Article Date: 3/1/2011

Improving Patient Care and Running a Better Business With EHR

Improving Patient Care and Running a Better Business With EHR

How an eyecare-based software system can take your practice to the next level.

Kowa's activEHRTM is an electronic health records software solution with best practices added in to help provide consistency in clinical care and improve your patient's experience.

“activEHR enhances patient care tremendously and improves accuracy when ordering prescriptions,” says Mary Lou French, OD, in private practice in Orland Park, Ill. and a longtime customer of EMRlogic. “I can look on the system and be reminded to run certain tests, and I have everything in front of me on one page. The system is easy to manage and helps make me a better clinician. I document clinical notes more clearly and have easy access to old records. It's just a click with a hyperlink, not a page-turner, which makes me scan for information. The system makes me more efficient.”

David Mills, OD, MBA, in private practice in Warwick, R.I., was concerned with the lack of connection he was seeing between other doctors and their patients. “I saw that when doctors were collecting case histories on their EMR systems, they had their backs turned and had no eye contact with the patient. They were busy typing,” he says. “One thing I like about activEHR is I don't have to do that. I can use information pages and with very little typing, capture the information I need. I never lose that personal touch and that's important in my practice.”

Best Practices

Action Manager is the adaptive workflow engine inside activEHR that has developed templates based on the best practices within your office and that drives consistency for business and clinical decision-making. It helps to ensure that you provide better care, earn the pay-for-performance you deserve and build a better practice. The EHR system gives you the data to do so, but Action Manager makes sure it gets done at the right time, all the time—from driving follow-up appointment calls to automated referral letters and all those dispensary details that so often fall through the cracks.

“The software has continued to grow and expand,” says Dr. French, ”and while no software is perfect, this system is extremely powerful. I like that I can have the same patient record open on multiple stations in different areas of their record. I use all of the front-desk options, the pretest and all parts of the exam that are appropriate to that patient—90% of the system works for me as is and there are also places to manually enter data if something falls outside the supplied limits, such as something specific to pediatric patients.”

With activEHR, spectacle and contact lens purchases, lab orders and inventory control aren't just efficient, they're also optimized through continuous improvement.

“When I complete my exam, I transfer the refractive data to the optical center and it's there for the optical department. They can use VisonWeb to send the orders to the labs. This step is integrated into the system. By having VisionWeb tied to activEHR, we increase our practice's efficiency. We then print the order to track it. There's also an option in the software to track the order electronically,” says Dr. French.

“The flow of the exam makes sense on the screen,” adds Dr. French. “The activEHR Scheduler screen displays appointments. There's a patient history section, a pretest, refraction and finally, eye health exam. I can also choose to do these in a different order—the flexibility is there and there's a logical flow to the software.”

“Most of us have a different style of examining patients, and while every practitioner practices differently, I can say that when the encounter is complete, it still looks like I examined the patient,” says Dr. Mills.

Communications Core for Pay-for-Performance (P4P)

Communications has been the core concept within activEHR since its inception. That's why activEHR offers the eyecare industry's only internal Web browser. It's also why activEHR is built on health care's gold standard database and integration platform: Ensemble with CACHÉ (InterSystems Corporation).

CACHÉ is the embedded database technology that America's top hospitals and healthcare organizations rely on. It's a fast, stable and web-centric platform (Ensemble) designed with the future of health care in mind.

“I chose activEHR because of the huge potential I saw,” says Dr. French. “The underlying CACHÉ database was more powerful than any of the other databases available when I was looking to buy. This database was being used by hospitals.”

In the summer of 2006, Dr. Mills started to evaluate optometric EHR systems. “ We looked at three or four different systems. The reason we chose acitvEHR is that it was the only one that could submit claims electronically to our current clearinghouse. Our claims process was running so smoothly, I didn't want to take the chance of interrupting the cash flow to our office. It was an easy and smooth transition for the office.”

Today in eye care, there remains much skepticism around PQRI and pay-for-performance. In 5 years, however, P4P with evidence-based medicine will be the accepted standard and every optometrist, young or old, will need a fully functional, compliant software solution. activEHR is committed to be not only the solution that drives business processes, but also the optometric EHR solution that leads the eyecare industry both with information and technology.

