EyeWorld Asia-Pacific September 2019 Issue

EWAP SEPTEMBER 2019 23 FEATURE There are also internal and external IT costs associated with the systems. There are other issues associated with EHR, like how it affects the patient experience. There are doctors who have shared concerns that they are now talking to patients over their shoulders while looking at the patient records instead of face to face. Mr. Pinto said he likes to the use the analogy of early automobile production. “Back in the early days when the automobile was invented, there were hundreds of companies,” he said. Similarly, in the early days of EHR, there were a large variety of companies. In the automobile world, there are fewer and fewer producers making more and more cars, and that’s the same arc we’ve traversed with EHR, Mr. Pinto said. “Now we have half a dozen or so in the ophthalmic space who are the leaders.” Mr. Pinto added that his observations relating to EHR technology can be mirrored on the practice management side. These systems have been in place much longer, around 30–35 years. If you look at where the world is right now, practices capture all kinds of demographic data on patients, however, they’re still “fairly primitive [in] harnessing that data to automatically benchmark.” He added that a practice’s accounting system and software may play into performance assessment in the future. “Perhaps in the next 10–20 years, a lot of work done by consultants will be automated and practices will be able to run the diagnostics on how their business is doing, and the system will spit out a narrative on what needs to be done to improve performance.” Mr. Pinto expects more software to be developed over time, possibly in other spheres, as ophthalmology is just “a tiny little corner of medicine.” Physician’s perspective John Hovanesian, MD, weighed in on his experience with EHR and other software he uses in his practice to help with outcomes, the patient experience, ˆ“«ÀœÛˆ˜} ivwVˆi˜VÞ] >˜` “œÀi° Dr. Hovanesian noted that “it seems like developers develop the systems the way they think they should be developed.” There are a few notable exceptions where physicians have developed, and they tend to be better, Dr. Hovanesian said. “Most of us end up working for our EHR rather than the other way around,” he said. Dr. Hovanesian discussed MDbackline, which he founded. It’s triggered by events that happen in the EHR, he said, giving the example of a patient who is scheduled for a consultation for cataract surgery. With MDbackline, the patient receives communication by email or text before coming into ̅i œvwVi] >Έ˜} ̅i“ ̜ Å>Ài some information about their vision and visual habits. Around T here is no doubt that EMRs are here to stay, much like the many things in life that we don’t like! If you ask any clinician about his views on life after the introduction of EMR, very few have positive things to say spontaneously! Let us look at both sides of the story. Without a doubt, EMR has a lot of positives going for it, particularly when it comes to patient logistics management, such as capturing excellent demographic data, sending reminders, alerts, setting up appointments, taking a glance at previous visits or taking a look at various investigations that may have been done for the patient (e.g. OCT, biometry). It may also have tremendous impact on planning or designing clinical or research studies with the wealth of data collected. This is more valid particularly for larger practices, group practices, and multidisciplinary hospitals. The majority of hospitals in our part of the world are standalone ophthalmic hospitals run by a single doctor. The practice pattern is also very different; ours is a more “direct” patient practice compared to a “referral” based practice system present in other countries. Realistically, having high-speed internet access at all times is also a challenge for many places. For them, adapting to EMR is likely to add È}˜ˆwV>˜Ì VœÃÌà ˆ˜ ÌiÀ“à œv >VµÕˆÀˆ˜}ɓ>ˆ˜Ì>ˆ˜ˆ˜} ̅i ÜvÌÜ>Ài] >˜` needing extra personnel in the team to help make use of the software. Also, the time spent per patient for the EMR is likely to hamper high volume practices, which are more common in our part of the world. /…ˆÃ ˆÃ ˆŽiÞ ̜ “>Ži ̅iˆÀ «À>V̈Vià v>À iÃà ÀiÜ>À`ˆ˜} w˜>˜Vˆ>Þ >à Üi ÀՈ˜ˆ˜} ̅i yœÜ œv ̅i Vˆ˜ˆV° *iÀܘ>Þ] >Ü>Þà w˜`…>˜`ÜÀˆÌÌi˜ ˜œÌià œÀ ëiVˆwV È}˜>}i that I do on the patient records more helpful in “tuning” with the «>̈i˜Ì] >˜` >Ãœ…i«Ã ÀiVœiVÌ Ì…i «>̈i˜Ì½Ã w˜`ˆ˜}à LiÌÌiÀ `Õi ̜ visual memory. Therefore, at our set up, we have both EMR as well as paper records, where we use the EMR for all our demographic details, SMS alerts, storing diagnostic images of the patient, and other >`“ˆ˜ˆÃÌÀ>̈Ûi «ÕÀ«œÃiÃ] ܅iÀi>à ̅i Vˆ˜ˆV> w˜`ˆ˜}à >Ài “>ˆ˜Ì>ˆ˜i` ˆ˜ ̅i «>«iÀ ÀiVœÀ`ð , ˆÃ `iw˜ˆÌiÞ > ÛiÀÞ ÕÃivՏ >``ˆÌˆœ˜] ˜œ `œÕLÌ about it, but I still think paper records have great value to a clinician and are not going to become obsolete any time soon. 'FKVQTUo PQVG &T 8CUCXCFC FGENCTGF PQ TGNGXCPV ƂPCPEKCN KPVGTGUVU Shail Vasavada, MD Consultant Ophthalmologist, Raghudeep Eye Hospital, Ahmedabad, India shail@raghudeepeyeclinic.com ASIA-PACIFIC PERSPECTIVES