Software Solutions/EHR

EHR: Your Patient Education Tool

By Scott A. Jens, OD, FAAO

Beyond providing efficiency, electronic health records can help you to educate your patients about maintaining their eye health. Some systems can be programmed to do this automatically.

Your electronic health records system gives you a wealth of information to better care for patients, but how well do patients understand the care you are providing, and why you are doing so? A quality EHR system is able to give you the information you need to explain and show patients why you are providing care based on their past visits and their visits to other healthcare providers. It also allows you to have a more informed discussion of what worked and what didn’t in the past, and what you and the patient can decide on to provide better care for the future.

Identify Who Needs an Education
EHR technology has been certified within the EHR Incentive Program to sift through data fields in patient records to identify patients who might have a set of characteristics that would necessitate education. EHRs typically provide users with the opportunity to build customized rules that will then cause alerts to be displayed during the process of patient care, including notification that a patient may benefit from being educated. This is different than in the days of paper recordkeeping, when the provider needed to keep mental or written track of education that was to be delivered based upon the analysis of just that patient’s presentation.

Patient Education Case Study: The Diabetic Patient
An example of patient education based upon the record within the EHR would be a patient who is seen for an initial comprehensive eye examination at the recommendation of the Primary Care Physician (PCP) due to the patient’s ongoing diabetic condition. When the patient is going through the examination case history process, the optometric technician will complete the case history to reflect the PCP’s documented diagnosis of diabetes and add it to the master diagnosis/problem list in the optometrist’s EHR, and will also document the state of that present condition (called History of Present Illness) as it relates to any reported visual symptoms as well as the PCP-prescribed medications.

If the patient has a recent lab result from the PCP that can be documented, that data would also be noted in the optometrist’s EHR. If the EHR is set up to identify any diabetic patient (ICD-9 diagnosis code 250.xx) with a certain level of lab result or a particular medication as a candidate for particular education, an alert will show up during the optometrist’s course of documenting information in the EHR. This allows the optometrist or delegated staff person to deliver education, such as providing a web site link to the American Diabetes Association page about the importance of good control of blood sugar levels, or delivering an in-office video animation of how diabetic retinopathy can develop.

EHR Facilitates Education Better than Paper Records
EHR data reviewing processes are infinitely more complex and thorough than when optometrists use paper records. An EHR can analyze the patient’s data against pre-defined rules, and there is no limit to the number of data queries that can be happening in the background while the patient’s information is being documented into the EHR. Additionally, the EHR alerts for patient education can assist the optometrist during the intense patient process time when many patient care and advisory activities are taking place.

While a patient is proceeding toward the completion of an eye examination, the optometrist is faced with a flurry of actions including determining final prescriptions, explaining vision correction options, delivering diagnostic advice and treatment plans for vision or eye health concerns, and handing off the patient for the purposes of maintaining smooth flow in the office. Thus, it is easy for the doctor to become distracted away from the vitally important education activities and an EHR’s alert processes can help maintain a commitment to patient education amidst all of the other activities.

OD Automatically Alerted to Treatment Options
Like patient education requirements, Certified EHR Technology contains Clinical Decision Support (CDS) alerts that can assess the patient’s data and deliver to the optometrist any alerts for treatment options or optimization that may be appropriate. Some EHRs will offer treatment plans and others will define actions that the provider might consider given the patient’s presentation. These treatment options can then easily be explained to the patient while they are still in your exam chair.

EHR Provides HIPAA-Compliant Tool to Deliver Information to Patients
Unlike regular mail and faxes, e-mail is not a HIPAA-compliant method of delivering information to patients related to the specific issues of their health. While e-mail systems within PMS technology and third-party communication systems are available to perform patient recall and appointment reminder messages, they are not to be used for convenient patient education activities. Many optometry EHR systems have secure message delivery capabilities including password-protected online portals (called Personal Health Records or PHRs) where the patient can receive information from the practice. By 2014 these secure communication portals will be required for the EHR Meaningful Use program.

The use of EHRs to message patients with particular conditions needs to be done carefully. If the EHR system creates a list of patients who are due for care based upon their health information, the message to the patients must be sensitive and must not disclose the conditions. Therefore, most e-mail systems deliver a message that incentivizes the patient to contact the office to set up a time for a visit without disclosing the specific reason.

Help Patients Get the Picture
Integration between EHR systems and image management systems is variable. Today’s high-tech image management systems are often complete patient data software applications that provide the most robust capabilities of reviewing images, performing comparisons over time, and manipulating the images. Thus, many EHR users will use the EHR and image management systems separately, with some using integrations to launch the image management system directly from the patient’s record in the EHR. It is also common for copies of images to be saved directly within the EHR, making it easier than ever to show, rather than just tell, patients about their eyes.

Educate Patients Via Use of EHR: Action Plan

Utilize the EHR education rules to spur the optometrist and paraoptometric personnel to identify patients who would benefit from educational activities and develop practice protocols on how the education is delivered.

Follow clinical decision support advice from the EHR to improve the diagnostic and treatment plans that are invoked for the patient’s condition.

Perform periodic patient searches against the database of information in the EHR to identify patients who would benefit from care but who have not been in the office, and activate those patients by outreach using e-communications processes.

Related ROB Articles

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Training Staff Can Maximize EHR’s Power

Lead Your Staff in the Transition to EHR

Scott A. Jens, OD, FAAO, is co-owner of Isthmus Eye Care, with offices in Middleton and Madison, Wis. In addition, Dr. Jens is the CEO of RevolutionEHR, a provider of online-based electronic health records. He can be reached at: sjens@revolutionehr.com.

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