The Importance of Accounting

activEHR Analytics ensures that claims processing, patient accounting and inventory control are not just efficient, but are optimized through continuous improvement.

“The financials are wonderful and I run daily reports,” comments Dr. French. “Statistical analysis is available as well. It's kind of a summary, breaking down information per patient, by revenue, percentage and so on. It helps me on the management side of things.”

Dr. Mills is also a fan of activEHR's reporting. “I was very concerned about the types of reporting I would get from the programs. At the time I was looking for a system, nothing could match the financial programming that activEHR provided. For example, on the business management side of things, it has a very robust reporting module, which is critical to my practice. It provides both patient insurance and payer information, which is critical in evaluating the health of my practice.

“Six months ago, we did a mailing to patients who might be interested in LASIK. Through the program, I could isolate my query by age and by prescription and send just to the patients I wanted to target. Another example, I could do this for the release of a new contact lens for astigmatism. I could target my astigmaticpatients within a range and reach only those patients who could really benefit from the new lens,” says Dr. Mills.

Making Connections

activEHR can be linked to most optometric hardware in your pre-test and exam lanes. Dr. French has her autorefractor linked to activEHR and is planning to add others. The system will eventually be linked to her OCT, Optomap (Optos), visual field and tonometer. The ability to link ophthalmic instruments to EMR systems is quickly becoming essential to EMR success.

Another connection that both doctors are enjoying is the link to e-prescribing.

“I began using this in the last month or two,” says Dr. French. “A patient comes in and needs an anti-infective, for example. Inside his patient record, I can access his pharmacy and send a prescription right to the pharmacy from the record. I can also check what medicines he is taking on e-Prescribe. This gets imported into my patient record. This is a truly wonderful feature.”

“The functionality has changed dramatically from the older version to the new,” says Dr. Mills. “Kowa and EMRlogic have made some streamlining changes that the staff likes and they're incredibly responsive to any issues we have. I haven't recently evaluated anyone else's system, but I don't feel the need to look at any other programs.”

The Needs of a University Exceed Some EHR Systems
■ Academia, like a hospital, can put a drain on EHR resources. That's why Western University College of Optometry's Associate Dean, Charles Haine, OD, MS, turned to activEHR when he was seeking an electronic health records solution.
“We started with another program in a one-chair office and began to build our patient population with students. It soon became clear that the system wouldn't meet our needs in the long term,” says Dr. Haine. “We're not like a standard optometric practice—none of the schools are. We're bigger and the software we began with had problems handling our size.”
Though the options for large schools may be limited, activEHR has met Dr. Haine's needs. Within activEHR, everything is tied to a Scheduler. “The patient is put on the Scheduler and we have modules within the clinic set up within the Scheduler,” explains Dr. Haine. “I customized the Scheduler, not for the doctors or the students, but for the staff at the front desk. I wanted it to be as user-friendly as I could make it, while still emulating our practice. The people at the front desk either make or break your system in terms of success. If they don't schedule properly, doctor time isn't fully utilized and everything starts to fall through the cracks.”
Action Manager branches off the Scheduler. “When a patient checks in at the front desk and their demographic data is correct, the front office staff hits an arrow and moves the record to the next step in the work flow, which is the exam. When the exam items are completed, the user hits the forward arrow and moves it on to the next task. This ensures that our patients are seen in the proper order, receive consistent attention and are kept moving. If our workflow does change, the system is flexible and can be altered as well,” explains Dr. Haine.
He also says that the billing system works well within the University setting and that the Kowa/EMRlogic team has modified some reports for them in order to meet their business model.
“One of the biggest reasons activEHR works for us is the way they're using artificial intelligence to help the practitioner make decisions,” says Dr. Haine. “This modern workflow engine, called Action Manager, templates the best practices within an office.
“I think the activEHR best-practices module has tremendous potential to change the practice of optometry and make it a better profession in terms of patient care.”
Although it's currently a work in progress, Dr. Haine says some day there will be many clinical decision trees that can be followed in order to reach a diagnosis. “The content has to be built, but I think it's a great learning tool. If a student gets stuck, they have a place to search for an answer. Learning to make decisions as a clinician is difficult. With this tool, I could provide better patient care. I can always look up a diagnosis someplace else, but why not do it while the patient is still in the chair?” asks Dr. Haine.


Optometric Management, Issue: March 2011