It’s been almost 11 months since I started my own practice. Though the practice of ophthalmology has always been familiar to me, the business side was a completely different language.
I remember receiving keys to my office from the landlord who told me where to put my occupancy license. My response: “What’s an occupancy license?”
Fortunately, most practice startup issues only need to be set up once and renewals are pretty automated. Making sure your infrastructure is sound is the most important step. Whether its staff, equipment, or marketing, you need to spend time deciding what is most important, as your budget will not allow you to start out having it all. Through this series I will discuss different aspects of practice startup, and what I chose (or didn’t choose) to maximize efficiency. For this article I’ll focus on EHR and my choice: Electronic Medical Assistant (EMA Ophthalmology) by Modernizing Medicine.
Choosing an EMR is one of the most important steps in setting up a practice, if not the most important. A bad EMR can decimate a practice, slowing productivity by as much as 75%. A good EMR, however, can provide many benefits to your practice.
In my opinion, any EMR you purchase should be cloud based. With client-server based EMR, you will spend much more money up front: new computer purchases, electrical upgrades, etc. Furthermore, you will likely have to upgrade your system multiple times – each time running the risk of system crash. If a virus gets into your system, your entire practice is demolished.
Cloud based systems can be accessed anywhere, so if you decide to expand to a satellite office you do not need to buy a second system. Furthermore, upgrades are done automatically, seamlessly and typically without charge. I love that when a patient calls me over the weekend I can access all of their records instantly from my iPhone. Most cloud based systems do charge a monthly service fee as opposed to the one time fee of many client server based programs, but it is foolish to think that client-server based systems will save you money. Just ask yourself one question: how long have I ever kept a version of windows of Microsoft office that I “one time bought” once the new version was released?
In the world of cloud-based EMRs there are only a few big players. Modernizing Medicine, a relative newcomer to ophthalmology, started in dermatology and quickly became one of the most used products in the field. They followed the same formula in ophthalmology, recruiting ophthalmologists to build the system from the ground up. The result: an intuitive iPad based format that allows complete eye exams to be drawn up rapidly.
It is worth mentioning the iPad interface a little further, because this was one of the deciding factors that led me to choose this EMR system. Using an iPad in the clinic has many benefits: 1) less space is needed (who needs desks when you don’t need computers?) 2) patients can sign all consent forms right on the screen 3) equipment costs are very low, 4) I can face my patients while documenting an exam and 5) patients love the technology.
A simple “upgrade” I put into my practice was wall mounting flat screen TVs in my exam rooms. Connected to an Apple TV (approximately $90), I am now able to select “Airplay” on my iPad to mirror any testing I want onto the big screen. Whether it’s a slit lamp photo or OCTs, patients are amazed by the “high tech” aspects and feel they are in a next-generation practice.
Of course, EMR has to make your practice efficient, and that is certainly the case for me. While nothing will be faster than a paper note, once I’ve completed an exam in my EMR (anywhere from one to two minutes), everything is complete. By everything I mean patient counseling handouts, prescriptions (which have been sent to the patient’s pharmacy of choice), consult letters to referring physicians, and billing.
In addition, the records are kept in a professional legible format, which is easy for me to access at any time, anywhere. When starting my practice I chose Modernizing Medicine’s EMA Ophthalmology for my EMR, and have been very happy with that decision.