Adapting Workflow to EMR at Your Practice

While discussing electronic medical records with a colleague, I was recently asked about the capability of customizing different systems. Some of the products on the market highlight simple use, or the fact that templates aren't required. This modular approach could have value in some individual practices, but this methodology strives for simplicity at a cost of ability. It would be enough to have patient records documented electronically, but it would be more difficult to make meaningful sense out of this info, or use it in an enhanced practical way, such as in identifying trends. Additionally, this info will prove invaluable in future situations such as pay-for-performance verifications.

By its nature, ophthalmology demands a robust system which can document both traditional SOAP notes and high-resolution images and drawings. Some years ago, we met with an IT company that was developing an EMR system for ophthalmology. As a result, we agreed to work with them as a beta test site, feeling that if their system could function for ophthalmology, it would also work for other specialties. However, the system wasn't really ready for the big leagues at that time, and we found ourselves immersed in increasing amounts of basic programming work. Our previous EPM vendor did not have a good product available for ophthalmology at the time, although a major player in the overall market.

The consequence to consider when customizing is the need to spend more effort modifying the system. Most systems come 'out of the box' ready after basic set-up. However, the true potential of these systems reside in their ability to alter operations to suit the needs of a practice and the physicians within it. Some modifications must occur in order to adapt the practice workflow to the basic EMR system. We discovered that the best way to do this is to break up workflow using mind-mapping software.

The best part about mind-mapping software is its ability to get a group of people to think visually. Participants actually 'see' the workflow, from the patient entering the office to check in, then moving to the exam room, and finally checking out. We can look at the overall flow of the clinical exam, be it an entrance exam, refraction, or dilation examination. This has helped us not only to modify our EMR system to fit our needs, but also to help locate where workflow could be streamlined to improve overall efficiency at the practice.