your practice paperless will free up staff and space, impress patients and generally
make your life easier.
For the past 15 years, our office
has been on a mission to become totally paperless, and we have achieved this goal.
Electronic medical records (EMRs) are currently a hot topic, with many vendors entering
the arena. But back in the day, practice management software companies were slow
to keep pace with cutting-edge technologies. MS DOS-based software remained the
only available option years after the introduction of Microsoft's Windows operating
It's hard to imagine today that
my simple request for an electronic
appointment scheduler was disparaged as a "pie-in-the-sky" feature that no office
would want. Our
appointment book was so heavily laden with White Out that it would crack as you
turned the pages. This pushed me to purchase an off-the-shelf appointment scheduler.
It proved to be a sizeable improvement in function and convenience. The success
of our makeshift electronic appointment book set us on a firm course to convert
more office tasks.
practice started to crawl by using the computer to maintain simple demographic data
and perform patient recall. Today, the computer is our most essential piece of office
equipment and we could not practice without it. (see "The Role of the Computer,"
left, for functions served
by our computer).
I'll show you why you should go paperless
Bring it into the exam room
Originally, our test room had a single,
stand-alone computer dedicated to the perimeter and topographer also in that room.
Printing test results was slow, costly and added more paper to the patient file.
These instruments came with high-tech software that included impressive presentations,
but all I had to show the patient in the exam room was the paper printout
much less impressive.
My solution: I set up a simple network
so I could access the testing room computer from my exam room while the patient
was in the chair. Bringing the computer into the exam room created a windfall of
new uses for my computer. I can now:
and review exam findings
prior examination data
diagnostic test results
PowerPoint presentations for patients about their disorder and treatment options
electronic routing slip
refractive and pharmaceutical prescriptions.
Now that I am "connected," I am able
to release the full potential of my practice management software. If you speak to
a computer professional, they will say you need an expert to set up an office network.
I'm no professional and I'm telling you, it's child's play.
Location, location, location
Now how many computers
do you need, and where do you put them?
These are potential hot spots for the placement of computer workstations: Exam rooms,
the doctor's private office, tech station, business office, front desk, optical
and the lab. However, all of these locations are not indispensable. The front desk
is the location for all primary functions and is thereby essential. You can expand
slowly as you incorporate additional features and modules of your practice software.
As a guide, everywhere you need a telephone is probably a good place for a computer
workstation. Adding stations as your demand grows is easy, especially with wireless
Manage those documents
A patient record is much more than
a collection of exam forms. Thus, making records paperless takes more than just
computerizing exams. Documents such as letters, reports, co-management
forms, record release forms, insurance cards, new patient registration, HIPAA
statements, duty to warn, informed consent and plenty more, fill our patient folders
to the bursting point.
Scanners provide an easy solution
by creating a link between written and electronic documentation. These devices are
inexpensive, simple to install and enable us to translate all of our paper documents
into a digital format. Many practice management systems allow paper documents to
be scanned directly into the patient's electronic file. Loose papers are organized
by date, category and name. You can then quickly search within these categories
for documents within a patient's file.
Hopefully, in the near future, practice
management software will allow us to store blank forms that can be filled out electronically,
bypassing the paper to scanner steps. This ability could save thousands of dollars
annually in printing costs.
Last but not least: EMRs
One final point completes my argument
for going paperless. Our optical and contact lens records had been computerized
for some time before we attempted exams. We held off because available EMRs took
longer to complete, offered limited options and made freehand drawing
difficult. They more resembled typical data files rather than the familiar exam
forms optometrists are accustomed to. Adding a digitizing pen tablet to my computer
made working with my EMR truly practical.
Pen tablets plug into any computer
and allow you to write, draw or type within your electronic medical record. I can
navigate through the record faster than my mouse and can draw on anatomical eye
charts within the record. I've even added handwriting recognition software to my
pen tablet. It's like writing on paper energized by the power of the computer.
Every phone call and office visit
necessitates a trip to the file cabinet. I've calculated the labor expenditure devoted
to filing and record retrieval (including misplaced files). This adds up to one
half of a single employee's work load. This is not only a huge hidden cost that
doctors normally do not place under scrutiny, but there's also a missed potential
to utilize this staff member for other important office responsibilities.
Getting the staff on board is essential.
A hatred for filing is universal, so you're guaranteed to have their full cooperation.
With a little extra staff training and proper setup of the software, exam forms
can be prepared at the front desk. Having the staff pre-fill the reason for visit,
chief complaint, history and refractive information (taken from the patient entrance
form and auto-lensometer) speeds up
The patient record is ready and on
screen when I enter the exam room. Data entered from within the exam room automatically
generates spectacle and contact lens orders as needed. Our optician adds frame and
lens information at the optical computer, which we can later view from our lab workstation.
The staff loves this because they no longer have to write up optical forms.
Easing into paperless
At first, the staff had concerns
about converting existing records and the extra work it would involve. We decided
to transition to EMRs by using the old paper files in conjunction with the new electronic
records. The alternative is to scan paper records into each patient's file as they
return for care. The staff was relieved that I chose the former approach.
We also found that paper files rob
a practice of productivity. What do you do when Mrs. Smith is in the chair and asks
about her mom's last exam? I used to have my receptionist pull mom's file and bring
it to the exam room. Now I just open the record on screen where I can review past
exams, visual fields, retinal
photos and her next scheduled appointment. I don't have to take my receptionist
away from what she was doing, nor do I waste time waiting for her to pull the file.
Lay to rest legal fears
Worried about operating paperless
in the event of an audit or malpractice suit? Don't be. Even attorneys have gone
to electronic record storage. Global financial institutions conduct electronic transactions
and it's ludicrous to exclude healthcare. The spotlight on medical error prevention
will eventually shift the standard of care to require computerized record maintenance.
Illegibility and improper documentation
are safeguarded by an EMR, which protects both the doctor and patient.
At the completion of my examination,
I "lock" the patient's exam record so that no one can alter it in any way. Prior
office visits are easily reviewed on a read-only basis to prevent tampering. EMRs
track the level of care provided during the visit and direct me to code the exam
appropriately. This prevents under- or over-billing to shield the doctor in the
event of an audit.
Don't fight it
The world around us is turning
digital. Business is wireless and paperless, setting new standards for
efficiency. This is the direction our practices must move in to keep
competitive and viable.
Dr. Kreda practices in a primary care
setting in Lauderhill, Fla. He's a frequent lecturer and author. You can contact
him at firstname.lastname@example.org.