THE future is now for the paperless office as eyecare professionals (ECPs) continue streamlining their practices by maintaining their records electronically rather than manually. The benefits to converting from printed documents to electronic ones are numerous, and as ECPs move an increasing amount of their records in this direction, they continue to enjoy more and more of these benefits.
The paperless practice begins when new patients pre-register via the Internet before their first visit rather than hurriedly completing a form attached to a clipboard in the waiting room. The no-paper route continues when their eyewear is ordered electronically after all of the digital data gathered during their visit is compiled and sent over the Web to the optical lab.
Benefits of Going Paperless
Every step of the way, operating a paperless practice offers numerous benefits to both the ECP and the patient. Complete and organized records are maintained in electronic medical records (EMR, where diagnostic measurements are kept), and in practice management software (PMS, where the day-to-day information necessary to run the office is stored). Since data can be shared, information need only be entered once. In cases where a diagnostic instrument takes the measurements and transfers that data electronically into the pertinent software, information is electronic from its source and never even needs to be entered manually.
Other benefits include more efficient use of office space and improved record keeping. Because the need for large quantities of paper files and supplies is eliminated, valuable office space can be used for activities that better serve to generate revenue. In addition, an increase in automation and subsequent reduction in human error result in more accurate records and coding compliance that ensure reduced billing errors and fewer claim denials. Finally, improved communication with optical labs leads to a reduction in redos.
Multiple Components
Because an ECP maintains many different types of information and data, there are many elements to making a practice truly paperless. Software programs can offer EMR management to maintain medical records or PMS for managing the plethora of information necessary to smoothly run an optical office, or they can offer both.
Diagnostic instruments can gather a patient’s measurements numerically along with digital images; they can then both be uploaded to software for future reference. Frame and lens data can be combined with a patient’s personal optical statistics and then electronically communicated to an optical lab to ensure accurate finishing of his eyewear. And all of this data can be accessed in-office or remotely to enable the doctor as well as the patient to remain informed with the most up-to-date and accurate information with just a click of a mouse.
Sources of Software
Available EMR and PMS software programs are numerous, and new software is introduced on a regular basis. Among the popular optometric systems are: Eyecare Advantage (Compulink Business Systems, Inc.), Medformix® (Crowell Systems), Crystal PM (Crystal Practice Management), OD Professional (EMRlogic Systems, Inc.), maximEyes (First Insight Corp.), My Vision Express (Insight Software, LLC), Max-Gold7: The Complete Optometry Clinic Management System (MAX Systems Inc.), MedInformatix EMR (MedInformatix Inc.), NextGen® EMR (NextGen), ExamWRITER (OfficeMate Software Solutions), and VersaSuite (Universal Software Solutions, Inc.). These programs vary in their functions and in their abilities to interface with diagnostic instruments and other software.
The New But Old Way
For ECPs who have become accustomed to the more traditional means of transferring data, i.e., by writing it down, there are software systems that accommodate this as well. For example, My Vision Express’ E-Charts/ Electronic Health Records (EHR) feature lets you write on computer forms just like you do now on paper with all the advantages of computerized documents. The process is complete in three steps: 1) scan in any number of office forms, which can be loaded into patient records as needed; 2) use the pen tablet to write, draw, or type any form (you can create your own pre-written text; load images such as a signature; and use patient data fields such as patient name, age, birth date, today’s date, and time to insert in the form), and 3) your completed form is now part of the patient record organized by form type and date.
SRSsoft started in the field of ophthalmology (one of the company’s owners is an ophthalmologist), so the software is particularly suitable for optical offices. This company’s practice management software also enables ECPs to organize information the way they have become accustomed to, by handwriting or dictating notes. At the end of the day, all papers are scanned in on a high-speed scanner, bar-coded, and automatically filed away. Dicta-tion is completed in a three-step process: 1) dictate into a digital recorder, 2) attach the recorder to the dock to upload recording, and 3) 24 hours later transcriptions are automatically filed in patient charts and ready for digital signature.
VersaSuite EHR also allows for data entry via voice and handwriting recognition, and it can capture and recall patient information whether it is in text, audio, or video formats. Freehand drawings can be added with custom text, and existing or newly produced paper-based documents can be scanned directly into the patient’s record. In cases where insurance carriers do not require a hard copy, insurance claims can be submitted electronically either directly to carriers or through a variety of cost-effective clearinghouses.
Electronic Diagnostics
Because the electronic transfer of data has become the norm rather than the exception, the optical diagnostic instrumentation being manufactured today features this capability. This ability to directly enter diagnostic measurements into a practice’s EMR software immediately improves that office’s efficiency by reducing transfer errors and saving the time that would have other-wise been spent transcribing data.
