11/9/2023 0 Comments Epic electronic health record![]() This SmartSet allows the surgeon to rapidly document and code an intravitreal injection. These SmartSets, often used for panels of laboratory and radiology tests, orders, and documentation, can help to document and code many common types of retina visits (Figures 4-6).įigure 4. Order sets in EpicCare can help guide and standardize elements of patient care. Further, this visual approach helps to avoid repeated cycles of noncompliance with injections in our urban, hospital-based practice, in which patients wait until florid macular edema recurs, appear for urgent unscheduled appointments for treatment, and later experience further recurrence because of noncompliance. Visual tools help patients to understand their own responses to treatment and treatment goals (Figure 3). We have found that patient management and patient compliance and acceptance of intravitreal injections are improved when patients can graphically see the effects of injections on their macular thickness. ![]() The response of this patient’s macular edema to anti-VEGF treatment (indicated by the small boxes at the bottom of the chart) is rapidly and efficiently demonstrated. The patient in Figure 2 had chronic CME after cataract surgery it can be easily seen, in the resulting plot, that the CME recurred after tapering the patient off steroid eyedrops.įigure 3. The patient in Figure 1 developed cystoid macular edema (CME) related to successfully treated endophthalmitis. Using data from two patients, Figures 1 and 2 illustrate how resolving edema can be followed and tracked over months. In some patients, the presence of macular edema may be obvious, but treatment may result in changes in macular thickness of only a few tens of microns over a month, and determining the endpoint of therapy can be difficult. This visual presentation of treatment response is particularly critical when taking care of patients who do not speak English. In this way, trends in response to treatment are presented in an intuitive manner. We enter the central subfield thickness of each eye into the EHR at the time of interpretation of every optical coherence tomography (OCT) image, and the information on response to treatment is then immediately and visually available to the vitreoretinal surgeon and the patient. We have implemented this using Synopsis, a feature of the Epic EHR, defining synopsis variables for foveal thickness. One helpful EHR technique that we have found to allow the treating physician to quickly evaluate the efficacy of treatment of macular edema is to create plots of central macular thickness versus time, noting where interventions such as intravitreal injections were performed. 6 There are retina-specific modifications to the Epic system, on the other hand, that can facilitate improved efficiency and surgeon satisfaction with this widely used system. Volume retina specialists who see their personal clinical efficiency reduced and a growing need to hire professionally trained clinical scribes at a time of declining reimbursements. These qualities, however, are of little comfort to high. ![]() Publications have noted the ability of the system to provide availability of the chart to billing personnel with improved billing, improved legibility of clinical notes, and reductions in (typically inexpensive) staff to pull and organize paper charts. 3 However, there are limited descriptions in the literature of direct, concrete benefits of such technology. ![]() There are numerous publications describing the inefficiencies and loss of productivity among ophthalmologists brought on by the introduction of electronic health records (EHRs), 1,2 and, in particular, the EpicCare Ambulatory EHR (Epic Systems Corporation). ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |