State of EHR systems in 2019

Those familiar with EHR systems discuss the advantages and challenges of today’s systems.

Electronic health record (EHR) systems can make your practice more efficient, for example, by decreasing time spent looking for files and filling out paperwork. EHR also presents challenges, such as organizing and managing a team to maintain system updates. This is some of the feedback Ophthalmic Professional received from a number of editorial board members and ophthalmic staff who completed an informal survey regarding the advantages and challenges they experience with their EHR systems.

Here, we provide detail on these advantages and challenges and offer some tips.


Customization. “Rather than modify our workflows to match the EHR, we have modified the EHR to match our workflows,” says Lisa Shaw, COE, practice administrator for Laurel Eye Clinic, western and central Pennsylvania.

As an example, Ms. Shaw says her practice has developed a triage template to assist call center operators in deciding how quickly a patient needs to come into the office.

To customize your EHR system effectively, Ms. Shaw recommends looking at the bottlenecks in your practice and finding a way to use the software to help.

Customization personalizes the application to the institution, says Erik Anderson, NCP, COA, applications development analyst at St. Luke’s Cataract & Laser Institute, Tarpon Springs, FL. “It creates better patient care by keeping familiar workflows that reduce time on the computer”

Efficient workflow. EHR also can decrease workflow steps, says Laurie K. Brown, MBA, COMT, COE, OSA, OCS, CPSS, senior consultant at BSM Consulting.

One way the software does this is integration. Darrin Landry, CRA, OCT-C, ophthalmic consultant at Bryson Taylor Inc., says that EHR software can integrate with software for scheduling and diagnostic equipment. Specifically, all imaging modalities have a seamless integration to the EHR — whether via JPG or PDF files or complete review software within EHR. Meanwhile, Elizabeth Holloway, COE, PHR, CPSS, consultant at BSM Consulting, says she finds advantages in batch posting from the EHR to a billing company.

EHR systems also help increase efficiency by making information easily accessible to the staff. Ms. Holloway says, specifically, that staff members can pull up the record from any work station, eliminating the need to hunt for charts. She also describes functionality within EHR that eases cross reference of medications with insurance plans and contraindications with currently prescribed medications.

Melinda Alderton, NCP, EHR, IT manager for Laurel Eye Clinic, describes features, such as quick lists and drop downs, that save the staff member time typing, among increases in efficiency. Specifically, the software can be programed to input commonly gathered information.

Provides a check. That the software is updated to be current and compliant with CMS reporting requirements is an advantage to today’s EHR software, says Ms. Alderton.

Pick and choose

American Academy of Ophthalmology offers a listing of more than 100 EHR systems used by ophthalmology practices along with information, such as whether it integrates with the IRIS Registry and how the EHR system hosts your practice data, via a cloud, server or both. Access this listing, updated in 2018, at .

Myra Nisly Cherchio, COMT, director of clinical operations at of St. Luke’s Cataract & Laser Institute, agrees, listing more compliant records among EHR advantages.

Additionally, the ability to do government reporting on the Merit-based Incentive Payment System, or MIPS, through her EHR software is among the advantages cited by Becky Bryant, project manager at EyeCare Associates of East Texas. “The product is continually updated to incorporate coding and documentation requirement changes, and enhancements to make it more efficient,” she says.

A number of respondents noted that the systems allows for more clear, complete medical records.


Implementation. Ms. Bryant says her practice held out as long as it could before implementing EHR. “We felt we could see patients faster and more efficiently on paper,” she says.

Changes in workflow can be a management challenge. Ms. Holloway recommends you “develop a streamlined implementation system to roll out software and updates. The system should include a company communication plan (who gets told what when — how do you keep everyone in the loop?) as well as a plan to manage when and how technology is upgraded.”

Customization. Customization, though more frequently among EHR advantages, takes time and effort.

“On the practice side, it is often hard to appreciate how much time and effort it takes to program/engineer what seems like a small and simple change,” Ms. Bryant says.

Updates. Customization can make updates to the software challenging, says Ms. Shaw.

To help your practice with updates, “identify an EHR team for your practice,” Ms. Cherchio says. “This team should be in charge of updates, developing protocols, maintaining the system, training staff.”

Jessica Barr, COMT, ROUB, clinical applications specialist at Quidel, offers similar advice. She says her practice experience included a designated staff member who was the champion of the software. The champion would be the resident expert and disseminate information in easy to understand and relevant ways.

Conversely, regarding updates, some platforms cannot keep up with user expectations. Mr. Anderson says dated graphical user interfaces, which lack intuitiveness that today’s users expect, can be challenging.

Training staff. Multiple respondents listed personnel-related issues among the challenges that come with operating EHR systems.

“Get as familiar with the EHR application as much as possible,” Mr. Anderson says. For example: shortcuts offered by the software could allow a user to create a paragraph of detailed information in two clicks.

Lyn M. Lane, COE, administrator at Florida Eye Institute, Vero Beach and Sebastian, FL, recommends engaging staff with annual conferences and webinars and investing in onsite training one to two times per year.

Additionally, keep a focus on continuous improvement after implementation to maximize EHR use and efficiency, Ms. Brown says. She advises working with your vendor to find solutions to maximize operations.

Mr. Landry offers the input of data, uploading of images, and scribing within the EHR should be standard across the practice, so cross coverage of technicians is not an issue.

That said, operator error can persist. Ms. Cherchio says her practice experiences challenges with EHR that are sometimes related to people using the system incorrectly — for example, making their own workarounds. One way to help identify this would be chart review. Martha Tello, senior certified ophthalmic medical technologist, Bascom Palmer Eye Institute, Miami, advises doing so frequently to identify consistent errors. Additionally, she says to share tips for working with the software during staff meetings.

Hardware constraints. Ms. Alderton says her staff members will always be happier with less clicks and a faster program, however, she acknowledges that this is not only a software concern. “They have to remember it will only work as fast as the internet connection and computer you are using to open it,” she says.

Dated frameworks of EHR systems can put a strain on server storage and usage, creating extra expenses for daily usages and backups, says Mr. Anderson.

Additionally, Ms. Cherchio says she would like to see more mobile solutions.


A longitudinal study of perceptions of EHR systems in ophthalmology offices, from Applied Clinical Informatics, found the need to adapt software to unique needs of a practice was crucial to satisfaction and efficiency.

To that end, survey participants offered the need to communicate as an additional tip for success, specifically with the software company. Make requests for functionality and ask questions to help make the system work for you and your practice. OP