Improving Workflow in an Existing EMR System

An image management system reduces data entry errors, improves office efficiency and delivers the fast, customized image views you want.

By John E. Stabel, MD

Where do you want to go with your practice? There are always obstacles that keep us from reaching the goals that we set for ourselves, but I think that EMRs, Forum and other types of electronic workflow systems will help us accomplish our goals. I've been using an EMR system since I started my practice back in 2002. It has many advantages and using Forum has enhanced my EMR system's quality and speed.

EMR Advantages and Limitations

EMR systems have some obvious and some not-so-obvious advantages. In the 8 years that I've used the system in my office, I've found that it provides more complete documentation than paper files. The EMR system also improves back-end efficiency, meaning we don't have to search through or file charts. Always having the information available is efficient and convenient. However, while the back-end efficiency is very good, I haven't really found that EMR systems fulfill their claim to save me time in the exam room. That's important to consider because it's billed as a key selling point.

As you search for an EMR system, keep in mind that they're not created equal. A few years ago, I hired a new technician who had worked at another ophthalmologist's office with an EMR system. One of the first things she asked was, “Where's the chart?” I said, “What do you mean, where's the chart? We have an EMR. What are you looking for?” And she said, “Where do you keep all of your images—the copies of the OCT scans and visual fields and those types of things? Where I worked before, we had a little folder that we carried around.”

To me, that defeats the purpose of having an EMR system. If you have EMRs for charting information, but you keep images in folders with paper charts, you've lost the efficiency that a good EMR system offers. In that situation, incorporating Forum would be an incredible benefit to the practice. It adds image management to an EMR system that doesn't have that capability.

Adding Image Management

I started with an EMR that has image management capability, but the addition of Forum helped improve the system. The key to understanding how a separate image management system improves an EMR system lies in looking at the three different types of interfaces that EMR systems offer.

Manual scanning or importing: This type of interface involves manually scanning paper documents or manually importing digital documents, such as PDFs, into the EMR file and choosing where you want them to be stored or sent. I think most EMRs will continue to offer this option, because at least for the next few years, doctors who are not using EMRs will be transitioning their documents. In addition, doctors with EMRs will need to import documents from other, paper-based practices.

Unidirectional transfer: Before I purchased Forum, most of my device interfaces worked with my EMR with what I refer to as a “unidirectional transfer.” For example, if a patient needs a visual field test, the technician goes into the visual field device, types in the patient's name, performs the visual field test and then hits “print.” That demographic information and the clinical data are then transferred into the patient's EMR, which is open at the adjacent workstation. The technician repeats this process with other diagnostic devices. There's no printing and scanning, but it's limited to one-way data transfer to the chart, which means it also relies on the technicians' redundant data entry.

Bidirectional interface: A bidirectional interface takes the EMR to the next level, in which the EMR software sends data to your devices, and the devices send information back to your software. This is what Forum brought to my EMR. When I incorporated it into my practice, it really helped improve my workflow.

The problem with unidirectional transfer was that technicians duplicated data entry, increasing the chances of error. Now, with EMR and Forum combined, a patient enters the office and checks in. His information is entered at the front desk, and when he needs to undergo tests—visual fields, OCT or others—his information goes from the EMR to the device. Technicians don't have to retype it into each machine. The test results are then sent to Forum and accessed with the EMR.

So, while I've always had all of the patient information available in the EMR, now I don't have the possibility that a patient was entered twice on a piece of equipment, or that the data won't match a patient's EMR chart because someone made a transcription error. Once I purchased Forum and we were integrating the system into our workflow, it was quite enlightening to find out how many times in the past we had duplicated entries, duplicated patients or made typographical errors. The bidirectional FORUM interface has virtually eliminated that problem.

Indispensible Adjunct

Although I already had an EMR system, Forum helped to improve my image management capabilities. Not only has its bidirectional interface saved time and prevented entry and duplication errors, it also has improved the accuracy with which patient information is transferred among devices in my office. In addition, it has enabled me to view images in a way that I couldn't with EMR alone. The more robust image interface allows me to customize the screens so I can view images from different devices onscreen together in the most productive way.

What's more, Forum preserves raw data storage on servers, so I can set it to generate custom reports that further enhance our workflow.

Whether you're already using an EMR system or thinking of implementing a system soon, a robust image management system like Forum will help you improve your electronic workflow, too.