EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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38 EW FEATURE February 2011 ahead December 2012 Innovation: A look Making headway with EHR systems by Vanessa Caceres EyeWorld Contributing Writer Perspectives from ophthalmologists in the EHR trenches T here are a number of analogies for implementing an electronic health records (EHR) system. Some compare it to phaco, where you need to have good people and good equipment, but you still need to be ready for a learning curve when you get started. Others compare it to moving to a strange city, where you really get to know it by exploring and getting lost. Still others liken it to a new baby, with all of the same anticipation and initial work. Whatever analogy works for you, ophthalmologists who are in the throes of EHR use believe it���s time for fellow ophthalmologists to let go of any related fears and move forward in their EHR plans. ���It���s time to get serious. You just have to do it,��� said Sandra Yeh, M.D., Springfield, Ill. Dr. Yeh���s office began using an EHR system 6 years ago. In January 2012, the office received its first federal bonus payment for investing in the system early in the game. Dr. Yeh examines a patient while her EHR is readily available in the background Source: Jena Passut Some pros and cons AT A GLANCE ��� Physicians using EHR systems find them helpful but say they involve a good deal of upfront work ��� The most successful EHR implementations are accompanied with preplanning and a slow, methodical roll out ��� Practices should get non-physician staff trained on using their EHR systems before physicians are trained on how to use them ��� Keep backup systems in place in case technology does not work properly Those using EHR successfully say they have trouble imagining practice life without it. ���It���s not easy, but it is worth it,��� said Marian Macsai, M.D., chief of ophthalmology, NorthShore University HealthSystem, and professor of ophthalmology, Pritzker School of Medicine, University of Chicago. ���In the long run, the communication between the doctors is better, as well as communication with the patients. Like any system, you need to really learn how to use it to take full advantage of all it has to offer.��� The EHR system she uses can develop customized patient education, send notes to referring doctors Monthly Pulse through the computer system, autofax a letter, forward email from patients through the EHR, and complete e-prescribing. She no longer has to do daily dictations. Keeping a good attitude about the switch to EHR throughout the practice, while challenging, will also help implementation go more smoothly, said Robert Lamont, CEO, Eye Center of Central PA, with 15 locations. Otherwise, bad attitudes from leaders at the practice can filter down to other employees, affecting their willingness to give the system a fair shot. Although EHR systems are helping some practices thrive, there still are a number of hurdles. There���s a lot of upfront work, Dr. Macsai said. J. Trevor Woodhams, M.D., Woodhams Eye Clinic, Atlanta, is finding his practice has had to reduce patient scheduling slots by 10-20% to accommodate the added work from the system. He has also had to buy newer and larger monitors and hire a full-time scribe to avoid a further reduction in productivity. Additionally, if you use a system that is not well suited for ophthalmology, you will end up creating more headaches for you and your practice, he said. Keeping a Pulse on Ophthalmology T his month���s survey attempts to quantify ophthalmologists��� adoption of EHR, use of off-label devices and drugs, and the FDA approval process in general. About 60% of ophthalmologists have transitioned to EHR. EHR is certainly penetrating more and more ophthalmology practices, and it is good to see that some ophthalmologists are experiencing ef���ciency gains. Nearly 52% of ophthalmologists use devices and drugs for off-label indications commonly. Only 4% of ophthalmologists never use drugs or devices for off-label indications. Clearly, ophthalmologists ���nd value in using medications and devices approved for other uses in their patient population. 84.7% of ophthalmologists felt the FDA approval process is too restrictive and should be changed. This shows a clear frustration with the tools available to treat patients and the various diseases we encounter on a daily basis. 88.9% of ophthalmologists felt that other countries have access to better technology than the U.S. I suspect that ophthalmologists feel limited when facing patients with various eye conditions and visual goals by not having tools that are readily accessible elsewhere in the world. John Berdahl, M.D., refractive editorial board member