pangputhipong, MD, Thai- land, said that ophthalmic surgeons such as himself who began with intracapsular cataract extraction (ICCE) and have since seen the surgical procedure evolve through extracapsular cataract extraction (ECCE) on to phacoemulsification, "never dreamed of the technology we have today, which seems like magic." While he has had to find ways to adapt his preferred techniques to using the femtosecond laser—such as using the X-pattern for femto fragmentation, later modified to the XO-pattern, as an analogue to the triangular cracking he prefers with phaco, the techniques similarly min- imizing the need for hydrodissection and rotation, as well as being quick and easy—he is astonished by what the technology allows him to do. "This is like magic because nothing touches the eye," he said. While beginners are better off avoiding complicated cases, Dr. Pangputhipong said he has grown accustomed to the technology enough to use it on cases such as cataracts with very hard nuclei or loose zonules, on posterior polar cat- aracts, and in eyes with small pupils. Editors' note: Dr. Simaroj and Dr. Pangputhipong have no related financial interests. EMRs 'future reality' of healthcare Electronic medical records (EMRs)— digital counterparts of paper medical charts—provide clear advantages for clinicians, administrators, and policymakers and researchers, said Johan A. Hutauruk, MD, Indonesia. For clinicians, they improve accuracy and quality of data, make said data immediately available when necessary, reduce prescription errors that are an inherent danger in handwriting prescriptions, and make information sharing—for instance, for the production of medical sum- maries—easier. For administrators, EMRs improve efficiency, enhance claiming and ordering processes, reduce billing time, allow for better customer service, and feature virtual- ly unlimited information storage. For policymakers and researchers, they improve data-gathering for the identification of best clinical practices, provide better avenues for medical audits for patient safety, and improve long-term planning for healthcare, accountability, and resource allocation. The implementation of EMRs was a focus of a pair of talks at an information technology session held by the ASEAN Eye Hospital Association on the last day of the 1st AOS Congress. Dr. Hutauruk detailed their 10-month experience implement- ing EMRs at the Jakarta Eye Center (JEC), beginning in September 2011. EMRs went live at JEC in October 2012. The process involved careful step-by-step planning that required commitment from both the individ- ual doctors and the institution as a whole. "Failure to plan is a plan to fail," said Dr. Hutauruk. He emphasized that successful implementation requires convincing everyone at the institution to be involved. Despite requiring a long, arduous process that, according to Robert Betz, PhD, U.S., spans decades rather than years and "looks like a mess" from the provider standpoint, the EMR is a "vital component of health reform." Successful implementation of EMR, said Prof. Betz, can automate and streamline clinical work flow, generate evidence-based decision support, contribute to standardiza- tion, which in turn can lower costs and, from the business standpoint, increases profitability. There are "real benefits," he added, with the implementation of EMR leading to better care, better service, and better safety for patients. Prof. Betz detailed lessons learned from two of the earliest and most successful cases of EMR implementation in the U.S.: the U.S. Veterans Administration and, more relevant for ophthalmology, the Phillips Eye Institute, Minneapolis. The U.S. Veterans Administra- tion's implementation of EMR, he said, serves as the benchmark for implementation in the U.S. The institution's experience demon- strates, among other things, that community building is vital to the success of implementation; that the process tends to be "decentralized," with "lots of contributors"; that implementation should minimize specifications and maximize feed- back; that the system should adapt to local needs, be simple to use while still being accurate, reliable, and evolving with customer require- ments. Above all, he said, the system should be fast. Meanwhile, the experience of the Phillips Eye Institute demon- strates the need for ongoing support for physicians, including contin- ued regular dialog with physicians. Institutions planning to implement EMR should also acknowledge that the process requires a protracted transition period. EMR, said Prof. Betz, is the "future reality" of healthcare and ul- timately, "this is for the betterment of the patients." Websites, mobile apps, and patient care Speaking from the perspective of patients, Jean-Pierre Dumas, Thailand, CEO of iHome, encour- aged ophthalmologists to bring "a bit of fun, a bit of humanity" to the healthcare experience. Mr. Dumas asked attendees of an ASEAN Eye Hospital Association session on information technology to think of their most recent health- care experience, not as clinicians, but as patients. He then asked them to think of the five "top key words" they would associate with the experience. None of them, he was certain, would have included "fun," "excit- ing," "pleasant," "interesting," or, for local flavor, "aroi!" ("tasty!") in their list. The fact is, he said, the health- care experience isn't any of those things. He asked attendees to consid- er two more facts about modern clinics: (1) There are probably more smartphones and tablets than there are patients in clinics; (2) people like to interact with their own devices as it is more personal, ubiquitous, and "based on private choice." He encouraged ophthalmolo- gists and administrators to consider providing their patients with mobile websites and apps that provide information on their respective clinics, the patients' conditions, and available treatments; games and other forms of entertainment; ap- pointment booking; patient health records; feedback and social media; virtual doctor consultations; and reminders. He also suggested provid- ing ways for patients to control their environment—including things like lighting, air conditioning, music, and nurse calls—through their personal mobile devices. "Giving control to a patient in a stressful environment is a great way to make the patient feel better in that situation," he said. Parallel to Mr. Dumas's call to "make patients 'APPY,'" the Singapore National Eye Centre (SNEC), said Dirk de Korne, MD, has developed three mobile apps: MyEyeDrops, an eye drop com- pliance aid for glaucoma patients; MyEyeGym, which provides a fun way for patients with strabismus to exercise eye movements; and MyEyeMatters, which provides pa- tients with access to information on ophthalmic conditions as well as on news and events from SNEC. These apps are available for free download on Android and iOS devices. Dr. de Korne suggested that, in addition to prescribing medication, ophthalmologists should now also "prescribe" mobile apps. EW EyeWorld Meeting Reporter live from AOS 2014 now online at ... digital.eyeworldap.org /h/i/16325816-aos2014- digital-mr