Integrating Information Technology
The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.
— Bill Gates
INTRODUCTION
The introduction of computers and subsequent development of information technology (IT) has revolutionized the lives of eye care providers. The center of all this innovation is data. IT deals with the way it is obtained, entered, stored, transmitted, and analyzed. Unlike other innovations, we are being required to implement these advances in the form of electronic health records (EHRs). Successful practitioners understand this unique situation and use these mandates to enhance their businesses as opposed to constantly fighting a losing battle against them.
The ubiquitous nature of IT can sometimes make us forget how much of it we use and rely on for our day-to-day activities. The most obvious application is with EHRs, but this goes beyond just documenting a patient’s clinical exam. IT and its associated systems allow for the patient to be scheduled, insurance to be run, medication to be transmitted to a pharmacy, and the referral letter to be sent out. These stored data permit advanced uses including analytics that improve company processes, provide information that helps shape practice patterns, and report to health insurance and government agencies.
The manner in which IT has entered our lives and its impact is modeled as a blueprint for how this section is arranged. The chapter begins with an introduction to computers and the surrounding technology that create the systems with which practitioners work. The focus then shifts to EHRs, which have revolutionized the process of how providers function. Particular topics addressed are the methods of selecting the tools and accessories needed, training other providers and staff on its use, identifying issues related to patient privacy, and optimizing the outputs provided by EHRs to excel in government-related mandates and payment structure. The goal is to take the investment the eye care provider has made on IT and return it manifold through efficiencies of systems in the company.
WHAT IS INFORMATION TECHNOLOGY?
For those of us belonging to the early Generation Y and older, we can remember a time when our lives did not revolve around the use of digital and electronic technology. Information was simply passed along from either word-of-mouth or in print form. The boundaries of our work and associated advancements in society were limited by the ability to locate, obtain, and transfer the needed data. This information was securely stored up and access was limited because of these barriers. Then we had a breakthrough—the introduction of computers and the Internet. The lost key to the lock on the treasure chest holding this desired data was found. We are only now appreciating the vast amount of data out there that are available and how we can use them.
However, this environment is not a static one. The technological world has significantly changed over the past 2 to 3 decades, and it will certainly continue to evolve rapidly into the future. This is primarily due to 2 main reasons. The first is the increase of access to this technology as computers in one form or another are becoming commonplace everywhere. Anyone at any time can tap into this information. The second is the rapid growth in the rate of this technological advancement. This is exemplified in Moore’s law, which in paraphrase states this technology is doubling every 18 months.1 The amount of computing power in our smartphones far exceed what was used for astronauts to land on the moon. The possibilities of our technology feel limitless.
How has the workplace changed given these parameters? What was once a privilege to have your own personal home computer to write a paper and print it out on a printer is already becoming antiquated. The desktop computer takes up too much space and we are trying to be more environmentally friendly by not using paper to print. Now, the better option is to utilize a mobile option like a laptop or smartphone and send the file using the Internet through email or posting it online.
This paradigm shift extends even further into the layout of a medical practice. Years ago, the perception of a doctor’s office within a practice as a private space with a window view and large table. The reality is that all the room within a practice is a valuable resource that can be converted into more revenue-producing space to see patients. It can be more profitable to have physicians utilize a virtual office with mobile technology and free up that office space for other uses. The advances in IT changes not just how patients are examined, but also how physicians function in the workplace. The most important question will be whether we can harness and capitalize on the new possibilities this technology provides, or will it be an inefficient use of our time and money to incorporate into our daily activities.
INFORMATION TECHNOLOGY IN EYE CARE
The importance of IT in the eye care setting is witnessed by the massive amount of data about the organization and patients that need to be stored and processed to remain competitive in this landscape. The unique consideration about this situation is that there is an outside force, in the form of governmental requirements, which is necessitating the use of electronic data. Instead of allowing these regulations to solely have a detrimental effect, the forward-thinking provider uses this obstacle as a stepping stone to improve different aspects of the business on many levels. These opportunities range from the practice side including operation and finance to the actual patient care such as physician correspondences. The skill set related to IT for the top-tier eye care practitioner to perform are the following: comprehending IT basics, assessing EHR selection, optimizing EHR implementation, ensuring EHR privacy, and utilizing EHR for government regulations.
Comprehending Information Technology Basics
Importance
Change is inevitable, especially when it relates to technology. The introduction of computers and the Internet have dramatically changed our lives, both at home and work. Successful individuals accept that change will occur. They view it as an opportunity for growth and improvement as opposed to an obstacle. The key point to remember is that the technological world is evolving at a rapid pace. This stresses that not only should aspiring people take time to familiarize themselves with it, but also commit to its continual learning. In order to take advantage of this situation, there needs to be a solid foundation of IT basics.
Keywords
Information technology (IT): The discipline of how information is stored, used, and communicated through the use of computers as its most common vehicle
Hardware: The physical components of a computer and its systems such as a monitor
Software: The nonphysical components of a computer and its systems such as a computer program
Upgrades: The addition of new software or hardware to update the pre-existing ones
Add-on: The addition of extra software or devices to a company’s core IT equipment to increase or improve its current system
Technical support: The service to help users with computer and associated systems issues
Interface: A method of connection that can take the form of devices or programs
Network: The resulting aggregate from a set of interconnected computers and their systems
Online: The status of being connected to another computer or network
Offline: The status of not being connected to another computer or network
Remote access: The ability to gain entry to a computer and its programs from a distant site or terminal
Website: The location of an entity on the Internet that connects to various associated pages
URL: A website’s address
Virus: A type of computer malware that replicates and integrates into a computer and its system’s programs and files
Malware: A malicious software such as a computer virus
Applications
The advancement of IT has been one the most influential factors leading to change in medicine. There is software available to facilitate the required work performed all throughout a practice. This includes registering a patient at the front desk, employing imaging technology to detect disease, storing the medical data in the electronic record, and billing the insurance for the provided services. A prerequisite to enable these applications is the availability of hardware. Examples of these are the computer work stations throughout the office and the capital equipment provided with the diagnostic testing.
The introduction of such advancements also brings upon continual change. These include installing the newest software for the company’s optical coherence tomography and obtaining permission to use a feature to allow data transfer from the visual field machine to the electronic record. The addition of such upgrades and add-ons improve the current functionality of the systems with the hopes of increasing productivity.1 One consequence to consider with this growth in IT integration is the need for technical support. Effective companies ensure that this support is readily accessible to their employees because its response time can have a significant impact on how the technology is perceived. Their help in troubleshooting permits the company to effectively use the technology.
The ability to interconnect all of these systems to work together using various interfaces through a network is valuable. An example would be the use of a laptop computer to interface between the physician and the electronic record, and then transmit that information through the network to arrive at the billing department for claims processing. This can be achieved by being online at the practice site or can be enabled with remote access such as at home. Certain applications can still work even if they are used offline.
A discussion about computers is not complete with the role of the Internet. The most common use of it for a practice is the company’s website. It is found at a certain address using a Universal Resource Locator (URL). The information hosted on the site can be a tool for both patients and staff members. Caution needs to be exercised whenever the Internet is accessible due to the risk of being infected with a virus through malware. The consequences of these can be devastating for the practice by disabling electronic records, billing services, and company communications.
Immediate Action Items
How susceptible is your practice and its IT system to viruses and hacking? Unwarranted entry and damage to your IT infrastructure can create significant harm to patients, employees, and yourself. Do you have a company policy on how to mitigate this risk? If not, work with your IT staff or utilize information from online and your ophthalmic society to create one. Certain topics are common among practices: protecting passwords, encrypting sensitive files, and avoiding exposure from malicious email attachments. This effort works in unison with your compliance officer as they share similar concerns. Creating a secure IT environment is everyone’s responsibility. One strategy to encourage IT security diligence is rewarding the staff at regular intervals that have gone without any issue.
Assessing Electronic Health Record Selection
Importance
The decision to introduce the use of computers and its capability into a business is critical because of its far-reaching effects throughout the organization. There are 2 major reasons why companies proceed with this transformation: it increases production efficiency or it is required from a governing body. For those industries where the latter cause is not applicable, the decision to institute computer-based technology is simply an analysis of whether the improvement in processes with the addition of IT will outweigh its cost.
This straightforward situation does not apply to medicine because the incorporation of EHR is essentially required. It is not absolutely required at this time since organization can elect to not use EHR but will do so with increasing amount of penalty over time. The unavoidable byproduct is the need for the capital that provides the EHR in the form of computer hardware and software.
The analysis for investing into IT is different in this situation. Therefore, the thought process needs to be revised. Successful organizations faced with this decision figure out and incorporate ways that ensure that the first reason is clearly met by maximizing IT-based efficiencies to their processes. This approach makes the requirement reason essentially negligible because it makes sense to embrace this change given its strategic advantages. In the field of medicine, the processes that need to be maximized all center on the wealth of patient data and its dissemination. The advantage to this large amount of information is that there can be many opportunities for improvement if the technology is properly implemented and employed.
Keywords
Electronic health record (EHR): A medical record that is in electronic form (synonymous with electronic medical record or EMR)
Data integration: The process where information from various sources are brought together
Electronic data interchange (EDI): The exchange of data between 2 computers or networks
Data migration: The process where information is moved from one source to another
Data archiving: The migration of data from one computer to either another computer or storage medium
Health information exchange (HIE): The secure and compatible sharing of health-related information between many different entities including clinics, hospitals, health organizations, and government bodies
Local hosting: The situation where the location of a company’s server used for EHR is physically onsite
Remote hosting: The situation where the location of a company’s server used for EHR is located elsewhere and made functional through the use of a secure software application
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