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Part 2: An EHR/EMR Review from One Who Has Faced Their Triumphs and Tribulations

Posted By LeRoy Judkins, COT, OCT-C, Friday, April 6, 2012, Wednesday, April 4, 2012
Updated: Friday, April 6, 2012

The current reality is that many of us are going to be, or are in the process of procuring an electronic records system.  Even though there is no perfect system out there it is still in your best interest to try and choose the system that is best for you.  A methodical and judicious approach is required for this activity.  Creating a standardized set of evaluation criteria will greatly benefit your process. 

Rona Lyn Esquejo-Leon, CRA receives a demo of an EMR.  Photo Credit:  Sarah Moyer

Rona Lyn Esquejo-Leon, CRA evaluates an EMR.  Photo Credit:  Sarah Moyer, CRA, OCT-C

Creating these evaluation criteria will be a process unto itself.  There are myriad things to consider and these considerations should go beyond the scope of the actual exam itself.  Impacts and capabilities of your computer infrastructure is a big part of the equation.  This is decidedly true if you have multiple locations or even a large amount of square footage.

Seeing exams in their simplest and also their more complex manifestations is good place to start.  Go through an exam where the patient is returning and all the elements are the same as a previous exam.  Then go through an exam where atypical or more extensive entries are made.  Count the number of clicks, key strokes, or steps that are required.  You will find there is great variation from one system to the next.  I have seen that often the easiest programs to use require many more steps and clicks.  The more elaborate systems require fewer clicks to complete some items but are at times more difficult to navigate and more overwhelming in their navigation.  The way a system looks does not translate at all to how well it performs.  You can put lipstick on a pig, but it is still a pig.  

Using the system yourself will tell you a lot about the system as well.  Take a few actual patient charts ranging from easy and typical to more detailed and complicated.  Transpose all the information from each of these charts into each system in the way you would normally go through an exam.  This will help give you a real life sensation on what it is like to steer through that program.  

A huge consideration should be made for special testing as well.  The method by which an order is created, how these orders are scheduled, how the technician is alerted as to what the physician wants, how the doctor is notified when the test is done, how the test is coded and billed, and how the interpretation document is created are all items that should be looked at.

The overall ease and use of letters and documents should be pondered as you preview potential systems.  For many of us the medical practice markets are becoming increasingly competitive.  Referral and consultation letters are really forms of marketing as well as conveying critical information.  How you present these letters and the information they contain casts a perception of your practice to the rest of the community.  Being able to format and create letters and documents that actually save you time and present well can be a very positive asset to your practice.  

The storage and ability to view images obtained by your devices is a monumental concern as well.  Understanding each piece of your equipment and what their individual capabilities are is also important to know.  Just because a system accepts images from a variety of devices does not guarantee that your device will export images in the correct format, or even at all, to a particular records system.  When we first implemented our system there was hardly an ophthalmic device out there that would interface.  Though that has dramatically changed, I would bet that almost every office out there has at least one piece of equipment that has no standard way of exporting an electronic image.  

You are also going to want a program that is savvy and written well.  In Stage I of Meaningful Use all we have to do is report on certain elements.  Stage II will require us to start doing things with these elements.  These requirements have not even been determined yet, so having a system that is clever enough and capable of adapting will be a necessity to make it viable going forward.  

In trying to prepare your evaluation criteria it could be beneficial to sit through a couple of demonstrations first.  This can give you an idea of how those activities unfold and may help you to formulate your thoughts, ideas, and questions. Vendors are usually willing to do more than one demonstration, so do not worry if you feel like you might have to come back and do multiple test drives of a system.  Everyone I have seen is capable of doing a demonstration on line.  If you have a speaker phone and a projector you can get several people involved.  In an effort to be consistent, you should limit those sitting in to the same individuals each time.

Rona Lyn Esquejo-Leon, CRA receives a demo of an EMR.  Photo Credit:  Sarah Moyer

Rona Lyn Esquejo-Leon, CRA receives a demo of an EMR.  Photo Credit:  Sarah Moyer, CRA, OCT-C

In addition to viewing a demo, seeing a system in the real world is unbelievably valuable.  Before you actually purchase a program I would strongly consider traveling to a clinic that has it in use.  The vendors can usually direct you to an appropriate practice that has their software live.  This is where you can get some of the most precious and unbiased information.  An excursion with a few key people could pay huge dividends in assessing the system as well as understanding some of the trials and tribulations of implementing that software at a comparable site.  

Lastly, the potential for the success of a system you choose is going to dramatically increase given the amount of preparation you do.  Anything such as drop down and pick lists that can be customized should have a lot of energy and forethought invested into them.  This process also has to remain fluid and flexible.  It will take a lot of active feedback for an extended period of time before these lists are as shiny and spectacular as they should be.  Try to keep an open mind and realize that an electronic records system is going to change the workflow of your office and likely even alter how you navigate through an exam.  The programs can be customized, but to realize the full possible potential of a system on our fantastic plastic machines it takes compromise and the ability to adapt.  A heaping dose of patience and poise will help as will the realization that a "perfect program” may never come to rise.

For those of you who are about to embark on this epic journey, you have my deepest respect and empathy.  If you have any questions or comments, or if I can help in any way, please feel free to contact me at or comment on this post below.   



LeRoy Judkins is a Retinal Angiographer, EMR Administrator and Lead Medical Technician at Eye Associates Northwest, PC, in Seattle WA.  He was originally trained in the United States Air Force where he worked in an eye clinic and was also a certified EMT.

Tags:  EHR  Electronic Records  EMR  Meaningful Use 

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