EHRs Fall Short for Eye Doctors: Report

Ordinary electronic health record applications lack features that eye doctors require and therefore, these specialists have been slow to adopt the software, according to a report by the IT committee of the American Academy of Ophthalmology.

The report, called "Special Requirements for Electronic Health Record Systems in Ophthalmology," lists ways that software developers can improve EHRs to meet ophthalmologists' needs. It appears in the Aug. 1 issue of the journal Ophthalmology.

The academy issued its report to influence future guidelines on meaningful use of EHRs. The current meaningful-use guidelines don't take into account the needs of ophthalmologists, according to Dr. Flora Lum, co-author of the study and deputy director of the H. Dunbar Hoskins Jr., M.D. Center for Quality Eye Care, a nonprofit quality-of-care and health policy research center in San Francisco.

"Currently, federal rules regarding meaningful use and certification of EHR technology govern many basic functionalities of EHRs, but they don't address needs of a specialty like ophthalmology," Lum wrote in an email to eWEEK.

Meaningful use for an eye doctor would involve an EHR application that provides timely information at the point of care between ophthalmologists and patients as well as between primary physicians and ophthalmologists, she explained.

Still the academy believes eye doctors should meet the meaningful-use guidelines regarding patient demographics, e-prescribing, clinical documentation and communication.

With EHRs designed for internal medicine and hospitals, the software isn't equipped to work with the diagnostic imaging and measurement devices as well as the high volume and intricate workflows of ophthalmology practices, according to Lum.

A lack of interoperability exists between eye doctors' diagnostic imaging and measurement devices and EHRs, she said.

"This interoperability is not just needed to exchange outside the office setting; it is also necessary for communication and exchange between the EHR system and all the different ophthalmic imaging and measurement devices," Lum said.

Many EHR applications use proprietary formats specific to that vendor. But the academy recommends that the software support the DICOM (Digital Imaging and Communications in Medicine) standard for storing images and measurements taken by devices and SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms) for coding measurements.

In addition, eye doctors draw sketches by hand on patient charts, and these drawings are not compatible with EHRs. "Many current EHRs rely mostly on mouse- or keyboard-based data entry, without an adequate mechanism for drawing, annotation of the drawing and use of color in drawing," Lum said.

Eye doctors have difficult navigating the software and entering data in many EHRs designed for large enterprises, she said.

Many EHR applications require users to entire vital data such as blood pressure, height and weight, measurements normally not taken by an ophthalmologist. Eye doctors take other measurements such as IOP (intraocular pressure).

The academy recommends that future EHR applications allow eye doctors to request tests specific to them and collect images from PACS (picture archiving and communications systems).

The EHR programs should be able to incorporate eye test data, including information on hand motions, light, distance and whether patients were wearing eye glasses, contacts or looking through a pinhole in the doctor's equipment.

In fact, using standard EHRs could lead ophthalmology practices to see fewer patients since they'd have to adjust their workflow to coordinate with the software, Lum said. Doctors are accustomed to viewing patient charts outside the exam room.

"Paper charts, which are often stored outside the examination room, allow this practice to occur seamlessly," the report states. "However, this ability to review charts outside the examination room is often lost after transitioning to EHR systems."

Although smaller vendors make EHR applications for eye doctors, these specialists are hesitant to use the apps from these companies because of concern about their long-term financial viability, according to the report.