THE PAIN AND GAIN OF ELECTRONIC MEDICAL RECORDS AND IMAGE CAPTURE IN OPHTHALMOLOGY - THE ADMINISTRATORS ROLE

THE PAIN AND GAIN OF ELECTRONIC
  MEDICAL RECORDS AND IMAGE
  CAPTURE IN OPHTHALMOLOGY
               Ann Koval
       Baylor College of Medicine

      THE ADMINISTRATORS ROLE

CHANGE

DENIAL

FEAR

WE WERE THE SMARTEST IN
 OUR CLASS – WE CAN DO
         THIS

HOW SOON CAN THEY BE GONE?

HOW SOON CAN I SEE THIS WHEN I OPEN THE
          PATIENT RECORD?

WHERE DO YOU FIT IN?
What role will you play?

WHERE ARE YOU NOW?

• EMR AND IMAGE CAPTURE IN PLACE

• EMR ONLY

• NO EMR AND NO IMAGE CAPTURE

•   KNOW YOUR ORGANIZATION

• WHAT IS YOUR ROLE IN THE ORGANIZATION

•   KNOW YOUR FACULTY AND CLINIC

•   PLAN

•   NETWORK WITHIN YOUR ORGANIZATION

YOUR ORGANIZATION
•   HOSPITAL BASED PRACTICE?

•   MULTI‐SPECIALTY GROUP PRACTICE?

•   SINGLE SPECIALTY GROUP PRACTICE?

YOUR ROLE
• ACADEMIC ADMINISTRATOR

• ACADEMIC ADMINISTRATOR with clinical
   responsibilities

FACULTY AND CLINIC
• HOW MANY FACULTY ?

• WHAT SUBSPECIALTIES DO YOU HAVE?

• WHAT IMAGES DO YOU NEED TO CAPTURE?

• WHERE DO YOU WANT TO VIEW THE IMAGES?

• HOW CAN WE IMPROVE WHAT WE HAVE?

PLAN
• WHERE ARE YOU STARTING?

• WHAT IS THE GOAL

•   DEFINE WHO NEEDS TO BE INVOLVED
                     Faculty
                      Staff
               Hospital personnel
              College or Hospital IT

•   WHAT IS YOUR TIMELINE?

NETWORK
Regardless of where you are in the process
        Be sure to network with:
• IT

• HOSPITAL ADMINISTRATION

• FINANCIAL ADMINISTRATION

• INSTITUTIONAL EMR TEAM

THE BAYLOR COLLEGE OF MEDICINE EXPERIENCE

     2009 – EPIC Cadence (scheduling)
      2009 – EPIC Prelude (registration)
          2010 - EPIC Optime (ASC)
  2012 – EPIC EpicCare (ambulatory record)
        2012 – iViews Imaging System

WE LEARNED:
1.   It takes time
2.   Coordination with IT is essential
3.   Time invested in faculty buy‐in is valuable
4.   Collections do improve with EMR
5.   On‐demand record and image availability helps
     with patient satisfaction

PAIN

•   FACULTY FRUSTATION
•   INSTITUTIONAL INTERACTIONS
•   SOFTWARE SUPPORT
•   UNREALISTIC EXPECTATIONS
•   THE TIME INVESTMENT REQUIRED
•   RESOURCE ALLOCATION

Sigrid Button
          Casey Eye Institute
  Oregon Health and Science University

• History – OHSU leadership early adapters

• 2006 Go-live on Epic

• Workarounds and poor user interface results in:
                 •Decreased volume
                 •Increased workload
                  •Frustrated Faculty

• 2012 – Kaleidoscope not an institutional priority

• Casey must compete for institutional resources

• Presentation is made to hospital administration

OUR CASE:

1. 10 distinct subspecialties from plastics to neuro to
   contact lenses.
2. Diverse workflow.
3. Unique diagnostics.
4. High volume – up to 70 patients per day per
   provider.
5. 8 of the 10 busiest physicians at OHSU.
6. Casey provides over 14% of Ophthalmology’s
   outpatient visits.

WHY KALEIDOSCOPE
1. Specialty specific documentation tailored for
   improved efficiency and quality.

2. Capture discrete information from examination
   (critical for meaningful use).

3. Better workflow for imaging and numerical device
   integration

WHAT WE LEARNED FROM OTHERS
1. An institution already using EPIC reports that
   Kaleidoscope improved efficiency – 2009 15 FTE faculty
     see 38,000 visits; 2011 16 FTE faculty see 53,000 visits using
     Kaleidoscope.
2.   What we extrapolated for Casey – in 2011 we saw 79,404 patients
     with 26 FTE faculty. We have the potential of seeing 110,748
     patients in 2013 with 28 FTE faculty.

                  IS THIS REALISTIC?
                       POSSIBLY

ANOTHER WAY OF LOOKING AT IT

Could efficiencies with Kaleidoscope help us see
one additional patient per half day session? We
believe it could on average based on thoughtful
faculty analysis of Kaleidoscope features.

We have 6,336 half day sessions. Using average
pro fee and facility fee, our collection rate, we
could increase revenue to faculty and institution by
$1.9 million per year.

IS THIS REALISTIC?
              WE THINK SO IF:

1. Institutional resources are allocated for good
   implementation.
2. Patients are available – we think so because
   average third next available is 35 days and,
3. Demographic changes in the future should
   create more demand.

BEYOND DOLLARS WE ANTICIPATE:

1. IMPROVED DOCUMENTATION
2. BETTER PROVIDER SATISFACTION
3. RICHER DOCUMENTATION LEADING TO
   BETTER RETROSPECTIVE STUDIES
4. BETTER PATIENT CARE
5. IMPROVED QUALITY MONITORING AND
   REPORTING (Meaningful use and Research)
6. IMPROVED EFFICIENCY

Cameron Blount
    University of California, Davis

RELATIONSHIP WITH INSTITUTIONAL IT

THE UC DAVIS EXPERIENCE:
•   RELATIONSHIP IS VITAL! DON’T GO IT ALONE
•   INSTITUTIONAL IT INVESTMENT AT UC DAVIS
•   EMR IMPLEMENTATION
•   SPEAK UP! PERSISTENCE IS KEY
•   MEDICAL DIRECTOR’S ROLE
•   SET UP REGULAR MEETINGS
•   IT’S ALWAYS MORE WORK THAN YOU THINK IT IS
•   INDUSTRY DOESN’T HELP (DICOM, etc)
•   UC DAVIS’ HIRING SOLUTION
•   INVESTMENT ON BOTH SIDES

Jeff Good
Northwestern University School of Medicine

  CHARGE CAPTURE AND COLLECTION
          IMPROVEMENTS

THE GAIN

ROUNDTABLE

Image Capture Vendors – some vendors

    There are other vendors and your current institutional PACS may also be
                     willing and able to provide the service.

•    Merge Health (OIS)
•    Topcon Synergy
•    Topcon Imagenet R4
•    Sonomed Escalon Axis
•    Anka EyeRoute
•    iViews Imaging System
•    PACsPlus –ophthalmology
•    INFINITT ophthalmology
•    Visbion IPACS
•    MedVision IMPAX for ophthalmology