Article Date: 3/1/2011

An EHR for How You Really Work

An EHR for How You Really Work

One intuitive package saves time while optimizing your clinical and business outcomes.

It makes sense that you and your staff would only need to enter information into an electronic health record (EHR) one time, and then it would display that information instantly, anywhere. It makes sense that an EHR would pull together data and images from all devices and make them available quickly in one system, whether you access it with a PC or tablet, in the office or at home. It makes sense that an EHR would be modeled on how you work, not on how a computer works.

Although all of these features make perfect sense, your EHR may not have them—unless you're using activEHRTM from Kowa.

activEHR is different from other EHRs you may have tried. The system is designed not just to record clinical and business data, but also to optimize clinical and business outcomes. And doctors don't have to learn to work with the software—the software has already been designed to work with doctors.

A More Fitting Foundation

activEHR separates itself from other EHRs from the ground up. It is the only EHR built on a database platform made specifically for healthcare.

“The healthcare database that drives activEHR, called Ensemble (InterSystems Corporation), is not a generalized software package that we retrofit to healthcare—it was designed specifically for healthcare from the start,” says Ian Lane, OD, FAAO. As Kowa's Executive Vice President of Technology, working in concert with Kowa's development partners at EMRlogic Systems, Inc., he directs and oversees the development of Kowa's latest medical technologies.

Because activEHR software is built on this healthcare database, it can collect and display data in a way that's natural and intuitive for doctors, rather than forcing doctors to fit their work into the linear rows and columns spreadsheet style of other systems. Widespread use of the Ensemble database in large US hospital chains also means that practices connect seamlessly to hospitals, radiology and pathology.

“We're entering the era when health care will demand full connectivity and interoperability between all segments of health care,” points out Dr. Lane. “With activEHR, we want to achieve this quickly and reliably.”

Rather than show you lots of empty fields, activEHR only shows you the information that has been documented about your patient. That could be two lines of data or, as in this complicated case, much more.

Supporting How You Really Work

What does an EHR look like? A visually busy window, filled with blank fields and drop downs? A screen that takes a lot of clicking and changing of fields? That's how Kowa saw the competition when they teamed up with EMRlogic and designed activEHR to do something completely different.

“All those fields and pull-downs turn everyone into a data entry clerk,” Dr. Lane says. “ We didn't want to design for data entry clerks—we wanted to design for doctors. We asked ourselves since doctors have to do more for less forever, how do we present an EHR to make data input intuitively easy so that it won't slow them down? We made that thought first and foremost when it came to the design. We adopted a different approach from other EHRs.”

The result is a system that's intuitively designed for the way doctors work. When you open activEHR, you see only the recorded data for your patient—not all of the empty fields for things that are not recorded. If you need to type something into one field, you don't have to look through 60 fields to find it. And you don't need to click around in the EHR as you move through your exam because it already knows where to go. For example, in a routine spectacle refraction or contact lens fitting, activEHR goes to the prescription once you've entered all of the preliminary information. It records information, but it also moves you through exams quickly and smoothly. Based on a patient's data, activEHR may even change the direction of the process to ensure accurate billing and coding.

The Clinical Difference

Many EHRs help clinically by pulling together items such as demographic data and instrument data, and activEHR does those things as well. It also integrates these things with continuously updated information to support the best clinical outcomes and delivers it to you during the exam. These qualitative features set activEHR apart:

Clear, easy image access: “Doctors don't step away from activEHR to go to an image management system,” says Dr. Lane. “The system's internal browser displays thumbnails of all the patient's images and their dates. Just click thumbnail—the actual thumbnail, not a representative image—and go to the image. As images are added or modified in the process, the page is automatically updated.”
Continuously updated knowledge-base: All of the clinical information in activEHR is delivered through a knowledge base, maintained and updated by Kowa and EMRlogic virtually minute by minute. Doctors can sync up the knowledge-base anytime by clicking a button. “The first advantage to this is that the minute some new technique is published, it's in our knowledge-base. Doctors don't have to wait for the next software update to get it in their system,” explains Dr. Lane. “activEHR also allows doctors to custom design their content so they can choose exactly the information they want to see.”
Hyperlinked data for seamless access: Rather than accessing the knowledgebase encyclopedia-style, doctors can click on hyperlinks in the text. Every word, structure and organ in the EHR is hyperlinked. If a patient has glaucoma and dry eye, you can click on those terms to learn more without wading through information about every problem the patient doesn't have.
Decision support: When you're making a complex or borderline diaganosis, you don't want to leave the exam lane to do research. activEHR provides real-time help on the fly.

