Knowing how to use your EHR efficiently is more important than ever. As the population ages and the number of ophthalmologists remains stagnant, the demands on individual providers for both surgical and clinic services continue to grow. Even as ophthalmologists feel the need to see more patients, many choose to build an integrated care model that includes optometric services to meet all the vision care needs of their patients. A few hypothetical clinical scenarios will illustrate how effective use of EHR technology helps create the necessary efficiencies to manage ever-increasing demand.

SCENARIO 1: 68-YEAR-OLD MALE WHO NEEDS CATARACT SURGERY

The patient

Bill is a 68-year-old male who has been seeing his optometrist regularly for years. His trusted optometrist has advised him to investigate cataract surgery to help with his vision issues. Bill makes an appointment with the recommended ophthalmologist, Dr. Lopez, and the appropriate documentation is sent electronically.

When Bill arrives at the ophthalmology clinic, a technician calls him back and begins pre-test measurements prior to seeing the doctor. This is quick because the auto-refractor and lensometer are interfaced into the EHR. All the findings from these devices are automatically loaded into the EHR, avoiding the need for manual entry.

The exam

Once Bill is seated in the exam chair, his electronically imported medical history is confirmed and exam measurements are completed. Dr. Lopez is easily made aware that Bill is ready to see her while looking at her schedule on the EHR’s smartphone app. She can also review his chart, including the referral letter from the optometrist, before entering the exam room.

Dr. Lopez documents the exam by clicking a button on a mobile app that is linked to her EHR and dictates notes into her phone that will be transcribed by a remote scribe. This gives her support staff in the office more time to assist with the patient’s needs. An assistant finishes documenting the exam’s impression and plan while Dr. Lopez discusses her findings with the patient.

Post-exam

As the technician walks Bill to the surgery coordinator, Dr. Lopez dictates her correspondence letter back to his optometrist, again through her smartphone, using talk-to-text functionality. The letter is sent automatically through her EHR. Dr. Lopez sees her next patient and will sign-off on Bill’s chart later that day when the transcribed notes go into her Provider Approval Queue.

While Bill is with the surgery coordinator, he can look at lens options and sign the appropriate consent forms. He uses a digital pen that captures his signature through a camera and sends it to his chart when the pen is docked. The coordinator also schedules the surgery through the EHR, potentially avoiding multiple phone calls.

SCENARIO 2: A GLAUCOMA PATIENT

The patient

Dr. Lopez’s next appointment is with Raymond, a glaucoma patient who she has been monitoring for several years. Dr. Lopez views Ray’s optical coherence tomography (OCT) scans from inside his chart on a computer monitor. Also, she views Ray’s historical readings and findings before examining his eyes and deciding next steps in his care. His glaucoma history is accessible from an easy-to-read template. This is another time-saver, as clicking around in numerous fields to get information used to slow her down.

The exam

As she examines Ray, Dr. Lopez notices a slight change in his optic nerve. With her phone-to-slit lamp adapter, she takes a picture with a mobile app, annotates the change and sends the image to his chart immediately.

Post-exam

Since her scribe is assisting Ray, Dr. Lopez enters the impression and plan into his chart using a talk-to-text feature on a tablet. This allows her to remain facing her patient instead of turning her back to enter information in a computer.

SCENARIO 3: AFTER THE FACE-TO-FACE APPOINTMENTS

Telemedicine

Ray is Dr. Lopez’s last face-to-face encounter of the morning. Next, she sits in her office conducting telemedicine visits. One is with a patient who called in with redness in her eye and another is to review test results with a patient. With a HIPAA-compliant telehealth platform integrated with her EHR, her patients can schedule these appointments online and the needed information and documentation are in one place.

Around the practice

Dr. Lopez ends her morning by managing a few questions and refill requests that have come in through the patient portal.

Next, she attends a short staff meeting at lunchtime. Her office manager shares insights from her review of patient tracking reports generated from the EHR. It has been noted that patients are waiting longer than necessary for an OCT. After a discussion of this along with some bottlenecks in patient registration, several staff members volunteer to review these reports and come back with recommendations for improvement. The meeting ends, the paperwork is all caught up and Dr. Lopez still has 30 minutes left for lunch before the afternoon office hours begin.

GET THE MOST OUT OF YOUR PLATFORM

These vignettes convey much of what is needed to get the most out of your EHR platform. Staying up to date on your EHR’s capabilities is extremely important when it comes to efficiency. A simple configuration can speed up a workflow. Meaningful enhancements may be included in newer versions, and your EHR liaison can give you tips on how to maximize the utility of those upgrades. Understanding what is available from your EHR software and taking advantage of it gives you the opportunity to become more efficient, but you must be willing to adapt to workflow modifications to succeed.

A fully integrated care solution that brings together a patient portal, mobile capabilities, telehealth and interoperability with your external colleagues, with the EHR at its core, will improve your efficiency and financial performance, as well as enhance quality of care and service for your patients. OM

About the Author

Kristi Bolinger is director, specialty solutions at NextGen Healthcare, where she supports ophthalmologists and optometrists with implementing EHR software.