Province of BC EMR standards for Ophthalmologists - a start

I write on the eve of a conference call on proposing Electronic Medical Record (EMR) standards for ophthalmology for the Province of BC. The PITO program was designed to induce physicians into adopting EMRs in the form of subsidizing physicians if they purchase systems from PITO approved vendors. What of early adopters such as myself? We get to be consultants but adopted too early to reap any financial rewards aside from paying us for consulting time. What will we accomplish?

Allow me to provide a little more background information with some self indulgence. During my glaucoma fellowship with Dave Campbell at Dartmouth College in 1994, I had the opportunity to develop an EMR for ophthalmology and present the research at the ARVO annual meeting. I had also worked as a translator for Purkinje during my residency at McGill but the approach I took for this was very different by using FileMaker. Purkinje was actually doing some amazing work in creating their system to run on the first version of Microsoft Pen but they were geared toward general practitoners rather than ophthalmologists at that time. Fast forward some 15 years and what has changed - not much when it comes to the current PITO approved systems.

The currently approved EMR solutions are geared toward general practitioners and lack key features needed by specialist physicians such as ophthalmologists. Much of this is related to the nature of our practice patterns. As specialists, we frequently see patients in consultation and need to generate letters back to the referring doctor and correlate clinical and diagnostic findings. Some of us see primarily patients in consultation and others also have a large number of patients seen for regular follow-up care. For example, as a glaucoma specialist, I have an interesting mixture of both types of patient encounters. So in addition to generating consult reports, I need to track specific findings, such as intraocular pressure, over time and note when interventions occurred that could alter the eye pressure. I also need to draw clinical findings. None of these needs are not covered by any of the currently approved EMR systems.

Here are our goals to discuss in the morning:
- Create a list of requirements for an Ophthalmology EMR
- Complete review of EMR products currently in use by BC Ophthalmologist, as well as popular international vendors, to inform group of possible options
- Make a recommendation to PITO on next steps, potentially being one of:
*approach PITO-qualified EMR vendors to see if they are interested in building out the clinical functionality
*approach non-PITO-qualified EMR vendors that have clinical functional to see if they are interested in building out the billing functionality
*approach non-PITO-qualified EMR vendors that have BC billing to see if they are interested in building out the clinical functionality

I am currently using Optimed Software's Accuro and prior to that used iiiiSoftware's VisualEyes and Osler before that. Optimed's program fits my current needs very well but it does not mean that it necessarily fulfills all the PITO requirements as they currently stand or the needs of the majority of Ophthalmologists. In addition, although none of the PITO approved systems meet the needs of ophthalmology, perhaps they can follow our suggestions so that they can be useful. This series of meetings that begins in the morning should prove to be exciting and hopefully will help Ophthalmology. Wish me luck and I look forward to your input.