The first step in the transition to a mostly paperless, more efficient office is using electronic health records. “It’s not just doctors who the government wants to move away from paper. Effective this month, there will be no more Social Security checks. Money must be direct deposited, or the government will work with you to set up a special bank account,” Mr. Mahdavi says.
In the future, instead of moving paper, practices will be moving information. “When we move information and the information is all aggregated in an electronic form, it puts the doctor in a much more powerful position to act. This means that the patient’s eye history is all in one place. That’s very good for the patient, the doctor, society and billing,” he adds.
Beyond EHRs, here are some of the other ways that technology may alter current medical practices.
The Internet is an important component of a more efficient office, and the use of new technology can begin in the patient’s home with pre-encounter scheduling. Sophrana Solutions, based in North Oaks, Minn., offers a secure online patient portal for ophthalmology practice websites that allows patients to schedule appointments and to upload their medical history if they are a new patient.
“Information technology has allowed us to decentralize and delegate some of the processes,” Mr. Mahdavi says. “Shifting labor to the patient is great because we save the staff time and we also reduce the possibility of data entry error. Rather than a patient hand writing information on a clipboard and then a staff member inputting that information, let’s have patients do it either at home before they come to the office or by using a computer or kiosk in the office. This should help consumers be more interested and be partners in their own health care because they are more engaged.”
Requiring patients to input their own data frees up the staff and the ophthalmologist to spend more time with the patient. “Our hope is that the doctor has more time to have eye contact and to have a meaningful discussion, because nothing replaces the doctor/patient discussion,” says Mr. Mahdavi. “In addition, receptionists shouldn’t be typing when the patient walks in. Instead, the receptionist should be greeting the patient because all of the data have already been entered.”
It is also imperative to have a presence on the Internet. A practice’s website needs to be dynamic and constantly updated, and it needs to provide feedback to the practice through post-encounter surveys, according to Mr. Mahdavi. Staff resources will need to be adjusted accordingly. As an example, staff members no longer dedicated to inputting patients’ information will need to constantly update the website and respond to e-mails and texts.
Practices are also moving away from paper in the way they educate patients. Rather than having pamphlets, brochures, and videos on a TV screen, patients can be given an iPad with relevant reading material and videos to educate them about their condition while they are in the office.
Ophthalmologists are being educated in new ways, too. They can now participate in continuing education through webinars, and they can do consults over the Internet. “This will revolutionize education, because we are no longer bound by place,” says Mr. Mahdavi. “In other words, we don’t all have to be in the same place in order to get quality education. There’s nothing like meeting face-to-face, but, with webinars and real-time videoconferencing that can be done for free via Skype or Apple’s FaceTime and iChat, it gets pretty close. If we can get 80 percent of the way there with 10 percent or 20 percent of the overall effort because we didn’t have to get on a plane or book a hotel and we’ve avoided that expense, that’s progress.”
Putting Technology to Work
One practice that is already incorporating new information technology is the Eye Center of Central Pennsylvania, which employs three ophthalmologists and was the first ophthalmology practice to receive payments under meaningful use. The practice is located in a somewhat rural area and includes 10 locations and a free-standing surgery center. Scott Peterson is the director of information technology for the practice. “A lot of our focus has been on the implementation of meaningful use and EHRs,” he says. “Additionally, as we beefed up our network to support our 10 offices in these various locations, we switched to voiceover IP. Every office has four-digit dialing to every other office. If you are a single practice, this may not be that big of a deal, but with 10 offices, having the ability to four-digit dial without it being a long distance call is a big advantage.”
They have also been concentrating on the convergence of technology, so that all of the cameras, imaging devices and visual fields interface into the EHR. The practice is also making use of patient portals. Patients receive a secure e-mail message five days before their appointment. When the patient opens the message, he is presented with a button to push to confirm receipt of the e-mail. “Our practice is pretty typical. It’s a little more on the senior side, and we are seeing a 65 percent confirmation rate of e-mail reminders,” Mr. Peterson says.
Another benefit of new information technology is medication reconciliation. Surescripts operates the nation’s largest e-prescription network. “When you see it work, it’s pretty amazing. If patients come into our practice and can’t remember what medications they are taking, which is common, Surescript can provide this information if they have had a prescription filled through any kind of prescription plan. Prescriptions from our office are sent electronically to the pharmacy,” Mr. Peterson says.
He notes that all practices will need some level of IT support to fully incorporate new information technology. An in-house staff member would be ideal, but this may not be practical or affordable for smaller practices. “These types of practices will clearly need some kind of consulting service,” Mr. Peterson says. “We are still not hearing that there is a significant amount of adoption in the ophthalmology community. There is more awareness, but we are not seeing the floodgates open yet.”
While new IT can improve a practice’s efficiency, it also places ophthalmologists in uncharted territory, such as social networking sites.
“I work in the area of HIPAA compliance, and one of the aspects that needs to be looked at is security, says Joan M. Kiel, PhD, an associate professor in the department of health management systems at Duquesne University. “How is the new technology being implemented? Is the physician using one Smartphone for both work and home? Does he have both work messages and personal messages on the same phone? What is the protection on that phone in terms of security? Some people have separate phones and separate computers for home and work. Some doctors are even using Facebook, and they really need to watch what they put on there and how patients interact with them on their personal pages. Typically, it’s not the doctors; it is the patients who will push the envelope.”
Because patients want information quickly, they may ask about diagnoses or symptoms on an ophthalmologist’s Facebook page, and she cautions ophthalmologists about engaging in this type of communication with patients.
Seeing into the Future
According to John Pinto, eye centers of the future will look much different than they do today. “Every single member of the practice is going to be wirelessly connected to each other, and patients will probably have little clipon detectors so that their location in the clinic and their movement through the clinic can be tracked,” says Mr. Pinto, a practice management consultant located in San Diego.
Patients will check in at a kiosk rather than checking in with a receptionist. Ophthalmologists will be seeing many more patients in a day with the use of extenders, such as optometrists and technicians, and they may only be involved in the most difficult cases. “These are just the first few primitive baby steps on the way to what health care will look like in the future. Ultimately, we will have subcutaneous Chips so that if we faint on the sidewalk and are whisked to an emergency care center, our entire record would be right there with us. Obviously, there are all kinds of Orwellian overtones for that kind of environment,” he adds.
He also notes that the transition to kiosks will be much slower in medicine than it was in airports and that the transition in ophthalmology will be slower than in emergency medicine.
Jeff Grant, a medical practice management consultant with HCMA Inc., notes that in five years, the interface between the patient and the practice is going to be via computer or kiosk only. “This means that practices will need fewer staff members, and visits should be more efficient and take less time. One concern is the quality of the information because the data entered by patients is not always reliable, so there will still need to be some data review. However, scanning information coming from the Web should only take 30 seconds to review. If it’s done right and it’s done once, it should reduce errors,” he adds.
Mr. Mahdavi adds, “Five years from now, the practices that have adopted new technology will be doing very well. They will be doing more with less, which is important because reimbursements are only going to go down. The practices that have digitized, that have gotten out of paper, and that have become more efficient will be well-positioned. Ultimately, [IT], used properly, means more effective care. Those practices that don’t adopt EHRs and other tools are not going to survive.”
According to him, the next step will be that the regulations will adjust to be more in tune with technology. “The infrastructure is built, and the regulations will change. Doctors don’t communicate with their patients via e-mail because they don’t get paid for it. When the Medicare rules were written 30 years ago, e-mail did not exist. Eventually, the rules will catch up to the new paradigm,” he says.