By Ian Lane, OD
Integrating your electronic health record system with other pieces of software within your office aids workflow and improves patient care.
Electronic health records give doctors and their staffs the advantage of accessing patient histories at the touch of a couple buttons, but the technology has even greater potential if you integrate it with other pieces of software in your office such as the software that operates your instrumentation. That way, at the end of each appointment, you know the photos you took of the patient’s eyes will automatically be transported into the patient’s medical record while other information such as insurance provider and preferred appointment times and products will be available in the same file, thanks to integration with your practice management system.
Tools to Aid Your Transition to EHR:
Introducing XNetwork
AOAExcel, a wholly owned subsidiary of the American Optometric Association, is leading the way in patient care with a new innovative Health Information Exchange and Practice Support Network, available in March 2013.
XNetwork is a powerful selection of cloud-based healthcare applications intended to drive doctor productivity, improve patient care and connect doctors to the broader healthcare community. The portal, powered by AT&T Healthcare Community Online, has many benefits and features:
Benefits
• Vendor-neutral experience, giving doctors and administrators a high level of flexibility in selecting applications.
• Value-add services on top of traditional health information exchange functions.
• Streamlined workflow and quicker access to relevant patient data.
• Supports meaningful use by enabling the exchange of patient records and user authentication to certain pre-integrated certified applications.
Features
• Cross-system presentation of patient records, including medications, alerts, clinical documents, lab results, clinical statistics, problems, procedures and images.
• Rich integration with practice management systems (PMS) for patient demographics and appointment schedule.
• Customer administration and control of user access, privileges, content and presentation of clinical information.
• Pre-integration, including single sign-on (SSO) access to a catalog of best-of-breed health IT.
For more information, visit www.excelod.com/toolkit.
Integrate Other Software with EHR
Having your EHR vendor connect your other pieces of software, such as your practice management system and instrumentation software, means avoiding duplication of efforts. One of the most inefficient areas within optometric practices today is duplication of effort. Example; do an Auto-Lensometry, Autorefraction, Auto Keratometry and an NCT for IOP and then having to key all the results into an EHR. (Number of clicks can be at least 14 per eye (28 OU) per test on the refraction side alone. About 90 clicks per patient for routine pre-testing alone (multiply the number of clicks by the average number of patients per day…. say 10 conservatively = 900 unnecessary clicks per day. Add this to a few screening image tests like visual fields or posterior segment imagery where even summary data would have to be entered, and this can add an equal number of clicks to refraction.
In addition, if there is no instrument integration, this means that there will be multiple filing systems in addition to the EHR. This can cause a great deal of inefficiency and confusion in an office.
What Needs to Integrate with Your EHR?
Every ancillary software in your office needs to integrate with your EHR and PMS. If not, each piece of software not integrated becomes a bottleneck in the workflow. Everything not integrated needs a separate filing system. For example: An optician would have to re-key a patient’s spectacle prescriptions into the PMS System from the EHR System.
Do a Work Flow Analysis to Determine Needed Integration
Each office should do a thorough workflow analysis of every step in their current legacy paper-based process and match it against the candidate EHR systems being contemplated by the practice. This should include an analysis of each sub-process to assure that it is both effective and efficient. According to management expert Peter Drucker: “Efficiency is doing things right; effectiveness is doing the right things.” Often, because we have been doing something in the practice for a long time we become more efficient at it over time. But what if we become efficient at doing the wrong thing? So what is really needed is a complete review of everything that we do to make sure it is effective. If converting from an outdated PMS or EHR system, the same workflow analysis applies.
How Do I Get the Integration Done?
Most EHR companies have the ability to work on a doctor’s system remotely by logging into the practice system to perform the instrument integration setup. The office will need to have an installer who is familiar with the instrument being linked in the event that settings on the instrument have changed. In many instances the instrument company will have integration directions in a manual or directions which can be downloaded from their web site. Some instruments are more difficult to link than others and will necessitate coordination between the EHR and PMS and instrument companies.
How Much Does it Cost to Integrate?
Modern cloud-based EHR systems use what is know as a SAAS (Software as a Service) systems which require regular monthly payments that cover the use of the software as well as support and software updates. Legacy systems (those housed on a piece of software in your office rather than in the “cloud” online) generally require a large upfront payment for the system and then have an annual support, update and maintenance agreement, and instrument integration may be included. Another cost model is that there is an itemized menu and the practice pays per instrument that needs to be integrated and the annual support fees are calculated based on the initial cost of the integration.
Modest Cost to Integrate; More Expensive Not to Integrate
There is usually some modest cost to link the instruments and maintain that linking over time. “Modest” means integrating the system with your other pieces of software might increase the cost of the EHR between 3 percent and 5 percent. But compared to the cost of manually maintaining all these diagnostic technologies, keeping and maintaining separate filing systems, as well, and the staff time it takes to retrieve images from their respective silos, it costs a lot more NOT to integrate.
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Ian Lane, OD, is an experienced health information technology executive, accomplished lecturer and writer, with almost 30 years of extensive ophthalmic and global experience. As AOAExcel’s chief medical Information officer, he directs and overseas the development of next generation HIT, connectivity and interoperability platforms.
