Optometric Management Tip # 427   -   Wednesday, April 21, 2010
Practical Tips for Implementing Electronic Medical Records

I'm very happy to report that Electronic Medical Records (EMRs) are much easier to implement than I once feared!  We installed a new system in my practice about a year ago and I must say I'm very pleased.  There was certainly a learning curve, but once my staff and I embraced it, we found the pros far outweigh the cons.  I'll share my experience with the hope that it may assist the thousands of eye care professionals (ECPs) who have not yet made the leap but are seriously considering it – or have an EMR system but are not utilizing it.

My practice may have been one of the more challenging installations because it is very large, very busy, and office procedures are highly delegated to many staff members.  We also use scribes, so the recording of exam data is not in the hands of the doctors, but is completely done by technicians.  I'll discuss that aspect as well.

Our basic plan
Every practice is different, as is every EMR system, but I found it helpful to assimilate our EMR procedures slowly.  This approach caused very little stress on my staff and we did not have to reduce our patient schedule or our practice income.

We began with formal training on our EMR system for all staff members via live and prerecorded web-based courses and an onsite trainer.  One of our doctors was appointed to be in charge of developing the system for our practice and designing exam templates.  After the training sessions, we practiced on our system using fictitious patients during any down time in the office.  Staff members simply made up patients with the last name “Training” and often used their own first name so they could return to their practice record when they had time.  The doctor in charge of EMR worked with small groups of staff to assist them with the practice sessions and to provide fictitious but believable data.

Before actually going live with EMRs, we scheduled some of our staff members as patients into our appointment system.  This gave us time in our schedule to work with EMRs in real time in our actual exam rooms, but without real patients.  This was very helpful because the patient was a technician, plus we had a scribing technician and a doctor; all were able to learn and refine their skills.  We took some of these practice patients into the optical for an eyeglass order, fit contact lenses on some and ordered special diagnostic tests for others. 

Finally, when we truly started using EMRs for real patients, we limited ourselves to only two or three established patients per day for each doctor.  And in those cases, we still had the patient's old paper record in hand as a safety net.  This showed us areas where we needed to improve and gave us time to find answers to our questions.  We kept a spiral notebook in a central location so all staff members could write down questions and make note of quirky things we learned.  We reviewed this at our weekly staff meetings and in some cases, we had to change our office procedures to adapt to the new way of recording data and placing orders.

Shortcuts and aids
My practice is still evolving as we gain experience with EMRs.  Here are some work-arounds we came up with to make us more efficient.  It was helpful to continue with our old ways as we merged into our new ways.

EMRs and Scribes

The good far outweighs the bad
I think most ECPs realize they must move forward and embrace electronic records.  While we may focus on the limitations and time-consuming aspects of EMR programs, I think we also know that paper record keeping is expensive and time-consuming in different ways.  I'm convinced that EMR systems have far more advantages than disadvantages.  I have even seen a practice building aspect to EMRs because patients are very impressed when they see us using tablet and desktop PCs to record their visit.  If you don't already have EMR, I think the time is right to shop for a system, buy one and begin using it.


Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management