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A better practice means a better physician
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There are many factors that go into being a great physician and surgeon; experience, knowledge and bedside manner are perhaps at the top of the list. I practice with two other comprehensive ophthalmologists in a single-location practice that sees between 2,000 and 2,100 patients per month and performs more than 30 cataract surgeries per week. In my experience, I would add a complete electronic health record system to the list of items that help me be a better physician.
Communication
Effective health care is a team effort, and a good EHR system facilitates communication between various members of the team. This starts with the patients. With our EHR system, we were able to implement Web registration, which means our patients can fill out multiple pages of demographic information and medical history from the comfort of their homes before they even arrive at the office. Once in the office, all of this information is directly imported into their electronic charts, which can be viewed from any of the workstations in the clinic. One of the great features of our EHR system is that alerts can be automatically customized based on a patient’s diagnosis. For example, patients with diabetes, cataracts or glaucoma are automatically tagged to be contacted in the appropriate amount of time for a follow-up visit. This prevents critical patients from falling through the cracks.
The lines of communication are also improved with other medical players on the team. We have preset letters for consultations and also for postoperative cataract surgery. In other words, if an optometrist sends us a patient to have surgery, we have preset letters that are automatically created from the software that will be sent to the optometrist after the initial evaluation and as their patient returns. Similarly, if we are referring a patient for evaluation to a retina doctor or some other subspecialist in ophthalmology, we have preset consultation letters that will take the data from their last exam and create a letter with pertinent information that goes out to the referral physician. These are relatively simple tasks that can be time-consuming and costly without the appropriate EHR system.
Accuracy
Our EHR program has also helped me be a better surgeon in that it helps me to be very exact. We have set up our EHR with a pre-surgical evaluation on one specific tab. All surgical patients come in for a preoperative evaluation that includes all testing required for surgery. A checklist was created in this preoperative tab to make sure all of the measurements are taken and the necessary values are entered. We use that to determine which lens implant to use, as well as whether to consider using a specialty implant such as a toric or multifocal IOL. We use the Compulink Ophthalmology Advantage system and were able to customize a tab to have everything we needed in one place. By avoiding the need to click around to multiple areas within the EHR system, we have assured we are not missing any valuable preoperative measurements.
In addition, all of the data from the pre-surgical evaluation is printed out on a single sheet of paper that actually goes into the operating room with each patient. This information sheet has the patient’s name, date of birth, lens implant choices and any other vital information we may need about the patient while in surgery.
This is in contrast to the common system today of transcribing case information onto a white board in the operating room. In my operating room we are able to skip the step of a nurse or technician, who may not be familiar with the case, transcribing patient data. This information has been triple-checked by my office staff, and the single sheet of patient information can hang directly on the wall to make sure we have everything exactly as it should be and that our time-outs are performed directly from this sheet.
Efficiency
Having a good EHR system has also allowed me to be a much more efficient physician. One of the things we have done in our office is to customize our software so we have all of the information we need, and only the information that we need, at our fingertips. Every office performs certain functions in conjunction with others. By grouping those same functions together on the tabs in your EHR system, you spend less time clicking around pages to find what you need. This allows you to both direct more of your attention to the patient and shorten the duration of patient visits.
On a monthly basis we ask all of our technicians to make lists of things they wish were different or annoying things that happen when they are using the EHR system. I then go through each one of our tabs to see what we can do to make things more efficient. Most of the time this means moving a data field from one tab to another — a simple step that makes a big difference in work flow. The goal is always to spend less time clicking through screens searching for what you need and more time focusing on the patient. The ability to customize our software has helped us enormously in this regard.
Patients always have a positive reaction to technological advancements. All of our monitors are on swing-arms, and on each computer we have an integrated educational program so we can easily turn our monitor toward a patient to show a video or other educational material when needed. This way, while patients are waiting, they may watch instructional videos or get information about any conditions they may have. It is a really nice thing for the practice and for the patients when they see that your practice is more technologically advanced.
In short, all of the advantages of a good EHR system allow me to pay attention to details in a way that is difficult to do without help. Good communication with patients and the medical team, accuracy in data obtained and passed along, efficiency in interactions, and good educational tools all help to provide the best medical care to a patient. We have had our system for more than 6 years now, and we are definitely not only seeing more patients than we were when we started but also seeing them more efficiently and providing them with better care.
James E. Silone Jr., DO, is in private practice in Newark, Ohio, and is also an associate clinical professor in the Department of Ophthalmology at Ohio State University. He can be reached at 740-522-8555; email: silone@centerforsight.com.