Medical record keeping, amongst all specialties, has shifted almost primarily to electronic. The question is: which system to choose. Below are some considerations and a brief characteristic report on some of the
EMR systems available specifically to ophthalmology practices.
First lets discuss web based EMRs versus client server model EMRs, some liken to leasing versus purchasing a vehicle. Web based EMRs should be accessible from any computer connected to the web and function through Internet explorer. These systems should meet HIPAA requirements and be available throughout the workday.
Take some caution: if the system is operating via a remote connection, your office computer must have the required software (citrix or PCAnywhere). Your local computer must also have the same software, presenting a potential problem in a hospital based setting where administrative privileges to install any software may be limited.
With an application service provider (ASP) web based EMR, the data belongs to the web service, not you, so you are not free to use your data when and however you wish, but rather, they have control. They can also update their system whenever they want, without consent, potentially affecting hundreds of users who may not be prepared for such a change. Other disadvantages include inability to access your data if you encounter internet connectivity problems, performance issues during peak times of the day, potentially slow downloads, and monthly internet fees, although start up costs are lower. These systems do include fewer hardware requirements.
Locally hosted or Hybrid option EMRs are the newest option. With this system, you have the software and the data in your possession. Nothing actually goes over the web. When outside the office, you can connect via the Internet securely to your office server. You do have to buy your own server, but you will avoid problems with Internet crashes, as your software will be running locally.
Client Server EMR systems are associated with increased speed and system performances. You will not have to worry about Internet connectivity. Your practice will own the software and licenses and you host the system in your office on your own servers. The cost is higher at the beginning due to increased hardware requirements, installation costs and software licenses. Over time, the cost may be less than leasing ASP licenses.
For more details on how to choose an electronic medical record system in general, refer to my article from November 2010 "Shopping for Electronic Medical Records".
Once you choose which direction to go, as an ophthalmologist, it will be wise to choose a subspecialty-specific EMR system. Below are listed several ophthalmology-specific EMR systems.
EyeMD EMR was designed in direct collaboration with a practicing ophthalmologist. Advantages of this system include coding assistance that automatically suggests the appropriate level eye exam, E&M codes, ICD-9, diagnostic tests, etc. based on the data collected during the exam. There is a built in FAX, flagging of unread or unsigned charts, order follow up, Workflow Manager, Letter Engine for creation of templates, interfaces for Practice Management software, patient flow management and lab interfaces.
OmniMD ophthalmology EMR contains clinically defined templates for common ophthalmology complaints, history of present illness and review of systems. It also contains specific ICD-9 and CPT codes for accurate charging.
Keymedical Software offers an EMR for ophthalmologists called KeyChart that lets you draw on eye templates in color, allows incorporation of clinical data and images from automated equipment such as visual fields, autorefractors, lensometers, fundus cameras and retina scans. This company has trainers that will help customize your EMR program to best fit your practice. KeyChart also allows use of e-prescribing for electronic prescriptions and evaluation of your patients’ drugs that other physicians have prescribed. You will also earn your 2% bonus from Medicare. KeyChart gives the physician access to a patient’s chart through a virtual private network from a remote satellite office, home, the hospital, etc.
CureMD offers ophthalmology EMR that has built-in templates specifically for eye doctors of all the subspecialties. This system integrates with ophthalmology diagnostic systems and adds digital images and results directly to the patients’ records. This system integrates financial information throughout the patient encounter and is embedded with all the current ICD-9 and CPT codes, allowing ophthalmologists to capture, submit and track charges electronically.
EMRexperts offers an ophthalmology specific EMR system includes custom templates for history of present illness, complaints, review of systems, medication prescribing, immunization tracking and CPT coding. The software also incorporates an electronic superbill and E&M coder that has been customized for the ophthalmologist.
EyeTeknix EMR is another innovative system that helps eye care physicians document patient visits quickly and thoroughly at the same time as optimizing claims coding by ensuring compliance with Medicare and private insurance rules. The eyeTeknix EMR is designed to be used with touch screen computers and tablet PCs.
MDS Medical has an ophthalmology EMR with over 45 exam templates, including retinal laser procedures, referral letters, return to work/school notes, consent forms, orders, patient educations, etc.
And finally there is Ifa Systems, a program that I previously discussed in November that has been dedicated only to ophthalmology for the past 20 years. As an update, Ifa Systems has attained ISO-certification for internal quality management. They also incorporated SmartScreen technology based on a terminal server concept with an iPad verson, potentially taking the place of laptops for viewing test results and for coordinating clinical pathways of patients. Ifa systems long term partner, e-mediad, Inc. developed the Eye Care Patient Portal (ECPP), a web-based tool that helps eye care professionals keep up with the new regulations and new funding opportunities. Within their system are subspecialty versions, including glaucoma, retina, ophthalmic surgery and general ophthalmology for tailor made EMR.
There are many more systems out there. Bottom line is to choose wisely, and in that decision a hands-on demo is recommended, as choosing an EMR system can alter your practice financially, emotionally, and clinically.