Eyeworld

March 2018 • Ophthalmology Business 19 References 1. Read-Brown S, et al. Time requirements for electronic health record use in an academic ophthalmology center. JAMA Ophthalmol. 2017;135:1250–1257. 2. Boland MV. How much time should we be spending with electronic health records? JAMA Ophthalmol. 2017;135:1257–1258. Editors' note: The physicians have no financial interests related to their comments. Contact information Boland: boland@jhu.edu Chiang: chiangm@ohsu.edu Mendelsohn: admendelsohn@gmail.com Montzka: rbrice@dodgecommunications.com compare EMR systems and look at metrics other than speed. "[W]hat we have to understand is, right now, EHR are not commod- ity systems, they're not made the same, they are distinctive, there are significant differences in the design and architecture of the different systems, and I think we would find widely divergent results if we com- pare different systems," he said. Quality of documentation also needs to be assessed. One thing Dr. Montzka said many doctors using EHR are frustrated with is a lack of specificity in the electronic records. "When they had a paper chart they could describe with a great deal of specificity the patient's condition fairly quickly. Now when you get to pick lists, unless you have a system time if the documentation that is produced is readable and available to colleagues before, during, and after clinical encounters, for example," Dr. Boland wrote. More details about "the nature of each practice, the culture of the department and physicians, and the details of EHR deployment," would also give more context to studies about time spent using the EHR. "Only with such additional variables reported will we be able to draw conclusions about which factors are associated with success or failure using EHRs," Dr. Boland said. In an interview with Ophthal- mology Business, Dr. Boland further explained that the conclusions from Read-Brown et al.'s study are lim- ited due to it representing a single academic institution. "As I indicated in my editorial, we need more stories from ophthalmologists before we can say anything about how the profes- sion is doing overall. We also need more context to understand if this time is too much, too little, or just right," he said. The "right" amount of time spent using an EHR will be the amount of time required to complete tasks deemed useful to the patient or to the physician. "Many physicians don't like documenting, but it does serve a number of critical purposes— communication with other providers, communication with the patient, and communication to your future self at the next visit," Dr. Boland continued. "[This] work is a good start—we need more practices to report similar data. We also need to know more about what the physicians were doing during that time," Dr. Boland said. "As I wrote, we can't make judgments about what is too much or too little until we know what the physicians are actually doing." Dr. Montzka also said he thinks the Read-Brown et al. study is a good start, but future studies will need to that's designed very intel- ligently, it's hard to obtain that same level of speci- ficity, but there are some systems that are able to do that, and people need to look into that," he said. System design will also influence the ability to use the EHR as a data-mining tool, Dr. Montzka said. At this point, when choosing an EHR system, Dr. Montzka stressed the importance of visiting a clinic using the system to verify its features and efficiency. "All doctors who are looking at buying a system have to verify what they're hearing from a vendor in an actual clinic. … I shudder to hear of doctors making decisions [about] using a system and they never vis- ited a clinic; they basically took the vendor's word for it. You can get yourself into a lot of trouble doing that," Dr. Montzka said. OB 27% of the examination time was spent on the EHR

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