Practices can get more out of their EHR system than billing and documentation. Systems can be customized to provide many forms of clinical-decision support including alerts and medical evidence relevant to ophthalmology practices.
“Studies in the realm of clinical-decision support have demonstrated their ability to improve the quality and safety of our care,” Dr. Chung said. As a case in point, a study on the effectiveness of documentation forms and decision support tools for hydroxychloroquine screening showed a definite improvement in the appropriateness of screening (from 46% to 75%) and a decrease in inappropriate screening from 25% to 2% (Ophthalmology. November 2016).
Instances of clinical-decision support specific for ophthalmology medical alerts include:
- A graph shows that a glaucoma patient’s IOP is above the target pressure.
- Clicking an advisory icon for ethambutol, a rarely encountered drug, shows the recommend screening for ocular toxicity.
- The system highlights that a patient is taking certain systemic medications such as beta-blockers or alpha adrenergic agonists (e.g., Flomax).
- Systemic medications that have ocular side effects can be highlighted or flagged, and clicking the drug name for further information reveals what those are. For example, docataxel (Taxotere) could cause a host of ocular side effects.
- An intake form for patients on hydroxychloroquine will prompt the user to record relevant information including height, weight, and medication history. Further, the latest dosage guidelines can be incorporated into a standard letter to be sent to the referring rheumatologist to help disseminate preferred practice guidelines.
- Cataract surgery planning checklist: Medicare carriers require the notation before surgery that a small pupil might need special intraoperative management or that a cataract might need a capsular stain for billing a complex surgery code. A history of recent contact lens use or refractive surgery might be missed, resulting in erroneous intraocular lens power selection, and these items should be checked for systematically like a pilot going through a preflight checklist. The EHR can customized to provide these types of tools for any subspecialty or type of procedure.
- Reminders/ticklers: if a diagnostic test such as a sedimentation rate to check for giant cell arteritis or a carotid duplex study or neuroimaging is ordered outside of the office, a “timer” or tickler to remind the user to check on the result if it doesn’t get “pushed” to you.
“We are far from using the power that these systems could give us to enhance rather than just document care,” Dr. Chung said. “EHR companies have been so focused on other priorities that making clinical-decision support enhancements has taken a back seat to regulatory considerations,” she said. “Make your clinical-decision support work. Customize it to your needs, and implement best medical evidence into clinical workflows.”
Ask for help
Dr. Chung’s suggestion for practices: If you aren’t aware of all the decision-support capabilities of your system or need help with modifications, speak with your vendor and appoint a physician or technician champion in your office to lead this process from within your organization
Kelly E. Chung, MD
P: 503/292-0848 E: [email protected]
This article was adapted from Dr. Chung’s presentation at the 2017 meeting of the American Academy of Ophthalmology. She has no relevant financial disclosures. Clinical-decision support includes ticklers, medical evidence relevant to ophthalmic practices.