Three Tactics To Help Prepare Your Retinal Practice for the Future

Dr. Rivers shares his insights on how retina practices can set the foundation for future success.

This article was originally appeared in Administrative Eyecare and is available by subscription only.

With the increased use of new therapies and treatments, a large aging population, and the rising incidence of obesity in the U.S., retina specialists will likely treat a higher number of patients for the foreseeable future. Combining these demographic changes with the healthcare industry’s shift to value-based care means it’s more important than ever that clinical workflows increase accuracy, maximize efficiency, and improve patient outcomes.

Retina practices can implement a number of tactics to help set the foundation for continued success. I’ve outlined three changes you can make that may help improve the patient and practice experience.

1. Connect with elder generations through user experience.

Since the four major eyecare disorders―diabetic retinopathy, cataracts, glaucoma, and macular degeneration―are age-related, the impact of the Boomer generation’s so-called “silver tsunami” on ophthalmology-specific practices continues to be top of mind. To reach this growing segment of the population, it’s important to ensure that patient-facing technology and applications are user friendly and intuitive for all ages.

In fact, a recent study¹ suggests that aging patients are looking for better and more continuous communication with their healthcare providers in order to improve their health. Healthcare providers can improve communication with this population using an ophthalmology-specific EHR that includes patient-centric features such as app-based kiosks for front desk paperwork, online patient portals, and personalized educational handouts. These features will help to empower patients to become more involved and take control of their own care and well-being. By providing patients with tools to manage their eyecare, they can keep track of their past and future appointments, update their own medical information or prescriptions, and give electronic access to loved ones or caregivers who support the patient’s health. Other benefits include reducing potential errors from illegible documentation, while populating the patient’s electronic health record and making it easier to share with other providers.

Having an outdated, difficult-to-navigate system may not only increase the time patients spend at the doctor’s office but may also cause frustrations with their overall care.

2. Employ an ophthalmology-specific EHR system.

The adoption of EHR systems in ophthalmology practices has nearly doubled² since 2011 and continues to grow. If you’re considering implementing an EHR or upgrading an existing solution, keep in mind that not all ophthalmology EHR systems are created equally. Black Book Research annually reports the top ambulatory EHR systems by physician specialty, and although the 2018 list includes 20 in the ophthalmology field, the level of specificity the out-of-the-box software provides for ophthalmologists likely differs. For example, sometimes software comes complete with ophthalmology diagnoses, procedures, and treatment plans built in, and other times the practice is responsible for building templates that best suit their workflow. With some health IT companies, ophthalmologists simply consult to help build the software for their specialty. Other times the vendor employs practicing ophthalmologists and teaches them XML which allows them to code their medical knowledge right into the software. They also work closely with software engineers, medical illustrators, and other members of the team to create the final product. It’s also important to note that many EHR systems available aren’t specialty-specific, even if they have an ophthalmology solution within the larger platform.

For example, think about the patient journey during an appointment at a retina practice―s/he might be screened in one area, tested in another, transferred to a third to consult with the retina specialist, and seen for the final time at the checkout counter. Each of these stops must be accurately documented in the patients’ record, but non-specialty-specific EHR systems lack such workflows, requiring additional coding and workarounds likely by the doctor or other office staff. A true ophthalmology-specific EHR system is one built to match the patient journey and physician workflows that take place during an ophthalmic appointment for all subspecialties, including retina, ocular plastic surgery, cataracts and refractive surgery, cornea, glaucoma, and more. When an EHR isn’t designed specifically for a subspecialty, those physicians and their staff must often take unnecessary steps to complete patient paperwork. Not only is this inefficient, but the collection of unstructured data―which can be thought of as narrative, unorganized, and without a pre-defined data model―makes reporting difficult, and leaves practices without the ability to benchmark patient data.

Alternatively, structured data can be defined as³ any data that resides in a fixed field within a record or file. This includes data contained in relational databases and spreadsheets. The collection and benchmarking of data is important for meeting reporting requirements as well as for making better-informed practice or business decisions and monitoring how the practice performs compared to the rest of the industry.

Additionally, ophthalmology practices present a unique challenge because they operate from two different charts: one with clinical data and the other with surgical data. A truly specialized ophthalmology-specific EHR makes these clinical records easier to find and follows the workflows clinicians and technicians already use, with very little need to free-text or dictate into the medical record.

3. Consider keeping your data in the cloud.

Cloud-based systems, in addition to requiring a smaller up-front technology investment and reducing ongoing maintenance costs and issues, can be accessed virtually anywhere there is an Internet connection. For example, if a patient calls over the weekend with a question or a request for a prescription refill, a provider can easily access the medical records on a smartphone. The patient can then receive more timely care when needed, and the physician can reduce Monday morning’s task list.

The growing prevalence of multi-location practices makes cloud-based technology a more logical option. It’s easier to manage practices and patients when the information is readily available in each location and not in a silo at one office or another. The cloud can also practically eliminate on-site server limitations while ushering in peace of mind and security. For example, if a natural disaster were to strike, patient records aren’t stored on site and therefore should be safe, even if the rest of the office is affected.

While the benefits of cloud computing are many, some providers worry about losing control of their data, security, and more. These are certainly valid concerns, and it’s important that ophthalmologists and staff who are evaluating the various options do their homework and understand what questions to ask of potential vendors.

Whether providers are in the cloud yet or not, efficiently and securely sharing a patient’s protected health information with other providers is made easier with technological advances such as collecting structured data, direct messaging, and e-faxing. Today, medical practices employ various EHR systems with quite a range of technology, and although some practices still use paper records, the information sharing between software continues to improve even with the wide range of EHR systems practices employ. So as the industry continues to work diligently towards interoperability, we must continue to be flexible in how we share information. Ultimately, cloud technology will help improve accessibility and usability for patients and providers alike. Overall, the growth of cloud-based systems isn’t likely to wane anytime soon, and understanding both the benefits and limitations^4,5 will be important to future adoption.

Putting it all together

While practices can utilize many strategies to improve patient experiences, these are a few ideas I believe will continue to be important in the coming years. These strategies may help improve workflows, attract and retain patients, and, perhaps, provide better care. As technologies, treatments, and populations continue to grow and change, retina specialists should continue to innovate and adapt to stay ahead of the curve.

Notes

¹ Walker, T. (2018, April 2). What senior patients want from EHRs: Surprising survey findings. Managed Healthcare Executive. Retrieved from http://www.managedhealthcareexecutive.com/technology-and-patient-engagement/what-senior-patients-want-ehrs-surprising-survey-findings

² Lim et al. (2018). Adoption of electronic health records and perceptions of financial and clinical outcomes among ophthalmologists in the United States. Jama Ophthalmology. Retrieved from https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2666828

³ Beal, V. (2018). structured data. Webopedia. Retrieved from https://www.webopedia.com/TERM/S/structured_data.html

⁴ Dunn, L. (2018, June 20). Understanding the benefits of using a

cloud-based system. Modernizing Medicine [blog]. Retrieved from https://www.modmed.com/blog/public-vs-private-cloud-for-medical-software/

⁵Holden, J.S. (2018, Mar/Apr). Cloud computing: Storms or blue skies? Administrative Eyecare 27(2), 18–19.

Michael B. Rivers, MD

Director of Ophthalmology