EHR

THE IDEAL EHR Contact Lens Module

A look at the features O.D.s need

Adam P. Parker, O.D., Midlothian, Va,
Kevin W. Lafone, O.D., Cornelius, N.C.,
And Brian Chou, O.D., F.A.A.O., San Diego, Calif.

The contact lens module in electronic health records (EHR) is typically one of the more challenging facets of the software for an optometrist to use. There are intricacies due to the variation of contact lenses in terms of the vast array of parameters, replacement schedules, clinical findings to document and purchasing options. In an effort to make these contact lens modules more O.D.- friendly, we list some of the features we feel are essential for the optometric EHR companies to incorporate.

1 Complete history

There is more to contact lens success than lens type and prescription. We know that contact lens solution, wearing habits and lens wear history can significantly affect contact lens wear success. Therefore, the contact lens module's patient history form should include spaces for the contact lens solution the patient uses and has used, adverse reactions to solutions, if any, their history of lens wear (e.g. past lenses worn, wear frequency, infections and both successes and failures with specific lenses) and the patient's propensity for certain non-adherent behavior, such as overwearing or sleeping in lenses.

Armed with this data, the software should then alert us to potential issues a patient could face when we prescribe certain lenses and lens-care products.

For example, if we input an aversion to multi-purpose solution “X” in the patient's history form, that option should be grayed out (inactive) in the prescription form. Even better: If toric lens “A” rotates 10° left on a patient's right eye, the module should remind us of this at future fits.

In addition, the contact lens module should allow us to search for patients by wearing habits and contact lens complications, so we can selectively recall these patients for follow-up appointments and educate them on products that may help.

It is these small things that make software helpful and not just a repository for data.

2 Parameter “smart” forms

Hand-entering the base curve, diameter, powers and other parameters of commonly prescribed contact lenses is unfortunately commonplace with today's EHRs, making the prescribing process time-consuming and cumbersome. Instead, our EHR should use one of the frequently updated contact lens databases to save us time and improve accuracy.

Also, when writing contact lens prescriptions, the form should display only the fields we need to write that prescription. For example, if we prescribe a soft toric lens, the fields of cylinder and axis should show up once the soft lens toric of choice is selected. They should not show up for a standard spherical lens. Additionally, each field should only allow options that are available for the lens selected: We shouldn't be able to select an 8.2mm base curve (BC) for a lens that only comes in 8.6mm BC.

Such a “smart” form would make the custom parameter field null in void, while simultaneously decreasing the risk of errors during the ordering process. For instance, we'll get less of this remark from our staffs: “Doc, that lens doesn't come in those powers!”

In addition, the software should have the ability to document advanced fittings, such as quadra-curve RGPs and lenses with atypical parameters, such as the return zone depth and landing zone angle measurements of Corneal Refractive Therapy lenses and the vault of SynergEyes ClearKone lenses. Atypical situations should be accommodated for as well, for example, if the patient has multiple presenting contact lenses, such as piggyback lenses, or wears a rigid lens in one eye but a soft one in the fellow eye.

3 Separate databases

A single trial lens and retail contact lens database automatically locks in information that places limitations on both the patient and practitioner. Why should we have to specify whether the patient will purchase a 90-pack or 30-pack of daily disposable lenses when we're choosing trial lenses? In addition, why should we be required to write a different prescription when a patient wants a private-label lens from a commercial retailer? Along these lines, the software should accommodate for private-label lenses in that it enables us to include the generic name of the lens. The Fairness to Contact Lens Consumers Act (FCLCA) requires all contact lens prescriptions include the generic name of the lens. This should also apply if the BC and diameter are private-label.

By having a separate trial lens database that is linked to the retail contact lens database, we and the patient have more flexibility in the decision-making.

4 Trials and fittings on one page

When we open the patient's record, we may be able to quickly view all the lenses we tried on him, but the information on “why” one lens didn't work is lost without going through all our notes. Therefore, the contact lens module should contain a trial fitting page that includes the contact lens we applied on a patient, the assessment of that lens fit and over-refraction without inducing confusion regarding which findings were associated with which lens. Without the assessment and plan under each trial lens, we can't follow our thought process efficiently.

Likewise, if we make numerous lens exchanges, the EHRs contact lens module should clearly keep track of which lenses we did or didn't dispense, the patient returned and sent back for credit. Without such functionality, our staffs may forget to return lenses before their warranty period. This would cause our practices to have to pay unnecessary costs.

5 The manifest refraction

The contact lens module's parameter form should automatically display the patient's manifest refraction and keratometry values, as both assist the clinicians in determining the final contact lens prescription. We've seen EHRs that display the most recent eyeglass prescription instead of the manifest refraction. The eyeglass prescription is not necessarily identical to the manifest refraction. This is because we, as eye doctors, commonly reduce the magnitude of astigmatic or anisometropic correction in the eyeglass prescription to facilitate adjustment. Since contact lenses often can correct more astigmatism and anisometropia, we need to know the full manifest refraction and not the final eyeglass prescription.

6 Cost-savings adjustment

The contact lens module should adjust cost-savings for patients purchasing an annual supply of contact lenses. Having a straight percentage discount is not viable because a great deal of variability exists in a practice's cost of goods from one lens to another.

Specifically, a mechanism should exist that sets two prices for each product: One for an annual supply purchase of lenses and one for a smaller retail quantity of lenses. This feature would financially incentivize patients to purchase an annual supply of lenses regardless of whether a manufacturer's rebate on the lens is available.

As a result, it would enable us, as practitioners, to better compete with online contact lens distributors who already offer the functionality of reduced per-box cost when the patient purchases a large quantity.

7 An “eligible CL purchase option” button

If a patient calls our offices to purchase contact lenses, the staff person has to access the patient's chart to check his contact lens history, expiration date, replacement schedule, etc. This takes a lot of time, and the staff member can end up selling the incorrect lenses or amount of lenses. To rectify this, the contact lens module should have a button staff can click on the patient's history form that enables them to see the eligible contact lens purchase options.

Specifically, upon clicking the button, a list of the products associated with the patient's finalized prescription, along with the contact lens expiration date, past purchases, solution care system, wearing and replacement schedule, warranted vs. non-warranted and whether the patient must be seen by us before the order is placed, would be extremely helpful.

An open plea

We ask that EHR manufacturers consider adding the aforementioned features, as doing so will reduce inadequate exam documentation, botched orders and lost profitability for optometrists. The best EHRs enable the user to document quickly with minimal clicks and keystrokes. Such EHR manufacturers will be rewarded with a loyal base of users willing to pay for the quality of the product. OM

	Dr. Parker practices in a multi-O.D. private practice in Midlothian, Va. He also owns and manages ehrcompare.com, an EHR review and comparison website that lists more than 402 EHRs, so the user can decide which product to choose. E-mail adamparkerod@gmail.com.
	Dr. Lafone is in solo practice in Cornelius, N.C. He is a frequent consultant to Dr. Parker on ehrcompare.com. E-mail drlafone@gmail.com.
	Dr. Chou practices at EyeLux Optometry in San Diego, Calif. He is co-developer of EyeDock.com, a clinical reference for eyecare practitioners that offers a contact lens database, among other user-friendly tools. E-mail chou@refractivesource.com, or send comments to op tometricmanagement@gmail.com.