The wide range of instruments capable of integrating directly with your EMR database include digital lens inspection sytems, autorefactors/keratometers, computerized refraction systems, perimeters, autolensmeters, corneal topographers, and wavefront analysis. Companies manufacturing and distributing instruments such as these include Topcon Medical Systems, Carl Zeiss Meditec, Canon Medical Systems, Haag-Streit USA, Heidelberg Engineering, Optos, and Vision Medical Instruments, Inc.
In some cases, communication is limited between certain diagnostic instruments and specific EMR programs. For example, currently the Eagle Eye 3000 Pachymeter by Vision Medical Instruments is the only pachymeter compatible with Exam-WRITER. This self-calibrating, high-precision pachymeter features 1⁄4-micron resolution and ±1 micron repeatability that eliminates the need for averaging. By the third quarter of this year, this pachymeter will also be compatible with My Vision Express.
Topcon offers a group of instruments with paperless capabilities, including the EXAM-5000 Auto-mated Refraction System, which combines the CV-5000 Vision Tester, chair and stand, chart projector, autorefractor, and topographer all in one system.
Stereo Optical Co. has custom-ized software for use with Optec® vision testers for use with Functional Acuity Contrast Test (F.A.C.T.®) slides. Responses are entered directly into the system while testing and data are automatically checked for consistency.
First Insight’s maximEyes program is compatible with the diag-nostic instruments from Marco, Topcon, Zeiss Meditec, and Veatch Ophthalmic Instruments.
Digital Imagery
In addition to the numerical data determined by various diagnostic instruments and transferred into a practice’s EMR software, digital images can also be similarly maintained and manipulated. For example, Optos’ Panoramic200 (P200) Scanning Laser Ophthalmoscope produces an ultra-widefield image of the retina in a quarter of a second. The digital images generated by this optomap® Retinal Exam can then be integrated with many EMR packages, including maximEyes and most specifically OfficeMate, with which it is fully integrated.
In May, Optos released the latest version of its proprietary software—V2® Vantage, designed to assist healthcare practitioners in capturing and reviewing the optomap Retinal Exam. A new capability known as ResMax™ increases the image resolution of the macula and optic nerve, and 3D Wrap™ allows the practitioner to create a three-dimensional representation of the human eye on to which the patient’s optomap Retinal Exam is projected.
Topcon offers an image management system known as EyeRoute™ that integrates images and reports from all types of ophthalmic instruments into a single, secure digital environment that is accessible via any Web browser. EyeRoute allows you to view, organize, edit, and transport data and images as you manage patient care and supports a wide range of instruments from many manufacturers, including fundus cameras, slit lamps, OCT, ultrasound, visual fields, and more.
PMS Plus
The CyberEYES digital dispensing system from CyberImaging, Inc. contributes to the paperless office by electronically compiling in one place all of the information that has been gathered during the patient’s office visit. Because the CyberEYES unit acts as a dispensing device, it is generally the last stop before patients make their eyewear selections. However, prior to reaching this stage, the various instruments throughout the ECP’s office have already gathered a patient’s information and transferred it to the centralized practice management software that is run in that office.
All of these data are captured electronically directly from the PMS database by the CyberEYES unit, combined with its own measurements such as pupillary distance and seg height, and com-piled to generate the final frame and lens order. Because CyberEYES interfaces directly with the optical lab, it can electronically transmit a text-based e-mail with all of the necessary frame and lens data to the lab, all without the need for a paper order.
In the third quarter of this year, CyberImaging intends to convert this process to an xml format so the lab’s system can directly interpret this information, thereby eliminating the need to cut and paste the text-based e-mail.
While many of CyberEYES newer capabilities are due to its ability to access the information in an ECP’s practice management system, this conduit of information actually flows both ways. The information gathered by the CyberEYES device can also be used to populate some of the PMS fields as well. For example, after patients use this digital dispensing system to select lens materials and treatments, then that information can be loaded into the practice management system.
An office’s PMS program is another way of compiling all the patient’s data, measurements, and frame and lens choices for Internet transmission to the optical lab. For example, First Insight’s online optical lab network paradEyes.com includes a built-in interface with VisionWeb.com where you can place and track secure online lens orders with Essilor Laboratories of America from within the maximEyes program.
These days everything from the time a new patient enters background information via the Inter-net through the digital diagnosis made by computerized instrumentation to the final order sent to the optical lab, there is no need to use paper anymore because all of this information is gathered and stored electronically. Now what are you going to do with all those old file cabinets?
John Sailer is Senior Editor of Vision Care Product News.
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