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Should ophthalmologists jump on the EHR bandwagon now or wait until ophthalmic standards for EHRs are completed?
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Delaying EMR adoption will not hurt quality of care
 Steven Nissman |
I am asked all the time about my opinions on EMR. I choose not to use one in my private practice and am willing to accept Medicare’s reimbursement penalty, but I do have to use one when working in my university office setting. There are some advantages to EMR for ophthalmology and certainly lots of potential disadvantages. No one could say this is a one-sided argument. However, the notion of jumping on a bandwagon, especially one driven by government mandates and not necessarily sound medical and business analysis, is a slippery slope. My advice to colleagues is to look critically at these systems, see what they have to offer, and decide if it is a good fit for you and your practice. If the answer is no, then wait. Maybe when the ophthalmic standards are better defined, the time will be right for you. Let your decision be driven by the quality of the emerging systems and your own practice needs, not a carrot the government is dangling in front of you.
If you decide it is not right for you, as I have, I am confident we will all still be able to provide excellent care and enjoy career satisfaction just as ophthalmologists have for generations. Many of my colleagues have come to the same conclusion, that life will go on if you let the EMR bandwagon pass you by for now.
Steven Nissman, MD, practices at Nissman Eye Associates, Plymouth Meeting, Pa. Disclosure: Dr. Nissman has no relevant financial disclosures.
Practices can adopt now but must choose carefully
 Michael Chiang |
This depends on the individual practice. On one hand, computer technology has dramatically transformed virtually every modern industry. Nobody would expect a 21st century bank to manage money with handwritten accounting. From that perspective, it is surprising that so many ophthalmologists are still using paper-based charts. Studies have demonstrated that EHRs can improve patient safety and facilitate information exchange. EHRs also have potential to improve efficiency, manage administrative burdens associated with data submission to legal agencies and insurance payers, and support clinical research. For these reasons, the U.S. government is making an aggressive effort to stimulate EHR adoption through financial incentives. Several other countries have already achieved near-universal EHR adoption, and this is technologically feasible now. Ophthalmologists use measurement devices (eg, autorefractors) and imaging devices (eg, fundus cameras, visual field machines) on nearly every patient, and it is critical that these machines communicate seamlessly with EHRs and image management systems using vendor-neutral standards such as DICOM (Digital Imaging and Communications in Medicine). Fortunately, these standards already exist for most ophthalmic devices.
On the other hand, this must be done carefully, with strong commitment from physicians and staff. Selecting a system that is not matched for a practice’s needs or that requires cumbersome proprietary device interfaces, rather than adhering to standards such as DICOM, can result in worsened physician satisfaction and patient care. Implementing without proper consideration of office workflow can result in decreased productivity.
But motivated practices can jump on the bandwagon now, improve patient care and efficiency, and benefit from incentive payments for “meaningful use.”
Michael Chiang, MD, is professor of ophthalmology and medical informatics and clinical epidemiology at Casey Eye Institute at Oregon Health and Science University, Portland. He is also chairman of the American Academy of Ophthalmology’s Medical Information Technology Committee. Disclosure: Dr. Chiang has no relevant financial disclosures.