Focus Eye Centre is a group ophthalmology practice with an in-house ambulatory surgery center and refractive laser suite. Our center also has a satellite clinic in another suburb several kilometers away. Since the practice was established in 1980, it has grown and evolved with constant improvements in facilities and technology.
We worked with a practice management computer system for many years for patient appointments and billing. About 5 years ago, we reviewed a practice management system (Houston VIP) that offered electronic health record (EHR) capability. We decided to adopt that system in a phased manner.
The first phase was to transfer our large database of patient identification and financial records to the new system. We kept the old system alive until we were confident in using the new system for billing and appointments. After some months, we upgraded our computer network with a more powerful server and terminals in all clinic rooms. Our diagnostic and imaging devices were interfaced to the new system.
The system was adequately tested by creating some EHRs while still maintaining manual records. We then set a date for committing fully to EHR use by all clinical staff—that was 3 years ago. We have been happy with this process and would never go back to manual records.
We have seen major benefits from the implementation of EHRs, as detailed below.
Time. The elimination of manual file management—which included drawing files for each clinic, finding misplaced files, taking bundles of files away for dictation, periodic culling and archiving of idle files, and retrieving files from archival storage—saved many hours of tedious work.
Space. The banks of filing cabinets and secondary storage space were no longer needed, which permitted a redesign of our reception and administrative areas (Figure 1).
Access. We obtained vastly improved access to patient records from anywhere via laptop or tablet.
Reputation. EHR use provided the practice with a more impressive, modern style of patient consulting.
Cost. Going digital reduced the need for printers and costly cartridges and toner.
We have, however, encountered some challenges since implementing the EHR system, and these are described below.
Outgrowing the server. We outgrew our in-house server after 2 years. The solution was to get a higher-capacity unit. We also decided to locate the server offsite in the data bureau of our information technology service provider with fiber optic linkage to our main location and our satellite center. The offsite arrangement is better for backup and computer maintenance processes.
Handling delays. The computer terminal response can sometimes be sluggish, and upgrading of our data transmission capacity may become necessary at some point.
Coping with system outages. The system goes down at times, for various reasons. I had dreaded this possibility when we first considered EHRs, but the reality is not so bad. Usually outages are brief, and handwritten notes can be kept and entered later.
EXPECTATIONS VERSUS REALITY
I have discussed our experience with many interested colleagues, and a number of them have expressed concerns. In many cases, I have been able to address these colleagues’ concerns based on our own experience.
Some doctors in group practice do not want to change from manual records. However, I do not think that a hybrid system using both manual records and EHRs makes sense. All doctors must commit to using the EHR system. It is important to explain that this is not just about the individual physician; it is about the function of the center as a whole.
I myself hesitated for quite some time before moving to EHRs. I was uncertain about the capacity and speed of our network. I always liked to incorporate drawings into my notes. However, drawings quickly gave way to cryptic descriptions and images from our diagnostic devices. It is possible to include drawings in the system, but this has not proved important in our center.
Some physicians fear that entering data at a terminal during patient consultations will detract from relating to the patient. In actuality, I find the quality of the consultation is enhanced. I position my screen so that the patient can easily see it, and I can then display and discuss images with them (Figure 2). We have many long-term glaucoma patients, and discussing serial fields and OCT scans with them at the screen provides better patient interaction than looking at printouts spread across my desk.
Concerns about security and privacy of data have been expressed. The security of a modern data bureau is high, and backup provisions are thorough. I think the level of security is far superior to paper files stored on shelves or in cabinets. We increasingly rely on systems of this nature in our working and private lives.
Information technology is a powerful tool that is helping us to contain costs and to perform better. We are pursuing the goal of a paperless center further by integrating credit card transactions and our accounting system into our practice management system. We are using software systems for multiple functions, including payroll, staff rostering, and supplier invoice capture, to name a few.
These developments, alongside the exciting advanced technology of modern ophthalmology, have helped to keep the flame burning for me through my many years of practice. n
Richard Smith, MBBS, BSc, DO, FRCS, FRACS, FRANZCO
• Director, Focus Eye Centre, Sydney, Australia
• Financial disclosure: Director (surgicalpartners.com.au, a company that provides consulting services on medical practice software integration)