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18 EW SHOW DAILY Tuesday, April 23, 2013 ASCRS Symposia Symposium shares ASOA EHR Satisfaction Survey results by Ellen Stodola EyeWorld Staff Writer Mike Norbut spoke about the results of an ASOA EHR Satisfaction Survey. A symposium presented and discussed results of the EHR Satisfaction Survey looking at ASOA members' satisfaction with electronic health records. Candace S. Simerson, COE, Minneapolis, and Mike Norbut, management consultant for McKinley Advisors, Chicago, spoke at the session about those results. As our healthcare system continues to evolve, thinking about EHR is not the same as considering other things within a practice, like equipment. EHR is not something that will likely last for 20 years, Ms. Simerson said, and it will probably keep evolving over the years. In December 2012, 73% of physicians were using EHRs, according to CDC reports, she said. "I think the great value that you can get from this data and this research is the fact that it's from you," Mr. Norbut said. He said the satisfaction results are directed and specific toward ophthalmic practices, which often have very unique needs from these EHR systems. The survey was electronic, with a goal of doing customer satisfaction research. He said the goal was to gauge some of the issues that respondents were struggling with in their own practices. Many of the responses came from ASOA members, who the survey was originally sent to. Others respondents were those who were forwarded the questions from ASOA members. The response rate was 20.5%, which Mr. Norbut said was successful. In most cases, the majority of responses came from individuals. He mentioned several key findings that came from the study and discussed the data that had been compiled. Of those who responded, 75% were satisfied with their system, he said. "We had about 30% of our respondents who felt that the value of their EHR system was greater than the cost," he said. Of these respondents, he said a majority of the practices that responded have had the EHR system for two years or less. "Practices commonly see a decline in productivity after they implement their EHR system," Mr. Norbut said. The productivity levels tend to return to normal after about a year. Another question asked respondents to give an estimate for what they believe is the cost per doctor for the initial investment in an EHR system. The average initial cost per doctor given by respondents was just over $56,000, and Mr. Norbut noted that for the larger practices, those with 11 or more doctors, it was indicated that these actually had a higher cost per doctor than some of the smaller practices. The survey calculated the average ongoing cost per doctor, and this came in at just under $9,000 per doctor, Mr. Norbut said. Many respondents, 40%, indicated that they believed there were some "hidden costs" during the implementation of the system into their practice, and some of these costs included training, support and system updates. EW role of cataract surgery in managing glaucoma. For years now, cataract surgery has come to be regarded as refractive surgery. Now it appears to have undergone yet another reclassification. Glaucoma experts have increasingly begun to accept cataract surgery as another approach to managing angle-closure glaucoma. In fact, Reay H. Brown, MD, Atlanta, when considering whether to perform "Cataract Alone or Combined Surgery?" said he preferred to avoid combined surgery. "Cataract surgery is glaucoma surgery," he said. The goal, he added, is to perform cataract surgery early, when it can help, before glaucoma surgery becomes necessary. Combined surgery, he said, has too much risk, so much so that you may end up giving up the benefit of cataract surgery. When using cataract surgery, Dr. Brown said the key is timing. Not that cataract surgery is the solution in all cases, but it is certainly indicated, said Rengaraj Venkatesh, MD, Pondicherry, India, when the anterior segment is crowded by an intumescent cataract, in cases where the angles are occludable, with no synechiae seen on indentation gonioscopy, and a normal optic disc. Ronald L. Fellman, MD, Dallas, said that he likes to call these cases "glaucoma light"; in more severe cases combined with cataract, combined procedures may be necessary. In assessing patients to decide between cataract surgery alone or Editors' note: Ms. Simerson has no financial interests related to this article. Mr. Norbut has no financial interests related to this article. Is Your Administrator Certified? +ORTQXGRTQƂVCDKNKV[CPFUVCHH GHƂEKGPE[YKVJC%GTVKƂGF 1RJVJCNOKE'ZGEWVKXG %1' Leaders in Managing the Business of Ophthalmology r%1'KUVJGPCVKQPCN UVCPFCTFHQTQRJVJCNOKE RTCEVKEGOCPCIGOGPV r%1'TGEQIPK\GU KPFKXKFWCNUYJQCEJKGXG VJG0$%1'GNKIKDKNKV[ TGSWKTGOGPVUHQT QRJVJCNOKEMPQYNGFIG CPFUMKNNU r%1'RTQOQVGU GZEGNNGPEGCPF RTQHGUUKQPCNKUO Get Certified. YYYCUQCQTIEQG 6JG%1' JCPFDQQMUCORNG GZCOCPFUVWF[ TGUQWTEGUCTG CXCKNCDNGQPNKPG Questions: EQG"CUQCQTI or 703-788-5778 YYYCUQCQTIEQG %GTVKƂGF1RJVJCNOKE 'ZGEWVKXG continued from page 16 Indentation gonioscopy, for instance, can establish whether or not peripheral iridotomy would be helpful or not. Basically, said Leslie S. Jones, MD, Washington, DC, if gonioscopy reveals open angles, it should be helpful. If there is PAS, then it will not. Speaking further on peripheral iridotomy, Dr. Jones offered this pearl: Pilocarpine is not always necessary as preparation. Instead, shining a light on the opposite eye will cause the fellow eye to constrict. Patients may sometimes complain of visual symptoms due to the iridotomy. To avoid this, Dr. Jones recommended placing the iridotomy in an area that tends to be completely covered by an eyelid. Another concept that somewhat dominated the symposium was the combined surgery, Dr. Fellman offered the following acronym: PANIC Field. P for patient, i.e., the patient's status, including IOP and medications. A for angle. Is it open, closed, occludable? N for nerve. Check the state of the optic nerve. I for iris. What is the configuration? Is it convex? Are synechiae present? Finally, check the cataract and the visual Fields. EW Editors' note: Dr. Brown has financial interests with Allergan (Irvine, Calif.). Dr. Fellman has financial interests with Glaukos (Laguna Hills, Calif.). Dr. Jones has financial interests with Alcon (Fort Worth, Texas). Dr. Rhee has financial interests with Alcon and Allergan. Dr. Venkatesh has no related financial interests.