the path to paperless
Adapting Workflow to an EMR
It helps if both you and the system are flexible.

When discussing EMR systems with a colleague, I was asked about customization capabilities of the various systems available. This is a somewhat tricky area, as I will explain in this month's article.

Some products that are currently on the market tout their ease of use and the fact that templates are not needed. This "one size fits all" approach may in fact be useful in certain specialties and practices. However, this format maximizes simplicity at the expense of providing a wide range of capabilities.

Such a product would be sufficient for providing electronic documentation of patient records, but would make it more difficult to take meaningful advantage of the data collected for clinical use (such as spotting a trend in IOPs). As we look ahead, this clinical information will soon prove to be invaluable in pay-for-performance verification.

The System Must Be Robust

Ophthalmology, by its nature, requires a more robust system that can not only document traditional SOAP-based notes, but also handle high-resolution imaging and drawing capabilities as well. A few years back, we met with an IT firm that was trying to develop an EMR system for ophthalmology and we agreed to work with them as a beta test site. We felt that if their system could work for ophthalmology, it would also work with any other specialty.

Unfortunately, their system was not quite ready for prime time and we found ourselves more and more involved in the basic programming. Our previous EPM vendor, a major player in the market, also did not have a satisfactory product for ophthalmology.

You Will Need to Modify

The flip side to the customization issue is, of course, the need to spend time modifying the EMR system. Most systems are ready to use "out of the box" after some necessary set up. But the real potential in these systems is the ability to change the way they operate to fit the needs and desires of a particular practice and physician. Still, some amount of modification will need to occur in the other direction: namely, adaptation of the practice workflow to the EMR system.

We found that the best way to accomplish this is to break down our workflow using mind-mapping software (Mindjet's MindManager). We had previously used this powerful software to plan various large projects including our recent EMR implementation and the construction of a new office.

The beauty of mind-mapping software is that it allows a group of people to visually think out loud. In this way we can "see" the entire workflow from the patient moving through the office (check-in to exam to check-out) down to the flow of the entire clinical examination (entrance exams to refraction to dilated examination). This has not only allowed us to modify the EMR system to fit our needs, but has also helped us to see where our workflow could be streamlined to improve efficiencies.

Next: Optical Dispensary Software

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 140 employees. He can be reached by e-mail at ppolack@ocalaeye.com.