If you can’t shake the feeling that your EHR is more of a headache than helpful, you’re not alone. But with value-based care playing a larger-than-ever role in your operations—and your revenue cycle—it’s time to start using your EHR for more than those basic tasks.
One indicator of whether or not your practice will succeed under value-based reimbursement (and particularly MIPS) is where you fall on the quality vs. cost continuum. The most successful practices will pair higher quality with lower cost. Used to its full potential, your EHR is a valuable ally in reaching that goal.
How? Your EHR is an excellent tool for helping your clinicians improve patient care and safety. Eye care providers can more easily review a patient’s’ history, track changes or patterns that should be further evaluated, and even predict future issues based on the data that the EHR contains. That leads to better clinical outcomes, and prevents costly—and usually avoidable—mistakes that reflect poorly on your practice.
Tracking and Monitoring Patient Conditions
One of the most important ways the EHR can improve patient care is by keeping a running log of how the patients are doing. This was always possible on paper, but it wasn’t as easy to refer back to previous information and make comparisons that may prompt clinicians to quickly realize that the patient’s condition has changed enough to investigate further.
“If the patient divulges information to the ophthalmologist regarding a history of diabetes or family history of heart disease or other chronic issues, you can be vigilant about monitoring that since you’ll ask about it at every visit,” says Tracy Holt, MHR, COPC of Eye Care Leaders’ Practice Optimization Team.
Need another reason to limit the copy/paste “feature” on your EHR? Misuse of that function can lead to note bloat, and important changes or conditions can get lost in the documentation.
When an ophthalmologist sees a patient with diabetes, for instance, the physician will want to determine the patient’s A1C level to assess whether the diabetes is controlled or not, Holt says. “If it isn’t controlled, that will affect their visit,” she notes. Using the EHR appropriately will let the ophthalmologist compare new and previous numbers side-by-side with the click of a button, allowing for a quick review of how certain conditions are progressing.
Falls are the leading cause of non-fatal and fatal injuries for those 65 and older, according to the CDC. And while most of those falls most often happen at home, they also occur in physician offices and surgery centers, points out Anne M. Menke, RN, Phd, who coached eye care providers and their staff on preventing falls at last year’s AAO. When that happens, it’s usually the providers and staff who take the blame. And you know what that means, right? A lawsuit could be coming your way.
The Ophthalmic Mutual Insurance Company analyzed data from fall claims filed since 1987, and Menke shared that data with her audience. Here’s what they found:
- The biggest risk factor for falls, besides age, is dilation.
- Most falls occurred at the practice, but about a quarter of patients fell at the surgery center.
- About half of patients who fell during or just after office visits did so after a dilated exam.
Here’s what patients were most often doing directly preceding a fall:
- Trying to sit down, stand up from, or move on a stool or chair
- Moving from dark to light (i.e. from inside a practice to the brighter outdoors)
- Transferring to or from a wheelchair
What You Can Do
You should always be ready to assist a patient who seems unsteady, but you can also use your EHR to identify patients who are most at risk for falls. Eye care practices providers typically don’t assess a patient’s mobility, strength, and balance like a PCP would, says Menke, but you can ask these four CDC-recommended questions:
- Have you fallen in the past year?
- Do you ever feel unsteady when you stand up or walk?
- Do you ever worry about falling?
- How about feeling dizzy or lightheaded?
Note the patient’s answers in their EHR record. That way, physicians and staff can be made aware prior to each visit, that extra vigilance is required.
Most fall prevention techniques are aimed at older patient populations. But don’t forget your younger patients. Some patients feel squeamish over even minor procedures (a chalazion removal, for example), and can have an unexpected vasovagal response. Some medications are also risk factors for falls. Keeping a list of patients’ medications (don’t forget supplements!) in the EHR record can be a hedge against falls.
In our next post, we’ll reveal three more ways your EHR can help (yes, really).