Taming the paper trail

November 15, 2005

Now that practices in ophthalmology and other specialties have adopted electronic billing systems nearly universally, the next step for many is to explore office management solutions that can further improve efficiency, reduce overhead, eliminate considerable paper shuffling, and integrate a range of functions.

Many vendors offer office management solutions that include systems for electronic medical records (EMRs), scheduling, inventory management, and image management.

"More than any other specialty, ophthalmology has the opportunity to be paperless," said David Dickson, president of the consulting company TSI Healthcare, Chapel Hill, NC. "There are secure companies that have terrific products. Doctors don't have to come on board and feel they're going to be guinea pigs if they try the products.

"Anybody who is going to be in practice for more than the next 5 years will be into electronic medical records in some capacity," Dickson continued. "And if they're not, they'll be hemorrhaging cash or they'll be audited and find that their coding is off and face huge fines and possible sanctions."

An EMR product can eliminate transcription, automate prescription management, integrate chart records with the billing system, provide multiple points of access to critical patient information, transmit real-time imagery from ophthalmic testing equipment, and improve coding, Dickson said.

These capabilities translate into monetary savings, said Scott Riedel, director of marketing, MediNotes, West Des Moines, IA.

"Any time you have a physical chart, there's a cost associated with putting that chart together, and there's also a cost of having administrative people go to the file, pull the file, make sure everything's in it, and once the physician is finished with it, putting all the new records into the file, and getting it back in the right place," Riedel said. "People have done studies on that, and depending on where you are in the country, it costs between $8 and $10 or $12 every time you pull a chart."

Other aspects of the daily routine also affect productivity and the bottom line.

"Ophthalmology practices and ophthalmologists in general spend a tremendous amount of time and money on transcription, they spend a tremendous amount of time and money on personnel that are specifically used for coding, and even at that we have found that they are typically undercoding by upward of 20%," said Joe Warnicki, owner of J-War Systems, Pittsburgh. "The cost of shuffling paper and paper charts and the people required to do it is exorbitant. The norm is typically one full-time employee for every two doctors just for moving charts and paper."

Costs are substantially lower with an EMR system, because practices will have to spend far less time handling paper and should be able to reduce the number of administrative employees, he added. This could save thousands of dollars a year in salary and benefits.

As an example, an ophthalmology clinic in Indianapolis cut its payroll by one-fourth after installing EyeDoc's EMR system, said Kevin Doyle, a software engineer at EyeDoc, also known as Penn Medical Informatics Systems, Altoona, PA.

Ophthalmologists, including dispensing ophthalmologists, can also save money on transcription. Many office management systems have templates, based on typical patient encounters and preloaded with ophthalmic terminology, that can be customized to practice specifications. With these templates, the physician can quickly create accurate, comprehensive notes during or immediately after each patient visit.

"They don't need someone to transcribe," Riedel said. "The computer interprets what they want from keystrokes and puts the data on the note the way they want it."

Ophthalmologists or practice managers looking into office management systems are particularly interested in customizability of terminology and format or layout of the information in their EMR package, such as the patient notes section.

"People want a flexible system that they can make look the way they want it to look," Riedel said.