Article Date: 7/1/2003

paperless office
A Paperless Plan for your Practice
Want a smooth and efficient way to run your office? Toss out the pen and paper and let your computer do the work. Here's what you'll want to consider.
BY JAMES K. KIRCHNER, O.D., Lincoln, Nebr.


When we focus on the business side of optometry, our challenge is to develop a practice that's efficient, pleasant and profitable. We have many tools to choose from to successfully attack this challenge, but computerization is the most obvious tool.

I'm going to share my experience transforming my practice into a paperless office, focusing on the areas of practice we needed to address and the benefits we realized.

Starting the journey

I started to incorporate computerization into my practice in 1982, at which time we had only one workstation. We used this workstation for billings and patient demographics but we anticipated eventually using it to make appointments.

In 1999 we merged two groups together and decided to take computerization to the next level. Each group had matured to the level of generating patient optical orders and contact lens ordering, but we didn't anticipate how far we had to go to become totally paperless. We each had different software systems -- neither of which would allow us to reach our goals. So we started looking for a vendor that could get us to our paperless objective.

Plan and evaluate

Going paperless is a large task, with much depending on where you are when you start. You need to accurately plan and evaluate your means of attaining your goals, but the end result should be a smooth-running paperless office system. A totally electronic office will give you the efficiency of operation that allows any size practice to compete in our challenging ophthalmic world.

Assess your status

Before you get started, you need to address two essential items immediately:

1 Where do you presently stand with computerization in your office? Do you have an office system? If so, what areas of work is it accomplishing? Are you simply using it to bill patients or are you also using it to keep track of all your patient demographic information? Are you currently billing third-party payers electronically? Do you make patient appointments on your system and run your recall/pre-appoint tasks on it? Are you doing patient orders for optical and contact lenses and controlling inventories?

The list goes on and on. The question being asked is, "Are you fully using the functions of your present software?" Adding Electronic medical records are the final step in achieving complete paperless freedom.

Take an inventory of office functions to get a clear idea of what you have and haven't computerized. Most private O.D.'s offices have the same basic functions regardless of size, but the inventory of office functions is a minimal list that a paperless system will have to perform (see the sidebar on page 36). In fact, the new office will eliminate everything you do with pen and paper.

2 How much do you know about your vendor? Your current software vendor may offer a program that would let you move to a paperless solution, but just because a company says it can do this for you doesn't mean it has done it routinely and successfully. If it can't or you don't feel confident in its ability, then look for a new vendor.

Get a list of the clients who your vendor has converted to a paperless practice. Make sure you call and talk to some of them. Also ask your colleagues if they know anything about the vendor you're considering.

Making a decision

We researched the companies that write software for the eyecare industry (including our then present vendor) and after sorting through what each offered, ended up with a short list of companies that could meet our needs. We called the companies' referral lists and spoke to colleagues and eventually decided on Medformix by Crowell Systems in Charlotte, N.C.

Planning out the details

After we purchased our system, we began to plan with our new vendor. We needed to make many decisions about hardware upgrades, operational changes, implementation strategies, staff training and more. We spent almost six weeks with this planning process and it took all of six months to fully convert to the new system and for all staff to get to a level of proficiency and comfort.

At the time, we wanted to bring two of our offices on at the same time, so we needed to plan for the network system that would allow us to be on real time between offices in addition to having a stable system that would keep us running with each patient individually. The actual conversion, with our software vendor in control, took place over a three-day weekend.

We had done much staff training before and during the conversion and continued after the conversion to a paperless practice. We were disoriented for the first few days, sometimes standing in front of a screen and not knowing which button to push or what screen to go to next, but with time and practice, it became easier.

A total conversion to a paperless practice isn't easy. No matter how much planning you put into it, you'll most likely still encounter unexpected challenges as you proceed in the implementation. As an example, everyone has a different learning curve, so some on staff will quickly advance ahead of others.

When you are electronic, everyone needs to be completing their tasks on screen and not ignoring details. But initially, these errors occur and it takes a team effort to catch the omissions, so that all details are complete. You just have to face and resolve each issue as you encounter it. The outcome will be worth the stress that everyone feels while converting. Learning new ways of performing a task is never a pleasant experience; some staffers will have an easier time with it than others. But keep positive and look ahead at the end result.

