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EHR's: Significant Tool in Chronic Condition Management

Electronic health records (EHRs) provide a vital tool in caring for patients with chronic conditions. The technology allows providers to clinically exchange information, and provides a long-range view of patient health and enhanced treatment plans.

Dr. Scott Jens, OD, FAAO, CEO of RevolutionEHR

With more Doctor’s of Optometry (OD’s) building their medical eyecare services, the challenge in managing chronic conditions like macular degeneration, glaucoma and diabetic retinopathy has never been more pressing. Along with clinical expertise, doctors need tools that allow them to easily track the patient’s condition over time. Fortunately, a tool that is quickly becoming the standard in modern healthcare–EHRs–give doctors what they need to efficiently manage a patient’s chronic condition to increase patient care and satisfaction. Here is what my company, RevolutionEHR, has to offer in managing long-term medical eyecare conditions.

Technology Provides Baseline Patient Measurements

Electronic health record (EHR) data compilations are able to demonstrate normal findings from eye evaluations, and also abnormalities, of various degrees. When an EHR user uses built-in tools to aggregate that information into reports, the disorders that compose those eye abnormalities can be tracked. All conditions, from ocular health concerns like diabetes, glaucoma, macular degeneration, and dry eye can be “tracked” using software tools. But so can vision changes that are refractive, or binocular vision problems. For example, EHRs provide the ability to view an isolated piece of data, like an intraocular pressure test result, across multiple visits without the necessity of paging through each visit record to view the data in isolation. Many EHRs provide graphical representation of data to further enhance the user’s ability to visualize trends within the data.

Additionally, if an OD with a vision therapy practice would like to view all previous assessments of a patient’s eye alignment, an EHR may provide a view into a cluster of test results that in paper records would otherwise be looked at by paging, or within a master document that the doctor would have had to build and onto which the doctor would have had to have double-entered the data (once into the record, then again onto the master sheet) in order for that master document to be reliable.

Enhances Inter-Provider Connection

EHRs have significant potential to enhance inter-provider connection. Today, the national EHR certification standards for Stage 1 Meaningful Use are not specific in requirements to have doctors communicate directly with other doctors, nor EHRs-to-EHRs.  However, EHRs have inherently improved a doctor’s ability to efficiently create a summary document about a patient visit that becomes a “referral letter” in instances where the patient’s care must be transferred such as in OD-to-ophthalmologist scenarios, and a summary letter when a patient’s care must be explained such as when an OD summarizes the eye examination findings of a diabetic to that patient’s primary care provider or diabetologist. Beginning in January 2014, EHRs will be required to allow providers to exchange secure communications with other providers in outside clinics, and even to allow for secure message delivery between the practice and the patient.

Automated Data Aggregation

While there are no established standards for data overview capabilities, each EHR technology provides some sort of automated data aggregation process. These innovations might be common, like mapping intraocular pressure findings, or novel based upon the sense of need of the industry as defined by the EHR vendor. The EHR technologies also allow for manual searches of data fields which can provide a user with a highly customizable output of data relating to a wide range of information fields. For example, perhaps an OD is learning that all glaucoma patients who had been prescribed Xalatan in the past are being moved by the local pharmacist to the generic version, latanaprost; the doctor can perform a manual search of patients seen in a particular date range, with a particular glaucoma diagnosis and severity, for whom the drug Xalatan was prescribed, and generate a patient list that can be used by the practice to communicate the doctor’s position on this pharmacist’s actions.

Practices that want to maximize these EHR capabilities need to study their software’s capabilities and perhaps even take mini-sessions that the EHR vendor sponsors for improved practice activities that leverage the power of the EHR for improved patient care. All employees in the practice who participate in patient interaction need to be thoroughly trained on the EHR data fields that should be regularly documented depending on each patient presentation, so the necessary data is captured at each visit, and thus, is available for future data explorations.

Use Patient “Master List” of Past Care

EHR technology can provide an overview of all documented action items that have been assigned to any particular diagnosis in the past, within a master list. This master list should be reviewed by providers prior to examining the patient as part of the introduction of the patient’s care, and even technicians should be involved in this activity. For example, when preparing to initiate a patient visit, EHRs allow the doctor to see master lists of data from historical documentation, or even new-patient intake processes that might be online. Proper use of a diagnosis list would allow the doctor to see in one glance all of the patient’s current and inactive diagnoses.

For any diagnosis, the doctor might have access to historical documentation, such as all previous plans for management of dry eye. If a quick review of the past treatments included punctal plugs and use of artificial tears, then during the patient encounter the doctor can be thinking about newer approaches that provide further relief, instead of trying to look back at each past examination to see if new treatment Y or Z has been offered. The technicians are often involved because they manage the practice’s case history documentation, and they provide valued insight about the patient’s current complaints or updates to the patient’s data such as medication lists.

When the doctor and technicians have worked in harmony toward established practice standards for documentation, chronic diseases can be managed in real time instead of treating each patient presentation as a brand new engagement with the patient which costs time and reduces patient satisfaction.

But to be clear, there is effort required with EHR documentation to reap these rewards, so I encourage practices to position this as an investment that will bring increased rewards the longer that the patient’s care is managed via the EHR.

Manage Chronic Conditions via EHR: Action Plan

  • Develop strategies for collecting information from patients before they arrive for care. Establish educational scripts for phone staff that will help patients understand the value of collecting a medication list from the PCP, or submitting online case history information through secure portals.
  • Create in-practice systems for review and overview of data prior to patients being taken into the exam room. Explore the EHR for available tools that aggregate data about the patient’s past care creating a checklist of must-view data fields and master lists that each technician and doctor must review prior to seeing the patient, and take one to two minutes per patient to review those data. This preparatory step may save as much as five to seven minutes per patient encounter in the creation of new plans of care and the delivery of the pertinent information to the patient.
  • Use the EHR technology’s overview capabilities to review batches of historical data in one view. For example, if the EHR collects data about glaucoma patients including their intraocular pressure, C/D ratios, medications and historically performed glaucoma management services in one view, get familiar with navigating to that data review page when caring for every patient with glaucoma or glaucoma risk.
  • Provide end-of-visit education based upon any rules in the EHR that might trigger when a diagnosed chronic condition is documented as a diagnosis at a visit. The patients who are educated about the condition and the importance of follow-up care specific to the severity will be more likely to return for care as recommended.
  • Although not available today, prepare for Stage 2 meaningful use standards including inter-provider communications with DIRECT to enhance the flow of data from the practice to other providers who deliver health care for your patients.  It is incumbent on EHR users to study these emerging capabilities by mid-2013 if they are going to be used efficiently in 2014. While creating a letter that summarizes a patient’s visit is still an important process that is assisted by EHRs, the future of communication is going to change vastly.

Scott A. Jens, OD, FAAO, is co-owner of Isthmus Eye Care, with offices in Middleton and Madison, Wis. Dr. Jens is also the CEO of RevolutionEHR, a provider of online-based electronic health records. If you would like to contact Dr. Jens, send an e-mail to sjens@revolutionehr.com.


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