Experienced ODs recommend the move to paperless medical records

With the passage of the American Recovery and Reinvestment Act of 2009, the federal government is offering incentives to health care providers who implement electronic health record systems and will penalize Medicare providers who do not by 2015.

Practitioners who have already adopted the practice told Primary Care Optometry News that the technology is a boon to their businesses, both in terms of efficiency and better patient care.

“They’re the best things that have ever happened to my practice,” Kenneth A. Lebow, OD, FAAO, of Virginia Beach, Va., said. “I would never want to go back to a paper record.”

Incentives, penalties

On Feb. 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, a measure meant to stimulate the country’s sagging economy. The new law set the wheels in motion for the Department of Health and Human Services, its partner agencies and individual states to heavily promote the use of electronic health records (EHRs), including offering incentives for doing so.

Starting in 2011, practitioners will be able to receive Medicare incentives for the “meaningful use” of “certified” electronic health record systems. Officials are still working to define both under the Health Information Technology for Economic and Clinical Health Act, or the HITECH Act.

In addition to incentives, there will also be penalties for not adopting an electronic health record system. If practitioners do not have a certified EHR in place by 2015, they will lose valuable Medicare fees.

Choosing a government-certified vendor may affect a practitioner’s decision for practice software solutions.

“Choose a software solution that has a large user base and a company with deep pockets,” Kim Castleberry, OD, of Plano, Texas, advised. “Government certification is an expensive process, and only the strong companies will survive.”

Making a change

Though there are nearly always stumbling blocks to trying a new system, practitioners said going to electronically accessible records was relatively easy.

“The single biggest obstacle to incorporating any electronic medical record into a practice is change,” Dr. Lebow said. “Going from a written record to an electronic medical record means that you have to make a meaningful change in the way you do things.”

Dr. Lebow, who used a paper system for 30 years prior to going electronic, said he took his transition slow and steady over the course of about a month. But when he and his staff of nine became adjusted to the change, they did not look back.

“Early on, we had both handwritten and electronic records for the first patients we input into the computer,” he said. “It slowed us down. We quickly became acclimated to the computer and within a couple of days we stopped using handwritten records.”

Dr. Castleberry developed a list of potential problems with making the change:

• doctor’s lack of leadership and ownership of the process
• staff resistance to change
• staff inability to adapt to technology
• software that is not as intuitive as it should be
• purchasing technology that is not interfaceable to EHR

Image management software is still not where we need it to be in terms of interoperability, deploying images in native software and bi-directional communications with EHR to auto document interpretation and reports, eye conditions and treatment plans,” Dr. Castleberry said. “This technology is probably a year or two away.”

Practical benefits of EHR systems

Lorie Lippiatt, OD, who has a practice in Salem, Ohio, said one word sums up the biggest benefit to going paperless.

“It’s efficiency,” she said. “We’re no longer searching for patient records that are misfiled. I don’t have to refile information. Everything is managed at the point of entry. Now if we get a paper Explanation of Benefits from an insurance company, we simply scan it in once and then attach it to the necessary patient record electronically, whereas before we would have to make a copy of it, black out all the other names, find the chart and put it in the chart.

“Appointment scheduling is also more efficient,” she continued. “We used to do it with an appointment book. Our office is 7,000 square feet, so if you’re in the area of the office where the appointment book was not, you had to put the person on hold, go to a phone by the appointment book and schedule that appointment. Now, all the appointments can be made from any one of our many workstations.”

Integrating diagnostic technology

Dr. Lebow uses an Atlas corneal topographer (Carl Zeiss Meditec, Dublin, Calif.), Optomap (Optos, Marlborough, Mass.), Humphrey visual field, frequency doubling testing, GDx (Carl Zeiss Meditec) and a digital retinal camera in his 22-computer practice.

“Not all of them are integratable; that’s a little challenging,” he said. “Some systems integrate directly into [the EHR]. Others you have workaround applications for. In the future there will be more time and money devoted to integrating all of these into one system.”

For Dr. Castleberry, the system he uses has direct interfaces for most of his equipment.

“We use a client server Windows network with 50+ workstations and servers,” he said. “We have Optomap, 3D Wave (Marco, Jacksonville, Fla.) and motorized refractors, Marco automated lensmeters, Zeiss visual field, OCT Cirrus (Carl Zeiss Meditec), Konan specular microscopy, Zeiss Visante OCT, A-scan and B-scan,” he said. “The system I use has direct interfaces for most of the equipment. Non-interfaced equipment can be accessed through the Windows network and review software or remote viewing software. A few legacy instruments are simply scanned and linked into eDocuments where they can be accessed in the EHR/practice management system.”

Work with an IT expert

The practitioners interviewed agreed that a “do-it-yourself” approach is not recommended.

“We’re optometrists, not IT specialists,” Dr. Lippiatt said. “A lot of people get into trouble because they’re trying to put a system together that’s outside their level of expertise.”

She said practitioners need not fear being able to get help.

“A lot of my colleagues are in small towns and they don’t have experienced people who know how to handle this stuff, but there are solutions, and the solution doesn’t necessarily have to be in your hometown,” Dr. Lippiatt said. “Interestingly, our system got too large for our local computer center to handle, so our IT person lives in Alabama. He handles everything remotely. He can log into our system, manage our connections, manage our wireless router, all of that remotely from Alabama.”

Dr. Lebow said an IT person is needed for both computer and equipment upgrades, as well as networking and software issues.

“Where practitioners need to upgrade equipment periodically, they’re also going to need to upgrade computer technology periodically,” he said. “You really need to have someone who is familiar with networking and software and integrating these applications or you have to retain an IT specialist.”

Patient reaction

Dr. Lebow said patients have given their approval of both electronic health records and the networking in his office.

“Patients in the exam room are very impressed with the electronic medical records,” he said. “We have large wall-mounted high-resolution monitors in each of the exam rooms, and the patient and I look at a summary of the different images associated with their examination and review them together. It’s a delight to be able to pull up a picture right there instead of having to run somewhere else to pull up a picture and explain it.”

For more information:

• Kenneth A. Lebow, OD, FAAO, may be reached at 345 Edwin Dr., Virginia Beach, VA 23462; (757) 497-5555; fax: (757) 499-2636.
• Kim Castleberry, OD, can be reached at 5900 Coit Road, Plano, TX 75023; kim.castleberry@gte.net.
• Lorie Lippiatt, OD, can be reached at the Salem Eyecare Center, 616 East State Street, Salem, OH 44460; (330) 332-2080; llleyedoc@aol.com.

Reference:

• For a copy of the full American Recovery and Reinvestment Act of 2009 (Recovery Act), go to: www.hhs.gov/recovery/overview/index.html