the path to paperless
Assessing Alternatives to EMR
For now, a scanning system may be adequate.
By Peter J. Polack, M.D., F.A.C.S.

In a multipart series, Dr. Polack is describing how a seven-partner practice, Ocala Eye in Ocala, Fla., with five locations and 140 employees, makes the major transition from paper medical records to EMR. During the course of the series, Dr. Polack will provide readers with a "real-time" look at how the implementation is progressing. This is part 17 of the series.

A couple of years back, we were facing a lack of physical space for our patient charts and were even considering acquiring additional office space to store the flood of paper records that was threatening to inundate our practice.

I had been looking at EMR systems tailored to ophthalmology for several years and definitely felt that the time had come for us to go paperless. Since selecting an EMR system and developing a well thought-out implementation plan, we have been working on our eventual severing of the umbilical of paper records.

It has been a long haul of planning, training and implementing parts of the network a little at a time, but our practice will soon "go live" with our complete EMR system.

However, we know that Ocala Eye is not typical of every practice. In this article, I will discuss some possible alternatives for practices that either do not have the desire to — or do not have the resources — to convert to an EMR system at this time.

EMR is Not for Every Practice

Conversion to a full EMR system requires a considerable investment of time and money. As a moderate-sized practice with nine physicians and more than 100 employees that are dispersed across five locations, we have the necessary resources and staff to accomplish this goal. But what about a smaller practice, or one that is not ready to commit to such a considerable project?

A true EMR system requires input of data and stores it digitally into a database record. These data can then be manipulated in an almost limitless fashion – limited in most systems by the software and in others by the imagination of the user. The increased flexibility of some of these EMR systems can also make them more intimidating to the novice (as most physicians are). But once it has been set up and tweaked, an EMR system can be very powerful. Thus, the more extensive requirements on the front end reward the user on the back end.

Are There Alternatives?

What, then, are some alternatives to a fully digital EMR system for a practice that wishes to forgo the effort and expense (at least up front) that these systems necessitate?

Some practices have bought what is essentially an electronic practice management (EPM)/EMR product but are still not using the EMR system to its full capability. For example, notes are handwritten as usual and then they are scanned into the system. This is known as a scanning solution.

Many EPM systems — with or without EMR — have a module for scanning in paper records, letters or other items such as photographic prints. The result is what is known as an electronic medical record or health record. But since there is no actual data entry on the part of the user, it is not a true EMR system. The advantage of this method is that a practice can use an existing EPM system to handle the volume of paper records without the added expense of an EMR system. 

Scanning has Limited Uses

The practice can create a policy for shredding of documents as they are scanned, thereby freeing office space for other uses. The disadvantage is that because clinical data are not entered into the system, data cannot be retrieved for any meaningful manipulation.

Examples of the drawbacks of scanning would include being unable to follow a trend in glaucoma patients' IOPs over time or being able to pull up all patients with a certain diagnosis who are on a specific medication. This information may be invaluable for information auditing used for such emerging concepts as pay-for-performance (P4P).

It is almost certain that practices will need to have a fully functioning EMR system in order to meet the reporting requirements of P4P, which could become a reality in the next several years. Practices that cannot furnish the information required by a P4P system run the real risk of being reimbursed at lower rates than those practices that can clearly demonstrate efficient operation and a record of favorable patient outcomes.

Stand-Alone Scanning

One less expensive alternative to EMR is a stand-alone scanning solution such as the one from SRS Software (www.srssoft.com ). This system can even be used by those few practices that do not have a full EPM system. It can also be used as a temporizing measure until such time as a practice decides to use a full EMR system.

It is also useful as a means of archiving huge volumes of old paper records. Again, there is no data entry performed as this is a digitized copy of a handwritten chart. Some of the benefits of a scanning solution such as this include little or no learning curve, lower initial cost, no change in the way a physician normally practices and a higher rate of successful implementation as compared to an EMR system.

Lastly, for those practices that are not ready to leave the comfort of paper records, there are ways to improve efficiency and make patient charts more legible. Many medical practices now use handwritten notes on line sheets or blank paper, often written by the physician. Unfortunately, these types of records are vulnerable to misinterpretation in audits and so the apparent time savings of a brief note can prove quite costly. There are several specialty-specific forced-entry forms available that require checking off or circling of signs and symptoms as well as clinical findings. These can ensure that the appropriate components for coding and billing are included in the documentation.

Next: EMR and Imaging Solutions

Peter J. Polack, M.D., F.A.C.S., is co-managing partner for Ocala Eye, PA, and a specialist in cornea, external disease and refractive surgery. Founded in 1971, Ocala Eye is a seven-partner, multisubspecialty ophthalmology practice located in Ocala, Fla. The practice, which has five locations including an ASC and laser center, has 140 employees. He can be reached by e-mail at ppolack@ocalaeye.com.

Ophthamology Management, Issue: August 2006