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In choosing an EMR system for an ophthalmology practice, a major factor to consider is the system's ability to handle high-resolution images.

At our practice we have a multi-sub specialty which includes glaucoma and retina, which require that electronic images are viewable from devices such as both digital fluorescein cameras and ocular coherence tomography, GDx and HRT.

Many EMR systems have viewing modules built-in. Some practices may want to consider a solution which has more robust capability, such as the ability to view multiple images at the same time, meanwhile scrolling through other reports, along with the ability to view images over a WAN between office locations.

I recently spoke with Steve Thomas, CRA of Florida Opthalmic Consultants, an independent imaging consultant for ophthalmologists. I asked him about the key factors that a practice needs to consider when selecting an imaging system. His responses:

1. Durability. This is based on the reputation of the manufacturer and the average amount of use. Can you get it fixed fast if it breaks? Who provides the technical support?

2. Expandability. After the system has been in use for a number of years, will you need additional computer resources to manage the increasing patient image information? How do you backup this information to protect loss?

3. Affordability. This is based on your patient volume - how many fluorescein angiograms (FA) and fundus photos (FP) are typically performed? Based on the revenue from this volume what does the system cost to run and maintain?

4. Licensing. Is the system licensed per practice, per doctor, or per user? If it is per user, does the system limit how many users can be logged on at any one time? Can you network the system into all your exam rooms without having to purchase additional licenses?

5. Interoperability. Is it a self-contained system? Will it dovetail easily with your existing EMR system? Or is the "digital" part from a third party manufacturer, complicating service issues when the system goes down?

6. Usability. Do you need to hire special staff to operate the equipment? If not, does the manufacturer provide extensive training to your existing staff? Is ease of use offset by a lack of capabilities?

7. Accessibility. Can you access the information from office to office if your practice grows requiring that need? How easily/quickly can you view these images across a wide-area network? Will you be able to do any "tele-medicine" with the equipment?

8. Resolution needs. What image resolution (for FA and FP systems) will be required to suit your practice needs? Don’t fall into the higher-res-is-better trap – a high-resolution image viewed on a lower-resolution monitor may lose critical fine details, such as micro-aneurysms, due to compression. It is important to match the resolution of the system to that of your monitors with the lowest resolution.

I have not discussed the more technical uses here, such as hardware or software interfaces between different devices and the image system. These are important considerations, but should only be a part of your overall needs analysis for an ophthalmic image style.

With the large upfront expense and all the time that is required to properly implement an Electronic Medical Record Software, do the pros outweigh the cons? We all want our investments to pay off, and while EMR may deliver better patient care and keep you more organized, it needs to be financially worth it. There are 4 key financial benefits that can come from an EMR implementation.

1) Improved productivity
2) Increased revenue
3) Avoidance of costs
4) Increased profit

Increased productivity

Organizations see improved productivity as a result of the many processes that become automated through the use of EMR technology. Tasks like pulling/filing paper charts become replaced by simply clicking a patients name in the EMR system. End-of-day reporting becomes much easier as reports can be generated directly from the EMR system. Lab and imaging results can be placed directly into the EMR, thereby making it easier for users to access. Integration with diagnostic devices enables users to input results/findings directly into the EMR, eliminating the need to manage the many types of forms used in today’s offices. Though it is clear that EMR can make our offices more productive; what we do with this new time doesn’t necessarily translate into financial benefit.

Increased revenue

EMR can increase our revenue by giving us the ability to offer new services to patients. Many EMR vendors offer features for patients to view their medical information, schedule/cancel appointments and complete forms ahead of time via the organization’s website. This can help attract new business and reduce the load on your staff. EMR also enables offices to reduce their physical storage space by drastically reducing the amount of paper used for each patient. This can translate into having more office space available for treatment, possibly providing room for an additional associate. Improved insurance re-imbursement as a result of better coding and billing procedures can also increase your revenue. Being in closer touch with patient’s treatment plans and filing documentation at the right time can help maximize our reimbursement.

Avoidance of costs

EMR can help us reduce the many expenses associated to paper charts, poor documentation and high malpractice premiums but also creates new expenses as a result of support contracts, computer maintenance and product updates. Reducing paper chart costs including purchasing stationary (folders, paper), copying, management (pulling/filling) and storage (office space, cabinets) is the clearest benefit of EMR. Transcription costs can also be reduced as EMR can provide us with an easier means for patient documentation and report writing. When we become busier we can avoid the cost of hiring new staff by becoming more efficient with the EMR system. We can avoid expensive medications by offering patients more cost effective alternatives. We can help keep our malpractice premiums lower as a result of higher quality documentation and drug prescription alerts. A long-term implementation plan and commitment to eliminate paper charts is crucial if cost avoidance benefits are to be realized.

Increased profit

In order for us to increase our profit we need to take into account all these possible benefits and compare them to the new costs that we will incur as a result an EMR implementation. Many benefits however are difficult to quantify as benefits like, improved care, patient satisfaction and office image are items that contribute to higher profits as a result of increased patient referrals and better patient retention.

An EMR consultant or EMR vendor can help you do a thorough analysis of your business to help determine what kind of financial benefits can be expected. This might include a cost-benefit analysis, ROI or return on investment, emr planning, emr implementation, etc.

One thing often forgotten in major projects such as an EMR implementation within a medical practice: the impact the change has on the staff. Do you think they're prepared for the significant change of moving from paper record-keeping to electronic? How much training will it take to get your employees using the system proficiently, and who needs to know what? The staff's perceptions and use of the system are key in the measure of overall effectiveness and success. It's important to put people first.

Most medical practices, and ophthalmologists in particular, have a majority of staff involved in data input using basic writing and typing skills. When converting your EPM to NextGen from Medical Manager, we went from a DOS keyboard-stroke data entry system to a mouse-driven, Windows-based menu. This may at first seem a minor difference, but it proved a somewhat stressful change for office staff who had enjoyed comfort with doing things in a specific way. After transitioning over to the new system files started disappearing mysteriously, and printouts were popping up at remote offices miles and miles away. It certainly took a bit of time to hone in on the system and how to use it properly.

When preparing our technical staff to implement the EMR module, we established a computer classroom for teaching computer basics. When transitioning over to our new EPM, we switched a few employees into the classroom at a time, there giving them a basic skill set assessment and a bit of training. There they had the chance to use their new skill set by calling up patients to verify their appointment time and information, then entering it into the database. This also helped to make the training time more valuable, as we were able to enter the data and confirm the upcoming schedule information.

When the training was completed, the staff person should have a basic understanding of Windows terminology, including: maximize, minimize, restore, task bar, start menu, tool bar. Because the EPM/EMR system doesn't exist in isolation, users should also understand basic computer skills including: media, drives, files, folders, defaults, paths, and logging out.

An EMR system has its own set of functions and terminology. Staff members will have to be able to tell the difference between images and active images, distinguish between templates, tell fields from data grids, and pop-ups and pick-lists. It's best when your employees have an interest and want to develop it. Some of the details of your staff members' aptitudes and experience can be determined in short assesment quizzes or interviews.

In addition, now is the time to put your security policy for computers and the EPM/EMR system into practice. What are the password requirements? With what frequency will they be updated? What security hardware will be used, if any? What are the consequences for violating policy? How long will an inactive computer remain idle before and automatic timed log-out? Who will maintain security policy? In this day of HIPAA regulations, maintaining EMR system security for patient data must be continually instilled into staff procedure for implementation.

This blog will provide you information about the software's which are used in the medical world