By JC Gallegos MSHIMS, BSN, RN
As a product manager at CareCloud, my job is to listen. I listen to clients, identify their needs, and bring different perspectives together to build something new. So, when my team was invited to rethink our electronic health record (EHR) system for ophthalmology, we did just that. We listened for approximately 300 hours between calls, on-site clinic visits, text messages, and emails with top ophthalmology medical groups. We approached our product development process as a collaborative effort between our designers, developers, QA team, and the front-line clinicians, including physicians, mid-levels, front-desk staff, billers, technicians, and practice executives. What we heard, learned and experienced on this year-long journey is useful as the health technology sector continues to improve the functionality and usability of EHR systems.
One of the things I enjoy about working with medical providers is their bluntness. They’re incredibly busy physicians that don’t have time to sit there and play semantics, and I appreciate that. Our process starts by asking, “What are you trying to accomplish and why is that valuable?” to help get to the root of what they really need in a new system.
I have an unusual background for this role, coming from a career as a nurse in cardiology before switching to the tech sector. This medical experience helps me better understand much of the jargon physicians use — and also helps me consider a broader workflow across every member of the medical practice. I’ve used other EHR systems where I’ve worked as a nurse previously — systems where they didn’t put much focus on the user experience itself. I know that just because you build something, that doesn’t necessarily mean medical professionals are going to use it. It’s very important to get that level of understanding from a user experience perspective. The science behind why they would want to do this action versus that in the system. Working in this role as a product manager has provided me with an incredible amount of insight and appreciation as to what occurs behind the scenes in development.
Our requirements gathering kicked off with our product management group meeting onsite with the practice physicians. We then reached out to more ophthalmology physicians we had within CareCloud’s client network. It was amazing to see the level of dedication from physicians wanting to provide their input on this new system. I respected that because they were working full-time doing their jobs but still carving out so much time for us. Often, we would connect either really early in the morning before they started seeing patients, in between lunch, and then in the evening when they’d be done with their clinics.
During site visits, our professional services team and I met with people representing every role in the practice. Anyone who would be using the system in any way, we made sure that we understood their workflow and their exact requirements. We also used site visits to start validating what we were hearing from other practices across the country and other roles within the specialty.
Throughout the course of that 300 hours, we learned so much about the workflow of high-performance ophthalmology practices. Here are just a few things that are included in CareCloud’s new ophthalmology EHR because of our partnership with this high-performance medical group:
- Face View: We were able to cut 5–10 minutes of time from each patient encounter for physicians by building an easy-to-read, customizable facesheet into the new ophthalmology EHR. It had been taking the ophthalmologists several minutes with each visit to open up a PDF view of their previous encounter notes, review the information, and return back to the day’s note with their previous EHR system. With our new facesheet, each user in the practice can build a customized layout of information. Each time they pulled a patient’s chart, the past note data is arranged in a way that makes it easy to see exactly what they want every time.
- A different record for each eye: Before this process, I hadn’t realized that ophthalmologists treat your right and left eyes so distinctly, almost as if they were two separate patients. Each eye is treated very differently, and the EHR system needs to be set up to reflect this. We configured widgets in our ophthalmology EHR to keep the left and right eye records distinct.
- Bill-ready charting: It was interesting for me to hear that the physicians were very engaged with the specific, and changing, billing requirements for their specialty. They wanted a note that made it efficient to document data and also ensure compliance with payers. We introduced functionality that allows physicians to utilize structured data to quickly pull in previous information from their specific time with that patient, in certain sections of any encounter where it makes it relevant to pull information. We built in billing logic so that, based on the rules that have been configured and set up by the payers, we have the ability to help improve their reimbursement. It saves time because the biller isn’t having to send that note back and sifting through all that to make the appropriate charges. It prevents rejection from the claims that will go out.
- Imaging studies: We introduced a quick and easy way for technicians to preload patient imaging studies based on the practice feedback, too. When the provider gets a note, they can quickly review and add their interpretation, and it just moves forward from there automatically. We introduced logic where the appropriate modifiers would auto-append to the procedure code based on whether they interpreted the right, left or bilateral eyes.
Once we had an early version of the ophthalmology EHR ready to go, we went back to the medical practice partner for initial user acceptance testing. We had a good mix of different staff utilizing the systems — technicians, MAs, ophthalmologists, optometrists — as they were coming in and out, seeing patients, they were providing crucial feedback to help us polish the developing EHR system.
We implemented the new ophthalmology EHR in beta first across their 60 facilities. Later that year, we went to the American Academy of Ophthalmology (AAO) conference in Chicago to demonstrate our product there and to further validate everything we built for the specialty.
Our process of developing this new ophthalmology EHR continues today. I’m still listening to our existing and new ophthalmology clients. With our cloud-based platform, we’re able to make enhancements to our system in a short period of time in order to support regulatory updates.
What’s great about our work at CareCloud is the fact that we’re dedicating our time and efforts to making sure that we’re developing the software specifically for ophthalmology by working with experts in the specialty. This is an EHR designed for ophthalmologists by ophthalmologists — not only from an EHR perspective, but in seeing how it fully integrates with the rest of a practice’s practice management (PM) and revenue cycle management (RCM) applications. It’s very common to find ophthalmologists are utilizing two different systems for the PM and EHR solutions which sometimes presents some challenges with interoperability. It’s been great to be able to build a single system that addresses both the PM and EHR needs.
We’re almost a year in since we first launched this ophthalmology solution, and it’s amazing to look back on the process in detail. We’re lucky to have outstanding medical practices as our partners and clients. Together, we’re setting a new EHR standard for supporting high-performance ophthalmology practices without any interruptions to workflow and revenue.
If you’d like to learn more or see CareCloud Ophthalmology in action, check out our web page at: