“Red sky in the morning, shepherds warning. Red sky at night, shepherds delight.”
The Mavis Beacon Teaches Typing software had me type this over and over. We had just decided that we were going to ditch paper and use our practice management system for clinical records too.
Until now we had only used our system for recording dispensing details, generating lens orders and doing the billing, so this was a big move for us. Our major concern was losing the data when the system went down. Should we do an interim period of recording everything twice? One hard copy and one soft copy? Do automatic backups really work?
Paper records were real! Even if they were lost to misfiling at least one patient a day; and how the hell did you figure a system for filing Scottish surnames? Then there was handwriting, of course. I couldn’t really blame my colleagues because I couldn’t even read my own in the end. But it wasn’t until the system did go down that we fully appreciated digital records. They could be re-birthed; emerging from the panic like nothing had ever happened.
Digital record cards are normal now, as are those awkward silences when the healthcare practitioner turns their attention, and usually their backs, away from us to write something up. A mutually disagreeable experience! Both the record and the personal interaction suffer. There are not too many practitioners of my generation (and this Chalkeyes has been around for a while) or older, that have ever really adapted. The records show this very clearly.
Compare, if you will, the oldest optometrist in your practice’s notes with the youngest. Many records are not to standard with the notes very brief and incomplete – not really an accurate or complete record of what was examined and how the patient responded. At the end of the day, how can you do both in such a limited time?
A complex case was referred to me recently and the accompanying information was a fax of a handwritten card. It was almost completely indecipherable. Once my recoil wore off and I was able to work it out I was immediately struck by how much information had been recorded on that messy page, in abbreviations, ticks, scribbles and sketches. I’ll bet it was all done while chatting to the patient too. We have definitely lost something going digital!
But there is also lots to be gained if we could just have better systems that work for us and our patients, and if they were compatible with each other.
I have, at one time or another, had the opportunity to look at all the available digital record systems used in New Zealand. Some practitioners are definitely better at recording than others, maybe it’s Mavis Beacon, but then maybe it’s talking to the patient instead of pecking at their keyboard with their backs turned.
The last decade has been transformative in eyecare. The technology that is now found in most practices is mind boggling compared with when I started out! Automated perimetry and digital fundus imaging is an expectation. Even OCT today is almost normal. Widefield confocal images are also becoming standard as are topography, digital eye charts and many other things. Modern optometrists are able to get a very good idea of what is going on in and behind our patients’ eyes. Yet, typically, all of this technology runs on its own separate databases - I use seven - on different platforms and all of it poorly integrates with the practice management system, digital or written.
I am sure this is not just a Kiwi thing. American practice management advice recommends having a “scribe” in your consulting room to record your results. I suppose you would mumble your findings as you go along for them to record on a laptop. Personally, I don’t think I’d like doing that very much!
All the practice management systems on the market today have strengths and weaknesses, but are all ultimately similar. Our practice uses the Sunix Vision system, written in Foxpro. A Microsoft product that has been unsupported by them since 2007, written for the IT environment of the 1980s and ‘90s. A heritage application that surely can’t have much more to offer for the future. Although it is totally inadequate, it is familiar and no worse than the other systems when you look at the big picture.
We use many hacks to get it to work better for us. We import clinical images, once they’ve been zoomed and manipulated to highlight the detail we try to record, via the windows clipboard into Microsoft Paint, to attach them to patient’s files. We have to remember to record pinhole acuities on referral letters because that field can’t be transferred and contact lens orders are treated as consultations, which is just downright obstructive. And that’s just a few of the things I find frustrating about just our system!
It’s hard not to get a little sad about all this. It’s a major opportunity that is being missed. We all use databases that record findings from a diversity of people of different ages and stages, from all walks of life and in all sorts of states of health. We record notes on the same findings, using the same techniques in very much the same way, albeit that the specifics are a little loose. Imagine if this data could be anonymised and pooled. What learnings are hidden in those little boxes on our screens; across all our patients from across the country, or even the world!
We’ve got the gadgets, now let’s get the software. Surely it can be better that this! The current providers seem complacent and are unlikely to cannibalize their own market share to disrupt things. The “new cloud system” by Sunix seems to have burned off. It is time for better, surely! Is our industry too small? Are we too difficult?
This Chalkeyes would like to challenge someone from all those competing software providers to do better, to share better, to really make a difference for individual practices and, in-turn, the wider eye health world to better record and share our data. Now wouldn’t that be a technological advance worth talking about!
In the meantime, I better keep practicing my typing…
“Red sky in the morning, shepherds warning.
Red sky at night, shepherds delight.”