Putting the plans in action

We determined that in converting to the new system we'd bring in as much individual patient demographic information that we could and in addition, all of the financial information. Our vendor wrote a program to accomplish this.

We finished converting each patient's information as she came in for services, then archived the old paper record for future reference. This way, the EMRs contain all of the pertinent information. If necessary, we can always access historical information by retrieving the archived record. (In our office, we've found little need to retrieve archived records because once we create the electronic record and enter pertinent historical information, we accomplish future visits using electronic records). It took about three years to completely convert our previous patients' records into the new system.

Efficiency: The biggest perk

After being paperless for almost four years, the single most important part of our system is the ease and efficiency in dealing with records. We never misfile EMRs and we can access them from anywhere in the office without wasting staff time to retrieve the record.

In fact, we're now functioning in real time in all of our offices, so we can be at any of our office locations and view a patient record from any workstation. This is an obvious advantage over paper records. A rule of thumb here: Plan on having a workstation wherever you would do any work. Remember, you don't have a record to lay down and write on, so you must have a screen in front of you. We currently have 129 workstations in three offices.

In nearly every aspect of operation, a paperless office continues to show us new ways of performing tasks more efficiently. We've incorporated other new technology that requires staff involvement without expanding our staff base. Each of our doctors increased their patient loads by as much as 30% without having a full-time, chair-side assistant present as we had in the past.

We reallocated our staff time to accomplish tasks that we otherwise would have had to expand our staff base to accomplish. For example, one full-time employee takes care of third-party billing now, whereas before the conversion, this task required three full timers. We moved staff to other areas of the practice where we needed more help. With attrition, we reduced our staff size slightly, but that shouldn't be the goal of going paperless.

Incidentally, some staff found the transition to a paperless office too difficult and decided to resign rather than learn the new system.

We're now also able to do same-day billing to insurers and our accounts receivables have dropped dramatically. Our contact lens and optical staff can completely generate a patient order while the patient is present. The system then electronically sends our orders to the lab and tracks inventory, which helps us keep tighter control on spending. A paperless office offers countless other advantages, which you'll discover if you decide to convert your practice.

Facing reality

Transforming your practice into a paperless office isn't cheap. True, it'll generate new dollars for you once it's completed, but it'll cost you to set up. In the planning stages, get hard quotes from your potential vendors and make sure that you're realistic in your hardware needs.

In dealing with the computer industry, we all know that our equipment becomes quite deficient quickly. You'll probably spend more on hardware updates than you will on your software. Hardware upgrades, software updates and staff training are all expensive. It all becomes a new part of fixed overhead. But modernizing your practice will help it thrive and will allow you to deliver unparalleled eyecare services. It will also pave the way to success for the future.


Make a Note of It

A checklist of your office functions may look similar to the one below:


  • name, date of birth, gender, address, phone numbers
  • occupation, employer
  • family members
  • insurance/eyecare plans


  • appointment scheduling
  • recall/pre-appoint system
  • optical and contact lens ordering/tracking
  • medical records
  • patient history (family and medical histories, current medications, allergies, etc.)
  • testing results from all areas of data gathering (fields, IOPs, blood pressure, topography, retinal images, etc.)
  • exam room information (refraction information, internals, biomicroscopy, acuities, etc.)
  • all examination notes, diagnoses, treatment plans, etc.


  • employee data, which would include all service information about an employee
  • salary and benefits
  • date of hire
  • performance evaluations
  • time clock, which can keep track of all employees' hours, calculate pay checks including withholdings and handle vacation scheduling
  • inventory management. Accurately monitoring physical inventory of frames and contact lenses as well as reporting on use rates and inventory aging.
  • business reports. this should be strong function, allowing you to learn more about your business than ever before so you can make informed decisions.


  • creating individual patient bills as they move through your office. Includes services and materials, all calculated as your patient is being cared for during the visit.
  • properly tracking all collections and accounts receivables as they are generated throughout each day
  • electronically billing third-party payers and monitoring the aging of these insurance receivables
  • creating patient-responsible invoices separate from third party and accurately tracking that response.



Dr. Kirchner is the senior partner of a group, multi-office practice in Nebraska. He predominantly concerns himself with primary care optometry, with an emphasis on contact lenses and the treatment of eye diseases.



Optometric Management, Issue: July 2003