May 2019


Technology & Innovation
Software to help improve surgery and practice experience

by Ellen Stodola EyeWorld Senior Staff Writer/Meetings Editor

Integrating software like electronic health records (EHR), scheduling tools, and
other technologies can help doctors improve the overall experience for patients and office efficiency for their staff and themselves.

Practice perspective

John Pinto spoke about his observations of the evolution of EHR. “I visit practices all over the country and the world, see what’s available and being used in real time, and I listen to what staff and providers say about it,” he said. “Electronic health records are the most prominent shift in the last decade to 15 years. We’ve gone from about a 5% utilization to about a 95% utilization.”
EHR have a lot of positive attributes, Mr. Pinto said, and they make for more complete and legible records. EHR also make it easier to pass the records back and forth among collaborators inside and out of practices. Additionally, they can help free up physical space in offices where records used to be stored.
Mr. Pinto noted that there is still some untapped potential with EHR, like improving care pathways, assessing provider competency, looking at utilization, and trying to optimize coding. “Unfortunately, a lot of the potential of gathering and filling in all the fields [is not being recognized], and the profession is still not using that data for what it could do,” he said.
Mr. Pinto noted the differences he sees among practices in how dry eye is treated, in utilization of YAG postop, and in the care pathway applied to decide whether an OCT or visual field is appropriate.
He added that none of these systems presently have built-in algorithms to report to providers how they’re doing compared to colleagues to apply clinical benchmarks.
Precious few practices use this digitized data to inform their own pathways, he said.
“I would say that the profession has gotten over the hump,” Mr. Pinto said. “It used to be that every practice was throwing rocks at its EHR vendor and unhappy with the cost or the slowdown in the pace of patients.”
Clearly, however, we’re still at baby steps for extracting the value for the cost of these systems, he added, and not just the cost for the vendor but also the staff cost. For example, Mr. Pinto said that the average ophthalmologist using EHR is spending an extra 500 hours a year in lay labor to provide scribing and other services. 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, improving efficiency, and more.
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 the office, asking them to share some information about their vision and visual habits. Around 80% of patients generally respond.
Patients also view general educational material about cataract surgery and about premium options (whatever that particular surgeon offers). At this point, the information is not highly specific because the physician is not sure if the patient is a candidate, Dr. Hovanesian said, but it alerts the patient that these things exist. The system shares more specific information with the patient after their consultation.
The system touches base again when patients have upcoming appointments. After surgery, it follows them to make sure they’re doing OK and collects feedback on how they did.
A happy patient tells three of their friends about their good results, Dr. Hovanesian said, but an unhappy patient tells 10 friends. “We want to identify those unhappy or marginally unhappy people before they start to tell their friends.”
In addition to cataract surgery, Dr. Hovanesian said MDbackline can help with glaucoma, dry eye, and other diseases.
In terms of EHR, Dr. Hovanesian said it’s been more than 10 years since his practice has adopted it.
For those new to it, he suggested to slow down your clinic a bit initially. He also said that scanning and doing an extensive capture of all old records can be expensive and may not be necessary. His practice keeps active patients’ old records in storage. Trying to capture everything from the old paper charts was too much because there are just a few things you really need, he said.
Dr. Hovanesian also discussed technologies and software that can be used to improve patient outcomes. He uses VERACITY Surgical (Carl Zeiss Meditec), which he said focuses on improving outcomes. It puts all the information for choosing a lens implant power and type of lens in front of the doctor. Rather than having to look at different technologies to determine this, it shows all the information in one place and uses the latest formulas in simplified work flow. It saves doctors a lot of time and improves outcomes by systematizing the way they do things, he said.
Dr. Hovanesian spoke about the Vital Interaction platform, which is software he uses for things like appointment reminders through text messaging to remind patients about upcoming appointments.
Dr. Hovanesian said that physicians should look for solutions and software that fit into their existing workflow and don’t require a huge amount of time. “Look for solutions that save time and don’t cost time,” he stressed.

At a glance

• EHR can help in a number of ways, including providing more complete and legible records.
• EHR make it easier to pass records among collaborators inside and outside practices and ease the transfer of records to others.
• There are a number of products available to help with key activities like patient education and appointment reminders.

Contact information


About the sources

John Hovanesian, MD

Harvard Eye Associates
Laguna Hills, California

John Pinto
J. Pinto & Associates
San Diego

Financial interests

Hovanesian: Alcon, MDbackline, Carl Zeiss Meditec
Pinto: J. Pinto & Associates

Software to help improve surgery and practice experience Software to help improve surgery and practice experience
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