EMR: The second time around

Transitioning to a new system doesn’t have to be so traumatic.

Transitioning to a new electronic medical record (EMR) system is never easy — but with the right vetting and training, you can make it as seamless as possible.

Many ophthalmic practices are making the switch to a new EMR as vendors offer programs that deliver modern, efficient and less costly solutions.

If you feel like your practice’s first experience with EMR adoption was a less-than-serene experience, here are some of the biggest considerations to keep in mind as you choose a new EMR and get staff ready to use it.


When it comes to finding a new EMR, you likely want to pick one that, after the initial training period, doesn’t hinder your practice’s efficiency and ability to see patients. To do this, you may want to start by considering EMRs created specifically for ophthalmology.

“There are still universal EHRs that have templates you can kind of create to make sure they fit your specialty, but it’s important to understand the difference between specialties and subspecialties,” says Michael B. Rivers, MD, director, EMA ophthalmology, Modernizing Medicine, Boca Raton, Fla. This is because the work flow for the types of physicians in a given specialty — say, a retinal physician in a high-volume practice vs. a neuro-ophthalmologist — can vary so widely. You want an EMR company that understands those differences so they can be addressed in your EMR. While searching for a new system, you will likely ask other ophthalmic colleagues what they use or ask potential vendors for a client list for follow-up; however, veterans of the process recommend you take a few steps beyond that.

Carolina Eye Care Physicians in Charleston, S.C., switched to the Integrity EMR in early 2014; before that, staff members did an onsite visit to see its functionality in a “live” environment, says practice administrator Daniel Flynn. “Demonstrations can be deceiving, but a live environment provides a clear understanding of the pros and cons and limitations,” he notes.

One way to help assess a new system compared to your old one is with a click test, says Tera Roy, vice president of ophthalmology, Nextech, Tampa, Fla. “Perform a click test of your current system vs. other systems. If newer systems reduce clicks by 20% to accomplish the same task, then you may want to consider a new system,” she explains.

As you shop around for systems, consider specifications you wish your current EMR offered. At Florida Retina Specialists, Merritt Island, Fla., the physician and staff knew they wanted a system that allowed multiple users to be logged in to the same patient encounter at once and that enabled users to bounce around different screens within the encounter, says Juliet Venzara, practice administrator, Florida Retina Specialists. They also wanted a system that they could customize.

At Carolina Eye Care Physicians, leaders favored the system they ultimately selected because it was developed to meet Meaningful Use criteria. “At the time, that was an important aspect of its return on investment,” Mr. Flynn says.

“From a physician standpoint, we wanted a cloud-based system to keep maintenance costs down,” says Kerry Solomon, MD, a cataract and refractive surgery specialist at Carolina Eye Care Physicians. “We also wanted a system designed specifically for ophthalmology that was easy to use and intuitive. Integrity fit the bill perfectly for us.”


A cloud-based software system is beneficial nowadays, Ms. Venzara says. It’s an easier and less costly way to store information from your system without relying on servers, she adds. “We didn’t want to deal with a server that could go down or get hacked or with maintaining firewalls. As long as there is dependable internet, it takes that burden off of us,” she explains.

Although her practice was concerned at first to have all patient data in the cloud, Ms. Venzara says the benefits outweigh that concern. It also gives physicians easier access to patient information when they are not on site and while they are on call, she adds.

When searching for a cloud-based EMR provider for your practice, Ms. Venzara suggests a few pearls. First, consider the amount that a company charges for cloud storage. “We have the freedom to scan in all paperwork and attach diagnostic images into the patients’ chart without worrying about going over a certain megabyte limit,” she says.

Also, ask who will be responsible for the storage and protection of patient records. This may come down to personal preference, but Ms. Venzara feels it’s less burdensome to her practice if the EMR company handles it.


