System Puts Ophthalmologists’ Electronic Medical Record Needs in Focus

New Cleveland Clinic system benefits doctors, patients


By Peter K. Kaiser, MD, Cleveland Clinic Cole Eye Institute vitreoretinal surgeon

The revolution that electronic medical records (EMR) has wrought in most areas of medicine has been slow coming to ophthalmology.

“We’ve been reluctant to embrace EMR,” says Peter K. Kaiser, MD, a staff member of the vitreoretinal faculty of Cleveland Clinic’s Cole Eye Institute. “Our charts are visually based, and the traditional EMR system only allowed data. Ophthalmologists need to make drawings of the eye to create the visual history that is critical to the therapeutic plan. Until now, inserting drawings into an electronic record was all but impossible.”

That’s changed with the launch of Cole Eye Institute’s new EMR platform, which easily allows the incorporation of graphics and facilitates the move from paper charts to the computer. Designed within the institute by a group of staff, the platform sits on top of the common and widely used Epic EMR system. “The standard Epic EMR is text-based and not graphical, so it wouldn’t have worked for us,” says Dr. Kaiser.

Window on the Whole Patient

It isn’t just the eyes that concern us, it’s the whole patient. An ocular issue in a diabetic patient can now be shared in real time with that patient’s endocrinologist, internist, cardiologist and nephrology team.

The new system allows an expanded level of interaction between ophthalmologists and other providers, which is core to the collaborative practice of medicine. “It isn’t just the eyes that concern us, it’s the whole patient,” says Dr. Kaiser. “An ocular issue in a diabetic patient can now be shared in real time with that patient’s endocrinologist, internist, cardiologist and nephrology team. Having a single, all-inclusive medical record is much more than just a nicety; it opens important new channels to provide patients world-class care.”

Federally mandated medication reconciliation is a perfect example. Compiling all of a patient’s prescriptions was difficult to accomplish on paper, but with the advent of EMR is now easy. The electronic record maintains a real-time history of the patient’s medication orders and helps avoid omissions, duplications, dosing errors and drug interactions. Refills are sent electronically to the patient’s pharmacy, eliminating transcription errors.

Improving Information at Satellite Locations

In the past, a Cleveland Clinic ophthalmologist seeing a patient at a community location did not have complete access to the imaging available at the main campus. EMR has changed that, and not just for remote locations. Now, any doctor who participates in Cleveland Clinic’s MyPractice online referral and patient monitoring system can review all charts and images from any connected location. “The more information that’s available, the better the medical decisions,” says Dr. Kaiser. This is especially beneficial in emergencies, which can happen day or night.

Opening New Channels with Referring Doctors

Communication with referring doctors can now be maintained more easily, and can be updated far more quickly. “We can now send referring doctors electronic images. If, for example, we have a patient with a macular hole, we can image the macula before and after surgery and update the referring doctor almost in real time electronically,” says Dr. Kaiser. “This improves our communication and creates opportunities to further improve patient care. The referring doctors can see exactly what we did and why, since they can see patient records. This also can help ensure that patients return to their referring doctor for follow-up care.”

Better Care from the Patient’s View

Patients who use Cleveland Clinic’s web-based MyChart to track their medical care also can be kept more current, more easily. In the past, no patient had access to ophthalmology-related tests. The new EMR system allows ophthalmologists to make a variety of information available to MyChart. Test results and other relevant data can be released electronically, allowing connected patients to access it at will. “This gives patients a sense of involvement in the dynamics of their own care, which is very empowering,” Dr. Kaiser says. “They can track their progress in therapy, and this tends to improve their outlook, which is therapeutic in itself.”

Eliminating Billing and Insurance Errors

Financial efficiencies are built into the new system. “It’s a huge plus to be able to make sure that everything we order and interpret is billed appropriately,” says Dr. Kaiser. “With paper, this was often complicated, and, quite frankly, sometimes we missed things for which we should have billed.” The new system has automatic dropdown menus to remind the doctor to interpret tests. When interpretation is completed, the billing automatically goes to the patient’s insurance provider. It’s an efficient system in which little falls through the cracks. “For those of us who are very busy, it’s nice to have someone looking over our shoulder to make sure we’ve done everything that’s required,” he says.

Raising the Bar in Ophthalmology Care

The enhanced EMR system is setting a new national standard. “Other eye institutes around the country have tried to use the stock Epic system with limited success; they’ve lost productivity and suffered decreased patient volumes without improving patient care,” says Dr. Kaiser. “We didn’t want to follow in their footsteps. Our system is light years ahead of where we started.” As word of the new system spreads, many eye institutes using Epic have approached Cleveland Clinic to learn more, and the Cole Eye Institute is sharing its knowledge, the better to improve patient care nationwide.