At Advanced Vision Center, our adoption of electronic health records (EHRs) began with a false start. We tried a system recommended by the hospital with which we share many patients. In addition to offering nothing specific to ophthalmology, the software assumed workflows that were very different from how our practice functions. Once we realized it was not a fit, we began investigating alternatives and chose a fully integrated EHR and practice management system designed specifically for ophthalmology.
Accommodating the Implementation
We went live with the practice management portion of the system 6 months before the EHR portion to ease the transition. For the latter, we closed the practice for 3 consecutive days. I recommend not skipping this step. We found the time to be critical for template creation and onsite instruction, including refresher sessions on the practice management portion.
After reopening the practice with all-electronic charting, we proceeded with a low patient volume for the first week, then gradually returned to our normal volume within about 2 months. This helped us avoid excessive waiting times for patients.
Fine-Tuning After Implementation
Even the best-planned templates can be improved. We found that certain types of data entry were easier than others and added more dropdown menus and text boxes.
Additionally, we reduced free-form data entry, which can lead to errors. During the first 6 months, we worked to perfect our templates, as we grew accustomed to the new EHR system and identified ways to streamline workflows. In retrospect, customization was largely about adjusting the system to the skill levels and work preferences of our staff.
Match the System to Your Practice
Selecting an EHR solution is like acquiring any other core technology. Get a system with all the capabilities your practice needs. More important, you should not have to change how you deliver care to accommodate the software. Rather, it should be possible to customize the EHR system to accommodate established workflows. The software should let you determine how to enter data.
Alignment with your type of practice can help; our system was recently upgraded to integrate with the American Academy of Ophthalmology IRIS (Intelligent Research in Sight) Registry. The IRIS Registry runs in the background on our system, so we can compare clinical data and benchmarks and report data to the Centers of Medicare & Medicaid Services' Physician Quality Reporting System to qualify for further incentives.
John Lyon, MD
•Advanced Vision Center, Laurel, Mississippi
•Financial disclosure: none acknowledged