October 01, 2006
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Electronic medical records: a goal for all offices by 2014

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Many optometrists are slowly, but surely, incorporating electronic medical records (EMRs) into their practices. This shift has been further advanced by a federal initiative to computerize records in the Veteran’s Administration offices, as well as a July 2006 report by the Institute of Medicine of the National Academies, which calls for the use of e-prescribing by the year 2010.

According to Ian Lane, OD, FAAO, vice president of professional services for OfficeMate Software Solutions, Irvine, Calif., this objective is part of a larger plan to make computerized records mandatory in all of medicine.

“The federal government is looking at a date of 2014 for everyone to go electronic,” Dr. Lane said. “This might sound a bit aggressive, but I can tell you by the adoption rate of the doctors, by the way everyone is ramping up, if it doesn’t happen by 2014, it will be close.”

Institute of Medicine report

The Institute of Medicine report, titled “Preventing Medication Errors,” recommended that physicians electronically write all prescriptions by the year 2010. It also encouraged the implementation of other forms of health information technology, such as EMRs and personal health records.

“By tying e-prescriptions in with the patient’s medical history, it is possible to check automatically for such things as drug allergies, drug-drug interactions and overly high doses,” the report stated. “In addition, once an e-prescription is in the system, it will follow the patient from the hospital to the doctor’s office, or from the nursing home to the pharmacy, avoiding many of the ‘hand-off errors’ common today. In light of all this, the committee recommends that by 2010, all prescribers and pharmacies be using e-prescriptions.”

“Pay for performance” incentive

Kim Castleberry, OD [photo]
Kim Castleberry

According to Dr. Lane, while this “recommendation” does not specifically require e-prescribing, it will utilize a “pay for performance” incentive.

“What this means is, if you do not submit electronically, you will not be paid as much by insurance companies,” he said. “At the moment, some insurance companies will pay much sooner if you submit electronically. So it is not really mandatory, but it is mandatory.”

The Institute of Medicine report went on to recommend an overall shift toward progressive use of technology in medicine.

“More generally, all health care providers should seek to become high-reliability organizations preoccupied with improving medication safety,” the report stated. “To do this, they will have to take advantage of the latest information technologies and most up-to-date organizational and management strategies.”

According to Kim Castleberry, OD, a practitioner at Plano Eye Associates in Plano, Texas, the federally funded, not-for-profit Certification Commission for Healthcare Information Technology has certified the first electronic records products.

“Most hospitals and large institutions have already implemented EMR to some extent,” he said. “I am fairly certain that incentives will soon be in place to force most physicians into EMR. I think it will soon be illegal to use a Big Chief tablet and a #2 pencil for medical records.”

Advantages of EMRs: Time, accuracy

According to Brian Woolf, OD, a practitioner located in Baltimore, keeping a medical-legal record for each patient is often burdensome to the practitioner or staff.

Brian Woolf, OD [photo]
Brian Woolf

“When my grandfather kept optometric records 60 years ago, there were often several years of visits recorded on just one 5-inch by 8-inch index card. There was just a note on the refraction and a one- or two-word diagnosis,” he said. “Today, my standard record takes 15 pages to print out. The requirement that every visit’s documentation stand up in a court or insurance investigation makes the whole process much more time-consuming.”

He said EMRs are helpful in making this process more convenient. “A computerized medical record helps take care of this monotony,” Dr. Woolf said. “It lets the doctor focus more on the patient and less on the paperwork.”

Dr. Woolf said practitioners should be acquainting themselves with these types of technologies to keep their practices modern. “I recently filled in for a friend of mine who was taking vacation, and I had to use his paper-based records,” Dr. Woolf said. “The amount of time it took me just to sit and write was ridiculous. Even when I finished his record, it was still not as complete as my computer-based records.”

Dr. Lane said EMRs help reduce medical record errors.

“There is no doubt that far fewer medical record errors are made if things are done electronically,” he said. “Some good statistics indicate what the error rate is costing in terms of human life and in dollars.”

