By Kathleen M. Andersen, OD
Increase staff efficiency with mobile devices to quickly access electronic medical records from the cloud.
EQUIP staff with mobile devices like iPads to access EHR quickly.
INTEGRATE EHR into patient flow.
FINE-TUNE what works best.
The potential beauty of electronic health records that are “in the cloud,” meaning accessed online rather than through your local hard drive, is that they can be accessed anytime, anywhere–including on mobile devices. In my practice, we take advantage of the flexibility of our system, Eyefinity EHR, to access and update our EHR on iPads. This has allowed us greater efficiency in our patient flow.
Equip Employees with iPads
I have an iPad for every employee in the office, six total including mine. I am able to access the new Eyefinity EHR on any mobile device, as well as on any web-based computer. We currently use three PCs in the front, three iMacs (27-inch screen) in the exam rooms, and I occasionally carry my MacBook Air to and from the office for backup in case there is any issue with the iPads. Every staff member has access to the EHR in some capacity, but not everyone has unlimited access, as HIPAA requires.
Space Efficient to Access EHR via iPad
My office footprint is quite small, 1,200 square feet to be exact. This means work stations are small and cramped. It is an advantage to me to be able to demonstrate the latest lens technology, access the health record and create a fee slip, all from a mobile device from whatever corner of the office is available.
Fee for Housing Data in Cloud
The fee for holding our data in the cloud is $375 per month for our both offices. This allows us the freedom to use whatever mobile device we choose. I no longer have to worry about backing up and maintaining my server, and software upgrades happen automatically.
Eyefinity EHR enables doctors to use drawing glyphs on the external view of a the patient’s eyes. This aids record-keeping, and also patient education.
Integrate Mobile EHR into Patient Flow
Implementing the new EHR really was easy. We had minimal preparation as our data base was small. I was still using paper charts and maintaining the server only for practice management data. I purchased ECR Vault’s high-speed scanner, through Eyefinity, so that my staff could quickly add the previous years’ records to the new EHR. We spent several months “practicing” in the sandbox on special demo training pages.
Since I see three patients per hour, I decided early on to use scribes. When a patient checks in at the front desk, he or she is told that we are switching to electronic health records and they will be asked to update their health and demographic information. We currently hand the iPad directly to the patient so that they may update their demographic and health information. In pre-testing we still manually tap their auto refraction, k readings and vitals like blood pressure and pulse into the health record, but as soon as my auto refractor can be integrated, this will happen automatically.
After pre-testing patients are taken to the exam room where the scribe hands the patient the iPad and shows them how to update their information. The scribe remains in the room until the patient finishes in case there are questions about how to do this. Next, the scribe saves the information and begins to take the case history which is recorded on the iPad. I enter the exam room and review the data on my iMac and begin the exam. I have been delighted to find that I actually have more time to chit chat and make more eye contact with patients. I dictate the refraction and binocular tests, as well as the entrance tests which are recorded on the iPad.
The patient is dilated/or not and taken to the dispensary where the scribe now dispenses the patient, knowing exactly what has been discussed in the exam room. When the patient returns to the exam room to complete the dilated fundus exam, I record the findings on the iMac and escort the patient to check out. It is possible to record exam findings simultaneously on the iPad and the iMac for the same patient. It took me a couple months to figure out the most efficient way to see patients and I am a big believer in the scribe. While the scribe and I are seeing a patient, the next patient to check in is worked up by the next scribe.
Make Use of EHR via iPad in Dispensary
When the scribe/optician is in the dispensary, he or she has access to the manifest refraction and any other data recorded in the exam room. Our iPads are also used to demonstrate AR treatments, polaroid tints and progressive lens designs, which increases patient understanding, and, which leads to increased sales. The Eyemaginations app is loaded on each iPad and iMac which saves a great deal of time in explaining common health conditions which may require additional testing. This leads to an increase in medical billing.
Observe What Works Best for You
During the first few weeks I was also using an iPad carrying it back and forth between two exam rooms and logging into the patient’s health record each time. But I found it more efficient for the scribes to carry the iPad with them into the exam room with the patient, log the patient’s record onto the iMac sitting on the desk so that when I walk into the room, I can glance at the big screen, much in the same way I would with a paper chart and then begin the eye exam. This allowed for much greater eye contact. I record only the exam health findings into the electronic health record and this usually takes less than a minute to do. When the patient is escorted by the scribe to checkout, I finish my notes, staying in the exam room until I am done.
Guard Patient Privacy
We were concerned that iPads with patient information on screen would be left unattended, so we devised that the best way to avoid an accidental privacy breach was to have the scribe stay with the patient while they were tapping personal info into the iPad. The scribe maintains a respectful distance but is clearly there to help and ensure the patient is able to complete their electronic forms in a timely fashion. Eyefinity EHR gives us this ease-of-use and efficiency which is so important to the success of our practice.
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