Efficiency hinges on seamless integration

Laurie K. Brown

A robust ophthalmology practice uses various diagnostic measurement and imaging technologies. Integration of these devices with electronic medical records can enhance operational efficiency, according to one practice administrator.

One system, the GE Centricity platform, connects office departments and offers easy access to clinical data and patient files, Laurie K. Brown, COMT, COE, OCS, practice administrator at Drs. Fine, Hoffman, Packer & Sims in Eugene, Ore., said. The practice has used the Centricity system for almost 5 years.

“We’re fully functional and more efficient than we’ve ever been,” she said. “With the EMR itself, we’ve experienced … incredible efficiencies that we just want to build on. With enhanced and concurrent access to charts continuously, the great chart hunt is gone completely. Then, we have all of the electronic communication to pharmacies, patients and other providers that’s infinitely more efficient.”

However, Centricity lacks adequate interfacing with ophthalmic diagnostic and imaging equipment, Ms. Brown said.

“Interfaces are at the top of the list,” Ms. Brown said. “I think it will get there. It will be just an inherent part of the equipment and software in the future.”

Office organization, networking

Ms. Brown said the business office of the practice has nine personal computers. The 10 testing lanes and exam rooms have thin clients (server slaves) that act like PCs. The four physicians, clinic operations/refractive coordinator, technician supervisor, clinical research director and Ms. Brown work on PCs.

The PCs and thin clients are hard wired, not wireless, she said.

“For our practice, the way our building is built, [wireless] wasn’t stable enough. At the time, it was a very inexpensive few thousand dollars to just wire the place, so we did.”

The ability to sign forms electronically would be a big improvement in office operations, Ms. Brown said.

“This will help us greatly because we have all of our forms and consents in EMR right now,” she said. “We print out of EMR so they’re completely filled out, but we still have the patient signing a hard copy, and we’re scanning them back in. This is something that we’re looking into very seriously now.”

Interfaces and integration

The practice uses diagnostic and imaging devices that pre-date the EMR system, such as corneal topographers, wavefront analyzers, anterior and posterior segment optical coherence tomography, anterior segment cameras, lensometers and visual field analyzers.

“Those are all real mainstays of the anterior segment, cataract and glaucoma practice,” Ms. Brown said.

Currently, clinical data from diagnostic equipment can be saved to PDF files and stored in the EMR, eliminating the need to print on paper. However, more direct interface with less manual data entry would enhance efficiency, she said.

“We print paperlessly and import to EMR, but it’s not fully integrated and that is the ultimate goal,” Ms. Brown said.

Direct interface would also allow practice personnel to graph clinical results numerically from these external machines, which is a functionality that the practice is using more often with many types of clinical data, she said. – by Matt Hasson

• Laurie K. Brown, COMT, COE, OCS, can be reached at Drs. Fine, Hoffman, Packer & Sims, LLC, 1550 Oak St., Suite 5, Eugene, OR 96401; 541-687-2110; email: lkbrown@finemd.com.
• Disclosures: Ms. Brown has no direct financial disclosures. Mark Packer, MD, physician manager of Drs. Fine, Hoffman, Packer & Sims, participates in the GE Physician Champion Program.

Surgeons and practice managers in their 50s and older remember: Not all that long ago, systems integration was pen-based. Surgeons wrote down “patient doing fine” on a 3 × 5 card. Billing clerks registered patient payments on a ledger card and issued a receipt generated with carbon paper.

Twenty years on, we now have a growing constellation of ever-more-elegant, precise and labor-saving systems integration, to which each ophthalmologist is adapting with a greater or lesser degree of squirming. But 20 or 30 years from now, our current approaches will seem quaint. In that fast-approaching future, patients’ radio frequency chips will announce their arrival at the eye clinic. If they have not done so already from home, they will self-enter all of their particulars, and a history-taking engine with embedded logic will refine a list of obligatory tests. A patient, without the aid of a technician, will stroll to the appropriate stations where each of the needed exam elements are administered. At the end of the line, the doctor, who may be 10,000 miles away, will confirm or revise the machine-proposed diagnosis and treatment plan. Another office visit will be transited in 15 minutes flat — the first of hundreds seen that day by just one doctor. Aiding the disembodied provider will perhaps be a couple of low-level staffers to keep the NeoEye Clinic tidy.

This year’s first-year residents will retire 35 years hence from a career that is profoundly different from that enjoyed by today’s older surgeons. Their brave new world will disrupt both lay and professional labor markets and witness a seamless silicon interface between payer, patient and provider, between phoropter, photograph and pachymeter.

– John B. Pinto
OSN Practice Management Section Editor
Disclosure: Mr. Pinto has no relevant financial disclosures.