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Automating the Exam Lane With Software Integration



 One of the core objectives of Meaningful Use Stage 2 is e-prescribing.
As EHRs evolve, so does their efficiency. While older legacy systems may have been click and typing intensive, newer programs are offering more intuitive and adaptive learning interfaces for use on portable tablet devices. This frees up the ECP’s attention for the one-on-one eye contact that is so important during the examination. “You can go back to having conversations with patients, because you don’t have to have your back to the patient entering things in the desktop,” said Ryan Wineinger, OD, of Wineinger Vision Associates of Shawnee, Kan.

For example, VisionWeb’s new Uprise EHR starts by helping the doctor and staff do a better job recording the patient’s history. Through an online portal or on a tablet in the waiting room, the patient makes selections to document their health history. By the time the doctor sees the patient in the exam room all of this information has pre-populated their health record. As the doctor proceeds with the examination, any diagnosis entered automatically selects ICD codes, recommends testing and suggests educational materials that can be sent directly to the patient via e-mail. “We focused on reducing the amount of clicks and the time it takes to complete anything,” said Julia Medina, director of product strategy for VisionWeb.

Eyefinity EHR also offers adaptive learning and an intuitive interface, again to reduce the number of clicks necessary, eliminate the need for typing and streamline the examination process. The new technology combines Eyefinity’s practice management and EHR solution experience with Modernizing Medicine’s Electronic Medical Assistant. Pinch and zoomable on an iPad, the software is adaptive through touch, and it types out a diagnosis based on the choices the doctor has selected.

“Workflow is changing in the office,” said Floyd Webb of Eyecom3. “Technicians or pre-testers can prepare the patient record so it’s already on the doctor’s computer when he gives the examination. Doctors are now able to do more of what they went to optometry school for, attend to patients, because the staff can work on the gathering of patient history and pre-testing for the doctor.”

Diagnostic Instrument Integration


Reichert’s Auto Phoropter RS Refraction System integrates with First Insight’s MaximEyes cloud-based EHR software.
In the past, data and images generated by diagnostic equipment were stored and accessed separately from the patient’s electronic health record, or it was a cumbersome process to transfer the information between them. Today, these devices can automatically upload their information directly into the patient’s record. For example, equipment provider, Reichert Technologies recently released a built-in bi-directional certified integration between its Auto Phoropter RS Refraction System and MaximEyes cloud-based EHR software from First Insight Corp. The new equipment integration allows users to upload lensometer or auto refractor data directly into a MaximEyes patient exam record then export the final data, such as manifest refractions, pupillary distance and unaided VA from the EHR to the phoropter.

Both the time taken to create the record and the errors that might result are reduced. “The old way, you’d check the Rx with a phoropter then go into the EHR and retype it,” said Harris. “Now we have digital phoropters to generate the information. Hit a button, and it goes right into the EHR. Hit another button to authorize the Rx, and I’m done.”

“Uprise EHR will be integrated with digital refraction systems such as Marco and with other pieces of technology such as retinal imaging, OCTs, etc.,” said Lorie Lippiatt, OD, of Salem Eyecare Center of Salem, Ohio, who was involved in the development of the Uprise EHR system. “Image management will ultimately be built in as well.” Images are an important part of the eye examination, and incorporating them into EHR systems will enable ECPs to easily access, reference and compare them over time to improve the efficiencies as well as the outcome of patient care.

In addition to images, other information generated by diagnostic instruments also integrates with EHR systems. For example, diagnostic data automatically populates VisionWeb’s Uprise program, which includes pre-entered minimum and maximum values in each field. The system warns the ECP when numbers approach these minimum or maximum values. The vitals required by Meaningful Use are included and can be graphed to measure their changes over time.

In anticipation of the massive coding overhaul from ICD-9 to ICD-10 being undertaken by the Centers for Medicare & Medicaid Services, Uprise software is built on the new coding system but still automatically backs to ICD-9 while it is still in effect. CMS expects ICD-10 to be in place by Oct. 1, 2014. “In order to get paid for a claim, doctors’ certified EHRs will morph under their feet in 2014,” said Scott Jens, OD, FAAO, CEO of RevolutionEHR, referring to the coding changes that will take place and the fact that software developers will have to accommodate them. ■