“Healthcare reform is calling for computer-based clinical decision support by 2014,” Dr. Lane points out. “activEHR links disparate pieces of information—for example, something in the patient's history and one or two things that come up in exam—and raises a warning for you to consider the possibility of a potential, specific ocular or non-ocular problem. It helps new practitioners with less experience to draw on, and we can all use reminders about less common problems.”

Combined, these features keep you moving faster while putting more information at your fingertips at the moment you need it. There is potential not only to enhance outcomes, but also to enhance the patient experience as you spend less time interacting with the computer and more time interacting with them.

activEHR's integrated imaging begins with a thumbnail view of every saved image or drawing for this patient.

The Administrative Difference

When software eliminates duplicate data entry, provides continuously updated data, and seamlessly shares that data with other institutions, administrative efficiencies follow. activEHR eliminates some of the hassles that doctors and their staffs dislike the most and lets everyone focus on patients instead. It makes these things smoother and easier:

Adhering to new regulations: Doctors want to focus on being doctors, but government regulation and Medicare and private reimbursement rules require attention. The designers at Kowa/EMRlogic want activEHR to do that thinking for you. Dr. Lane explains, “Billing requirements are continuously updated. And because Health and Human Services has laid out its roadmap for the next 5 years, activEHR is already set to change when each enhancement is required.”
Prescribing medications: “As of next year, the government is mandating that all prescriptions will be computer to computer, not phone or fax,” says Dr. Lane. Rather than have a separate module, activEHR integrates that function into the EHR. It's automatically populated with the patient's information, including drug allergies and interactions based on data from your office and outside systems.

“It also provides drug formularies by insurance companies, so your staff saves an enormous amount of time because they don't have to chase these things down,” adds Dr. Lane. In addition, doctors can pick up electronic medical prescription renewal requests that patients make at the pharmacy, allowing them to prescribe on weekends or after hours without going to the office. Every activity is coordinated through activEHR so no additional charting is required.

Refraction and spectacle lens ordering: “Refraction is very click-intensive in most EHRs,” says Dr. Lane. “The activEHR interface module automatically populates the EHR system with data from autorefractors, auto lensometers, keratometers, and so on during the pretest. There's no more printing of little sheets of thermal paper (which fade over time) and making transcription errors, although doctors can change any text or refractive data on a custom basis at any point.”
Contact lens fitting: activEHR has a complete database of every diagnostic and revenue soft contact lens parameter on the market. The system automatically looks at the auto and manual refractions and other parameters and assists in selecting contact lens designs based on known fitting criteria. The system allows for the dcotors 'favorites' to be presented first. But all others are instantly available in the event the patient requires a different brand or fit.

Following the trial lens fitting, activEHR can even send a report to the manufacturer and order the lenses. The system even knows when to convert the trial lens to a revenue lens barcode to assure a seamless click and error free contact lens order and accurate patient billing. Staff members don't have to key in the parameters for orders, and the system can scan bar codes as well. It all contributes to four of Kowa's key goals for this system—speed, accuracy, freedom of choice and an enhanced patient care experience.

In this example, the doctor is shown an image of how a condition may appear.

Reaction to activEHR

Can an EHR really make your work easier and more productive? Many doctors have already tested out activEHR and, according to Dr. Lane, the response has been positive.

“When we show someone activEHR, we quickly hand over the mouse to the doctors and let them drive it themselves. We usually get oohs and ahs because it speaks to so many of the real or perceived roadblocks that they've faced in the past,” he says.

When software is intuitive, users catch on easily. It helps to have colleagues in on the design. “We have a standing focus group involved every step of the way,” Dr. Lane says. “They represent private practices and large groups and clinics. The framework and the knowledgebase are all driven by the processes that doctors follow in practice. It gives them the freedom and the support to do their work the way that they want.”



Optometric Management, Issue: March 2011