He added that optometry in particular would be sending a powerful message by adopting EMRs. “I think that, traditionally, optometrists have been relatively conservative in making these transitions in health care,” he said. “We should not be slower than the rest of the medical profession on this. As an optometrist, I think it would make a strong statement.

Dr. Castleberry agreed that it would be wise for practitioners to familiarize themselves with these innovations. “Electronic claims are now the standard, and paper claims will be eliminated completely very soon,” he said. “It [converting to EMRs] is a painful process, but a profitable one.”

Microsoft acquires medical record technology

Jessica S. Nowak
PCON Associate Editor

Microsoft recently announced the acquisition of Azyxxi, a software system that currently allows seven hospitals in Washington to access and display complete patient information from a single station, according to a company press release.

The system was formulated by three physicians looking for an alternative to time-consuming searches for patient information. The doctors used Microsoft technology to create the Azyxxi system, which provides comprehensive patient information. “We identified 300 data islands within [Washington Medical Center],” said Craig F. Feied, MD, who developed Azyxxi with his colleagues Mark S. Smith, MD, and Jonathan A. Handler, MD, in a 2004 Microsoft Executive Circle Case Study.

“Patient registration information was locked up in one system, while lab reports were in another; radiology readings from digital X-rays were in one format, CAT scans were in another, and electrocardiograms in another,” said Dr. Feied in the Microsoft press release. “The list goes on and on — 300 different systems that couldn’t talk to one another.”

Early results from the Washington Medical Center Emergency Room have shown a reduction from 9 to 3 hours patient wait time through implementation of the Azyxxi system. The staff are, therefore, able to treat and manage twice as many patients.

Purchasing the Azyxxi system allows Microsoft the opportunity to expand into the health care information technology market. Drs. Feied and Smith, along with the original development team, will work with Microsoft to expand the commercial applications of the original system.

Should it be required?

Nevertheless, Dr. Woolf is not entirely convinced that EMRs should necessarily become mandatory.

“I hate the thought of anything becoming mandatory,” he said. “I often feel that the decision to use a particular technology should remain in the hands of the person who will eventually need to use it.”

He added, however, that the current requirements for documentation make EMRs necessary.

“While the EMR takes a large portion of the drudgery out of filling out the medical record, it does put a huge technical burden on the doctor to install and maintain a computer network,” he said. “This amount of technical work can, in some cases, be worse than just sitting down with a pen and filling out a record. So it should still be up to the doctor to choose.”

Dr. Castleberry said he does not feel that practitioners should implement EMR until they are fully prepared. “Practices should not actually implement EMR until they can commit the time, resources and talent to converting,” he said. “Additionally, many software companies simply don’t have adequate EMR modules, so with some vendors, the technology simply isn’t ready.”

He added, however that some high-quality EMR modules are currently available. “The top vendors have very good EMR modules,” he said.

Dr. Lane said there are many good reasons for practitioners to adopt EMR in their practices. “The efficiencies that come out of going electronic are huge, in terms of elevated patient care and reducing the cost of health care,” he said.

For more information:
  • Ian Lane, OD, FAAO, is vice president of professional services for OfficeMate Software Solutions. He can be reached at 15375 Barranca Pkwy., Irvine, CA 92618; (949) 754-5000; fax: (949) 727-7479; e-mail: ian@officemate.net.
  • Kim Castleberry, OD, practices at Plano Eye Associates in Plano, Texas. He can be reached at 5900 Coit Rd., Plano, TX 75023-5959; (972) 985-1412; e-mail: kimcastleberry@verizon.net.
  • Brian Woolf, OD, practices at Woolf & Woolf Eye Associates in Baltimore. He can be reached at 2053 E. Monument St., Baltimore, MD; 21205; (410) 255-8056; e-mail: mail@Drwoolf.com. Drs. Castleberry and Woolf have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned.
Reference:
  • Preventing Medical Errors. National Academies Press. 2006. The full text of this report is available at http://www.nap.edu.