Q & A

Q: Why did you choose to implement an EMR system in your operating room but not in your regular clinic?

Dr. Chang: The OR is a little different from the clinic. It's an eye-only ASC with 15 different surgeons. All of the EMR records are basically checklists used by nurses and anesthesiologists, and the report is a standard OR report. The checklists are great because they're simple and they don't take much time. Everybody loves using them. I'm selective about what I print to bring to the operating room, but it's great to have all of the data there on the EMR system.

In the office, we have other documentation, such as referral letters and diagrams that I draw while sitting face-to-face with patients. Many colleagues told me that when you switch to an EMR system in the office, you either have to turn your back on the patient and type the whole time or have a scribe. For us, using an EMR in the office would be a huge step, but have EMR in the OR has been a nice compromise.

Q: Why did you choose Forum for your practice? Did you consider other options?

Dr. Chang: The most important thing to me is that we can link other machines with Forum—that was probably one of the main reasons we chose the system, along with the fact that we already use so many of the Zeiss instruments. We also evaluated and considered the Topcon data management system. One of the big differences is that with Forum, we could have a server and backup right in the office so we're not dependent on Internet connectivity. We like that.

Q: What's the set-up in your exam rooms? Do you use multiple screens?

Dr. Jacobs: Yes. My exam rooms have a small desk off to the side of the slit lamp, and I have dual monitors. I chose dual monitors to increase my ability to look at several different pieces of data at the same time. Even a 24-inch monitor has constraints, but with two monitors, I can see a great deal of detailed information without having to minimize and maximize windows. Given the inexpensive nature of monitors, it's a great, low-cost option.

Q: Dr. Stabel, you had an EMR system first. Why did you see the need for an image management system? What was missing?

Dr. Stabel: The imaging of my EMR system was good, but it wasn't excellent. It worked well bringing all of the information from auto-refractors and automatic phoropters into the EMR fields, but the image management for topography, OCT and visual fields was not as robust as I'd hoped. Using Forum allowed me to have the bidirectional interface that I'd wanted from the start, and that's been a very big improvement.

Additionally, I think Forum is a great way to start if you're not ready to jump into EMR. If you have the Forum image management as a starting point, I think it will help your practice greatly. You can then integrate it with an EMR system in the future.

Q: Would you say the cost of image management has been worth it in your practice?

Dr. Jacobs: The cost was well worth it. Just looking at it from a cataract surgery perspective, I've saved an enormous amount of time having all of that information at the beginning of my conversation with a patient. That's extra time that I can use to see more patients or do other work. The cost of Forum became insignificant in a very short time because it supports more patient visits or more time where I can be productive elsewhere.

Dr. Chang: It's hard for me to imagine walking into the exam room and getting into a conversation with a cataract patient without at least having keratometry. When it was just the IOLMaster and I could print one sheet, it was fine. But when I started using topography, I printed many full-color printouts that I often didn't use because some patients didn't need refractive services and possibly didn't even need cataract surgery. We're saving on printing and filing all of these printouts.

Q: Does Forum impact your interaction with patients?

Dr. Chang: It has been a very positive experience for them. First of all, patients like to see anything visual on the tests. They're curious. Second, it serves as a helpful teaching tool when you're talking about astigmatism and the patient is saying, “Why didn't anyone ever tell me about that?”

You can show them while you explain PK or toric IOL. A conversation might be, “The cornea here would be all one color if it were normal. You see this big yellow bowtie? That's your astigmatism. You can see that it's worse in the left eye than in the right.” Patients are very impressed when you click and they see all of these pictures and data for their cornea. They say, “That's my eye?” I use a 24-inch monitor, and I have my Eyemaginations LUMA there. I click back and forth, showing them, “Here is the retina, and this part is the macula.” Then I show them on the Cirrus printout.

We know how much goes into an eye exam and how incredibly precise all of our instruments are. We take it for granted. But patients sit through the tests for a few minutes and really have no idea what the device produces. I think the level of precision and analysis impresses patients.

Q: How do you use the combined Cirrus and HFA report on a routine basis?

Dr. Jacobs: The combined report is beneficial for a couple different reasons, particularly with regard to screening. I can evaluate the visual field and the RNFL at the same time, so it's easy to see if things look completely normal. Many times, only one or the other is abnormal, and this lets you stratify the risk for the individual patient. You may need to bring him back to repeat the test or follow him more closely. Looking at one point in time immediately gives you a sense of the urgency or lack thereof with respect to glaucoma.