PracticeMaker(R)- Ophthalmology Medical Records

® EMR
Electronic Medical Records

This is an open memo to all Ophthalmologists who are interested in electronic medical records. Be patient and do not rush into a decision too quickly. Going from papered to paperless is a chore, to say the least. It is a commitment to time and resources and in the beginning you will wonder why you ever undertook such a daunting task. In actuality, there is no such thing as truly paperless. If a patient signs something, you have to keep it for 7 years! Do not let anyone tell you different, but there is no substitute for holding a chart in your hand!

That being said, for the past 3 years I have been trying to come up with a design for electronic medical records that would be simple, straightforward and easy to use, while at the same time being flexible to most general Ophthalmology practices. I designed PracticeMaker® in 1993 and for the past 15 years have increased its feature set to make the managing of our medical practices easier while not costing "an arm and a leg". This task has been achieved. Now, it is time to put these same ideas and ideals into an EMR just for us...Ophthalmologists!

With regards to certification, the big buzz is CCHIT. As of today, 6/12/2009, there is NO available certification for Ophthalmology EMRs. We are NOT family practice or internal medicine. We have special record keeping needs. CCHIT certification tells you NOTHING...NOTHING about ease of use and has nothing to do with integrated systems (PMR + EMR). With regards to the "Stimulus package", there is mention of using a "certfied EHR", but the term "certified" does not need to be defined by "The Secretary" until 12/31/2009....no kidding! Oh, BTW it costs $30,000 for a software vendor to test their EMR-EHR with CCHIT (pass-fail, with an extra fee each time to test) and $6000 per year to maintain the CCHIT certificate. Hmmm...I guess the physicians end up paying for this and there is absolutely no guarantee the software is easy to use!

Below are some screen shots from the current alpha version of PracticeMaker®EMR.

This screen is where the Review of Systems is captured. The list on the right side fills with all the possible selections for that part of the ROS. On this screen shot, the user clicked the "Allergy-Immunology" button (a red dot lights up) and the the list fills with the choices for that section of the ROS. To append a symptom to the selected list, the user simply clicks on one of the listed selections (can't get any easier than that). Every time a new medical encounter is started, all the data in these fields fills into a corresponding field in the encounter records thus fulfilling the recording of the ROS for all encounters.

Note: The buttons on most screens are large to make using TOUCH-SCREEN monitors easier. I have found a combination of touch screen and mousing very efficient (and the patients think it is cool and high tech, too).

The screen below shows all current medications for the patient. This can be viewed when NOT in an encounter, or while the encounter is being recorded. You have the ability to enter ALL prescriptions a patient takes, and flag them as...

prescribed by another physician ("O" is checked)
Dispensed as Brand only (the "B" is checked)
a currently used medication (the "C" is checked)
an OTC product (the "T" is checked).

When you print a prescription for the patient, up to five prescriptions will print onto a half sheet of paper and each Rx has its own independent log. Eventually, e-prescribing will be attached to this system.

This is the Overview screen for a patient's examination. Many EMRs have a similar design. On the left is each component of the exam. The buttons across the top direct you to the major sections of the exam (Overview, Assessment, Plan, etc) while the buttons along the side navigate you to the page where that part of the examination is recorded. On the top right side is a list of all testing done so far for THIS encounter. The bottom right shows the IOP measurements for THIS encounter, along with the last record pachymetry results which are used re-calculate the IOP (IOPc) using the CCT results (the calculations are built into the software).

One of the newest screens is the Refractive Records Page below. You are allowed unlimited refraction related records for each encounter. On this screen, the patient has a Lensometry, Keratometry, Autorefractor and Refraction record. Related fields are "stacked" for maximum quickness of comparison (you can easily compare your Autorefractor with your Refraction However, you can have a pre and post-cycloplegic refractive record, or even several eyeglass records. This is a real world screen.

Below is the screen for entering the examination of the Lens. Each page has the exact same layout for consistency. You can add a finding to each eye individually, by making selections on the left side that fill the examination fields on the top right, or build OD and then apply it to OS because both sides have the same findings. You can also use previous findings from any previous examination date where that encounter is locked (and cannot be altered).

This screen is the IOP trend page. It has been exaggerated to show extra properties of this screen, which include the bar graphs, images of optic nerves and which medications the patient was taking when the associated IOPs were recorded. On the bar graph is the measured IOP and the CCT corrected IOP in parentheses. This screen in invaluable!

The final screen for your approval is the retina drawing screen. As you know, most Ophthalmologists are not Rembrandt, and we cannot be expected to draw pictures. It is way to time consuming. With this is in mind, I have designed a simple "Kidz-Pix" style of graphics page. First, you select the type of graphic you want, here "Horseshoe Tear", and get a list of images to select from depending on the location of the tear. Once selected, you click on the grid box that approximates the location of the lesion. You can then create a narrative from scratch or return to the Retina screen and select what you want to be the narrative from the pre-entered list of selections.

If you like what you see so far, stick around and more images will be posted, soon. Please feel free to call and schedule a web demo of the alpha version so you can see what else is on my plate awaiting your approval. Remember, we are in this together for the long haul!

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