Article Date: 6/1/2010

Recent Trends in EMR

Recent Trends in EMR

Integrating an image management system with electronic medical records significantly increases practice productivity.

By Philip J. Gross, OD

As the move toward the paperless practice in optometry accelerates, optometrists have an ever-increasing number of options for getting there. Many are finding, as I have, that electronic medical records (EMRs) alone may not be enough to allow a practice to reach its full potential for decreased costs and enhanced productivity.

Many of today's EMR packages include modules for recording diagnostic testing and imaging results, but some require extensive steps in order to get the information into the record. In addition, how data is recalled and how � or even if � an EMR system displays sequential testing or testing from different instruments simultaneously, varies greatly from software to software. After my partner and I adopted EMR, we realized how beneficial it would be to be able to digitally interconnect all of the dissimilar diagnostic instruments we use on a daily basis. This would allow us to have all of our specialized testing, reports and images stored in one location. For this reason, we interfaced the EyeRoute Ophthalmic Image Management System (Topcon Medical Systems, Inc.) with our EMR system.

Now, as doctors and technicians perform diagnostic testing and imaging, the resultant data seamlessly flows into the EMR system.

Figure 1. Any testing or imaging that patients have ever undergone in our office, regardless of the instrument or manufacturer, is housed within the EyeRoute system, making it essential for doctor collaboration and seamless patient management.

Seamless Access to All Patient Data

Here's how the integration of EMR and image management plays out daily in our practice. We have two full pretest rooms, each of which include an autorefractor/keratometer, topographer, lensometer and noncontact tonometer. We have two additional testing rooms, which house a visual field unit, scanning laser polarimeter, fundus camera and OCT instrument. In addition, we have eight exam lanes, all of which are outfitted identically with a computer as well.

Typically, patients flow through one of the pretest rooms to an exam room, with all automated instrument data captured directly into the EMR system. If additional testing is required, patients go to one of the additional testing rooms after which they return to an exam room. With EyeRoute capturing all of the specialized testing and images, we can see patients in any of the exam rooms without the need for additional review station software. In addition, any testing or imaging patients have ever undergone in our office, regardless of the instrument or manufacturer, is housed within the EyeRoute system, which makes it seamless to use for patient care.

A fully integrated image and testing management system is integral to a paperless office. The ease of data capture alone makes a system like EyeRoute invaluable. When the speed and accuracy with which all of a patient's data can be accessed and reviewed are also considered, it's easy to see how beneficial the system is for doctors and patients alike.

Easy and Affordable Addition

Topcon handled EyeRoute installation mostly behind the scenes, so there was little interruption of practice operations. Preparing for implementation was straightforward as well. In general, a practice adopting EyeRoute needs to take these steps:

■ Place computers in the examination rooms or at the point of care if patient data is to be viewed elsewhere. (We recommend all-in-one computers or ultra-small form factor models with flat-panel monitors. We also recommend ensuring that the computers look professional � as if they belong there.)
■ Ensure the computers are connected to the practice computer network and have Internet access
■ Decide ahead of time which instruments will be connected to EyeRoute and be sure that a network connection is available in the same rooms as those instruments.

Before adopting EyeRoute, we analyzed the financial aspects and we realized we were paying more in staff costs for manual integration of data and trafficking image printouts than what EyeRoute would cost to implement. Now that the system takes care of these tasks automatically, staff members have more time for patient care. Therefore, quality and productivity have been enhanced in our office.

Another appealing characteristic of EyeRoute is that it can be implemented before or after an EMR system. Adding the EyeRoute after EMR worked for our practice, but others may find it to be an ideal stepping stone to EMR adoption.

A Definite Improvement

EyeRoute has made integrating test results and images from all of our instruments and interfacing that data with our EMR system virtually seamless in our office. The easy flow of information and increased productivity can be appreciated by our technicians and doctors as well as patients. At times, some technologies for going paperless can create more work than they save for a practice. When that is the case, doctors and staff will simply not use them. In contrast, the EyeRoute system is clearly better than the old way of doing things.

Dr. Gross is a partner in Vision Quest Eye Care Center in Dover, Del. He is chairman of the AOA Health Information Technology & Telemedicine Committee and lectures nationally on the benefits of technology in clinical care. He can be reached at or (302) 678-3545.

Eye on the Future

Topcon Medical Systems is on a mission to change the way eye doctors interact with the digital information that has become integral to their practices on a daily basis. The goals: reduce costs, streamline office workflow and improve patient care.

Building on its EyeRoute Image Management System � which integrates reports and images from both Topcon and non-Topcon diagnostic instruments, stores them in a secure digital environment and allows access from anywhere via the World Wide Web � the company has introduced the EyeRoute Mobile application. The app gives doctors access to all of their patient information stored in EyeRoute from any 3G-compatible iPhone or the iPad.

The point-and-click interface can be used to view the information in a variety of formats. The user can zoom in and out on images and adjust brightness and contrast. Images captured at different visits can be compared. In addition to the data sorting and image manipulation features, the application enables the user to add notes or audible dictation to an exam or image, which can be shared and responded to.

The company plans to introduce an advanced version of EyeRoute Mobile designed specifically for the iPad, which it sees as an ideal technology for the paperless, ultra-efficient office. Other upgrades to EyeRoute Mobile, such as the inclusion of voicerecognition software, are in the works as well.

Using the EyeRoute Mobile application, optometrists who have incorporated Topcon's EyeRoute Image Management System into their practices can securely access all of their patient images and reports from the iPhone, iPod touch or iPad.

Future technology will allow users to manipulate data on multi-touch tables or wall monitors, using hand and finger gestures such as pinching, dragging and tapping.

Topcon's vision for the future also includes providing eye doctors with the ability to utilize the multi-touch technology that is quickly making its way into the mainstream. Much like Tom Cruise in the "Minority Report" or Anderson Cooper on his CNN program "AC 360°," doctors would be able to call up and manipulate data on multi-touch tables or wall monitors using hand and finger gestures such as pinching, dragging and tapping. At the 2009 meeting of the American Academy of Ophthalmology, the company turned heads with the multi-touch demonstration at its booth. Representatives provided a preview of potential uses, such as the ability to instantly overlay an ETDRS grid on a retinal image and then display it on a large video wall.

Topcon offers doctors a variety of ways to take advantage of its data management and interaction technologies. EyeRoute, for example, can be cloud-computing based or locally hosted. The technology solutions are scalable to the needs of any size practice, and options are available at a variety of price points.

Optometric Management, Issue: June 2010