Article Date: 7/1/2005

The ABCs of EMRs
How one practice's search for software solutions led to exceptional results.

Four years ago, our group practice of seven optometrists, four ophthalmologists and two locations was suffering from a classic case of "Has anyone seen Mrs. Smith's chart?" syndrome. With a rapidly growing patient volume (approximately 200 patient visits per day), we were averaging five to eight missing charts per day. This was not only adversely affecting patient care, but creating significant frustration among doctors and staff.

It was very tedious to train new staff on our non-Windows based computer system from

the 1980s. Accounts receivable were in line with the average for large group practices (52-54 days out), but much higher than we were comfortable with. Handling a denied claim took days to resolve.

We knew we needed to make a change to provide better and more efficient care. Our patient volume was creating severe strains on the practice's daily operations. It was obvious that any new electronic practice management (EPM) system would be Windows-based and, thus, relatively easy to use for today's computer savvy generation of employees. At the same time, we decided that if we were to invest in a new EPM system, we would limit our search to a vendor that also had a successful electronic medical records (EMR) package.

In retrospect, it was certainly the right course of action. On an almost daily basis we read about the emphasis the federal government, individual insurers and health care systems are placing on EMR. Let's take a look at the benefits the right system can provide for your practice.

Know what you want

The search for a new system began with establishing some specific criteria. As I mentioned above, we decided to evaluate systems offering both EPM and EMR. But we also wanted a system that was HIPAA-compliant. This narrowed the search down to about eight vendors.

We also wanted a system that had been successful in the optometric arena. This allowed us to call colleagues and inquire about functionality and support.

Once we narrowed the search, we traveled to specific practices to see the systems in action. This is a critical step in the process. Observe whether the patient flow is smooth, how easy it is for the staff to use and the overall functionality of the practice with the system in place.

Over the years we have all seen many technology companies bite the dust, so we limited our selection process to companies that were well established and well funded. There were numerous other features, most of which are fairly standard in a modern system, that we insisted upon.

We ultimately narrowed down the search to two vendors, but one really stood out and even beat all of our criteria. Site visits to two large practices showed a well-developed package with the flexibility that we hoped for.

Getting it

Once we made our decision, we dedicated resources to teach the staff the system. The company offers on-site staff training, which initially focused on converting data from the old system to the new one. (We had a programmer convert all of the critical demographics for approximately 52,000 patients). We kept accounts receivable and recalls on the old system and just let that run down over the next year. With the patient demographics loaded, we trained staff in a "test" environment, setting up work stations in the lunch room. This allowed them to practice and make mistakes before we went live. Having our staff enter appointment schedules from old to new system was enough practice to train them on the EPM system.

We also used this time to establish scheduling templates and develop all practice-specific data, like insurance companies, UPIN numbers, provider numbers and recall protocol.

Making it work

Initially, we planned to run the EPM system for four to six months, then start the EMR system. However, at that time, the company was in the midst of developing new exam templates that we knew would be well worth the wait. So it was actually 12 months later that we started with EMR.

This required a bit more work up front to customize the drop down menus, alter the exam template to better resemble our old paper formats and create the documents driven by the exam templates. Now chart notes or referral letters are complete before the patient even leaves the exam room.

A company EMR trainer was on hand for our first two days of live EMR and everything went extremely smoothly. Of course, during the first week or so we discovered numerous items that needed to be tweaked. For example, for corneal findings we adjusted the list to rank the clinical findings in order of frequency.

For the EMR training we had our technicians create "virtual visits" with established patient data one or two days before the patient's exam. We created a "visit" that included the previous family, medical and ocular histories along with medications, previous procedures or treatments, and recent spectacle and CL information. Additionally, we scanned in all pertinent referral and consult reports and forms. By doing this, at the patient's first "electronic" visit, their record was already in the system.

With medical records, it took approximately five to six weeks for everyone to starting thinking "electronically." EMR creates a new way for our brains to assimilate data and get a complete picture of the patient. This involves re-working a lot of old habits.

The reality test

Now we have been up and running for over two years. Our patient volume has increased (at an annual rate of 15%) without the need to add additional human resources. Several staff members have even shifted to other responsibilities. Accounts receivables have plummeted from 54 days out to just 24.

We no longer lose any charts! Calls for prescription refills are handled while the patient is on the phone. Billing denials are seen from a computer screen and immediately handled.  Doctors can review patient records while on call from just about anywhere.

Essentially, our entire practice has been transformed and is well positioned for the future.  I don't think we could ever go back.

Dr. Edlow is Chief Operating Officer of the Katzen Eye Group in Towson, Md. He is Chair of the Information & Data Committee of the AOA. Send e-mail to


Optometric Management, Issue: July 2005