Anyone who has gone through EMR implementation knows that getting staff on board can be a huge challenge. However, the staff at Carolina Eye Care Physicians actually looked forward to the new system. “We took an internal poll, and many ophthalmic technicians identified EMR as an opportunity for improvement. So, when we announced we were going to implement it, many were excited,” Mr. Flynn says. Ophthalmic techs were part of the EMR development team, which helped with staff buy-in.

You can get staff involved in advance by having a contest based on benchmarks reached toward successful learning of the new EMR, Ms. Roy says. It also helps to remind staff about specific ways the EMR will make life easier for the practice and for patients, Ms. Venzara says. For instance, at her practice, patients now are able to log on to the Integrity EMR patient portal and print medical records, which saves time and money.

Another valuable component in Mr. Flynn’s office was a detailed on-site training calendar, which had teams of employees training over a six-month period. “This allowed each team to assist the next team with questions and functionality. We invested in on-site training, and while it was an expense, the results and implementation paid for themselves over and over again,” Mr. Flynn says. The development of this training took some preplanning as well to work out anticipated details, he adds.


Dr. Rivers recommends finding out about the training resources from your EMR provider and to view that company as a partner in getting your staff used to the system. This could potentially include on-site training, conference calls, webinars or other training sessions, conferences for users and remote help. “It’s nice to know about the features available on your EMR, but you have to have a partner. Buying a system is really about partnering with that company,” Dr. Rivers says.

In fact, your practice will want to have a transition team from the company that is accessible for six months to a year, Dr. Rivers advises. As you work with a transition team, make sure they know pain points at your practice when it comes to training or any idiosyncrasies with physician work flow, he adds. Mr. Flynn recommends ensuring live customer support is consistently available during the transition period.

One bit of transition advice still holds, unfortunately: cutting your practice’s work flow in half for two or three weeks is reasonable, according to Ms. Venzara, as staff learn the ropes of the new system. Further, the overall transition period from one EMR to a new one will extend beyond those initial weeks when you slow patient flow.

The old joke about diving in without reading instructions may apply to EMR transitions as well. Mr. Flynn notes it’s easy to forget about the “help” function common to EMRs, but make sure to use it when you, well, need help. Also helpful is creating a “cheat sheet” with notes on functionality that may not be obvious once the trainer has left, Ms. Roy recommends.

One feature that some EMR systems have is a “sandbox,” which lets users practice with the system to get used to it. Ms. Venzara’s practice encourages newly hired techs and even new physicians to use the “sandbox” account to practice with the EMR on pretend patient encounters that don’t affect the live site.

You still need to be flexible

Keep in mind that even your new-and-improved EMR system might not conform completely to your current routine. Dr. Rivers, formerly of The Retina Group of Washington in the Washington, D.C., area, points out that, after your training period with a new EMR system, you and your staff can fine-tune work flow with it. He cites his previous experience getting used to a new EMR at the 27-physician practice. After the initial period with the new system, work within the EMR was redistributed among the various people touching the chart, “so no one was a bottleneck and every patient and staff member had a smooth path,” he explains.

That re-evaluation of work flow is crucial. “Training is a lot like drinking from a firehose,” Ms. Roy says. “With all the massive new things to learn about the system, it is nearly impossible to grasp all the features and functionality with initial training.” That’s why re-evaluating your transition process and possibly bringing in an optimization expert from your EMR company after a couple of months is a solid idea, she says.


One consideration when your practice transitions to a new system is what to do with your old patient data. You may archive that data, you may have your new company move the older data to the new system for a price or you may have your staff help move that data to the new system.

“Data from an old system can be transferred into a new system through complete data transfer or through a transfer of patient summary information, or simple data archiving,” Ms. Roy says.

Florida Retina Specialists recently purchased a practice that was using a different EMR system and paid the practice management company to migrate the data of thousands of patient records into the practice management software and EMR. This included paying some of that money in staff hours to manually enter data.

“It won’t be an easy transition, but it’s necessary and worth the time if you have the right practice management system and EMR,” Ms. Venzara says. OM