Transition to EHR a common goal for OD practices

Purchasing technology but focusing on staff

Thomas P. Kislan

Thomas P. Kislan, OD: We will spend many dollars this year converting to full electronic health records (EHR). We have spent much time researching the options available and after talking to colleagues have finally chosen OD Professional (EMRlogic Systems, Burnaby, B.C.) as our new practice management and EHR system. Our goal by the end of 2010 is to be totally paperless. This will streamline patient care and allow for more efficiency.

We purchased two new Cirrus HD-OCTs (Carl Zeiss Meditec, Dublin, Calif.) this past year and we may make some improvements in our physical plant such as furniture, chairs and stands.

We also are planning on adding a retina specialist in our second office and will be researching a new digital fluorescein angiogram to use when he is there.

We have also allocated dollars to staff training. Staff are a very valuable tool and could be argued more important than some technology. Our goal is to have all staff cross-trained in all aspects of office/patient procedures from optical to billing to refracting to scribing to teching to front desk. Having all staff able to participate in any part of patient care allows for efficiency and saves time and money, especially if someone is out sick.

For more information:

• Thomas P. Kislan, OD, is medical director of Hazleton Eye Specialists, Stroudsburg Eye Specialists and the Dry Eye Clinic of Northeast PA. He can be reached at 281 Airport Road, Hazle Twp., PA 18202; (570) 453-2020; fax: (570) 453-1020; e-mail: foreeyes@ptd.net. Dr. Kislan has no direct financial interest in the products he mentions, nor is he a paid consultant for any companies he mentions.

EMR, diagnostic, finishing lab

Carl H. Spear

Carl H. Spear, OD, FAAO: With seven optometrists, two ophthalmologists and five offices, the wish list for 2010 is extensive. We try to base our decisions on purchasing technologies that result in better patient care, new services or better patient perception and education.

Our list of priorities for 2010 is influenced by managed care, increased patient volumes and the need for efficiencies and delegation. Our top priority is to add either automated refracting lanes or an automated refracting station or a combination of both. With the integration into our electronic medical records (EMR) system and the automated charts, we feel this can allow us to delegate to staff and maximize doctor-patient encounter time.

One of the offices has a first-generation OCT, and they are looking at adding an RTVue (Optovue, Fremont, Calif.) with the anterior segment package. Another technology for that office will be the addition of a digital sign to replace the existing signage.

Our goal this year is to centralize our finishing lab, so the addition of a new-generation edger with capabilities to do drill mounts and transmit remotely from all locations is our second priority.

As far as low technology/high return, there will be some basic painting and office merchandising overhauls. We have always found that updating the office with new paint, new carpet and rearranging displays in the dispensary with updated merchandising gives patients and staff a feeling that things are progressing and changing.

Finally, we will invest in making sure that we are utilizing our existing technologies. We have committed to better utilization of the EyeMaginations (Towson, Md.) education software. Our number one focus is to utilize our Web pages, patient e-mails and social network sites to promote our offices and all the great technologies we have and plan on purchasing.

For more information:

• Carl H. Spear, OD, FAAO, is the managing partner of Panhandle Vision Group. He can be reached at 5101 N. Davis Highway, Pensacola, FL 32502; (850) 438-1277; fax: (850) 438-1278; e-mail: cspear@icareventures.net. Dr. Spear has no direct financial interest in the products he mentions. He is a speaker for Optovue.

Make a list of long-term purchase priorities

James L. Fanelli

James L. Fanelli, OD, FAAO: For those of us in private practice, the addition of technology in our offices is usually something that requires a good deal of forethought, both from a financial perspective as well as from a practice integration perspective.

Whether we are talking about computerization of the office and similar “infrastructure” items or technology to increase the ability to appropriately manage our patients, such as imaging systems, we need to look carefully at the costs associated with such purchases. Those costs include not only the hard costs associated with acquiring that instrumentation, but also costs associated with integration: staff training, perhaps additional staff hours or restructuring staff scheduling and, in the case of moving to EMR, the initial temporary decrease in productivity that is to be expected when moving from paper to EMR.

Certainly, in an ideal world, any equipment purchase will result in a positive return on investment. While that is usually the case with most ophthalmic equipment purchases, it is not necessarily always the case.

With declining reimbursements for procedures, some equipment purchases take a much longer time to reach that “break even” point than in years past. That being said, while a positive return on investment (ROI) is important, there will be some instances when ROI may take a back seat to improved patient care.

Keep in mind, technology in and of itself does not improve patient care – it is how that technology is employed. I firmly maintain that one can provide excellent patient care without all the “bells and whistles.”

Just take a look at glaucoma care. There was a time, not so long ago, that glaucoma care was rendered quite regularly – and quite competently I might add – without pachymeters and optic nerve imaging devices. Competent care always boils down to the practitioner.

However, can a practitioner provide competent care with no instrumentation? Of course not, but the addition of instrumentation should be considered in light of facilitating already existing excellent care. If you are purchasing instrumentation to help you provide excellent care, you may be looking at this from the wrong perspective. Rather, you should think of the instrumentation as a means of assisting you in providing that care.

If you need the assistance of a particular technology, for example, an optic nerve imaging device such as an HRT (Heidelberg Engineering, Vista, Calif.), then that technology should be considered while carefully evaluating the costs associated with implementing it, knowing that it may take a long time to reach that break-even point.

Being in private practice has its own set of challenges when considering technology purchases, which hits home in the form of paying for that technology. Everything brought into the office ultimately will be paid for by the practitioners who own the office. Do I want it? Can I pay for it? These are real questions that require close scrutiny.

In making the purchase, do the right thing. Will it facilitate the care already given, or will it make my practice look better? Will it be a tool and an asset that I can use clinically, or would it be nice just to have it? Would patients benefit from it more than my bottom line, or vice versa?

There are no hard and fast rules for equipment purchases. Financial considerations are important, and you certainly would not want to purchase technology that would significantly drain a practice.

I would suggest for young practitioners who are in the building phase of their practice to take it slow: buy what you need first and let the other technologies wait until you are better able to afford them. Prioritize the equipment purchases. Make a list of technology to bring into the office over the next 5- to 10-year period, with specific time goals. It is interesting to look at some of those lists several years after they were created. What sometimes seems to be an important wish list item may eventually be dropped from that list for a variety of reasons.

For more information:

• James L. Fanelli, OD, FAAO, can be reached at Fanelli Eye Associates, OD, PA, 5311 S. College Road, Wilmington NC 28412; (910) 452-7225; fax: (910) 452-7229; e-mail: faneleye@aol.com. Dr. Fanelli has no direct financial interest in the products he mentions, nor is he a paid consultant for any companies he mentions.