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I.-C. Lin, P. K. Gupta, C. S. Boehlke, P. P. Lee; Impact of Physician Subspecialty and Electronic Medical Record on Dry Eye Care. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5061.
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Optimization of the evaluation and management of dry eye patients is an important topic in ophthalmology. The use of electronic medical records (EMRs) and care by specialists have been shown to improve the conformance to recommended practice guidelines in other areas of medicine. As such, we sought to evaluate the impact of the use of an electronic medical record on process and quality of care related to dry eye, as well as the presence or absence of a relationship to subspecialty training in cornea.
In the pilot study, 131 charts of patients seen at the Duke Eye Center from January 1998 to July 2008 with a diagnosis of dry eye were reviewed for conformance to the 1998 American Academy of Ophthalmology’s Preferred Practice Patterns (PPP) summary benchmarks for dry eye. Total and subset scores were calculated for all charts. Scores were compared between subspecialty types, as well as by medical record type: EMR vs standard paper chart.
Of all patients in the study, 28% were diagnosed by cornea specialists, 21% by comprehensive ophthalmologists, and 50% were diagnosed by other specialists (glaucoma, oculoplastic, pediatric ophthalmology and retina trained specialists). Of all charts, 16% were recorded by electronic medical record. The average total score was 67.4% for all evaluations. On average, 66.4% of the initial history key elements, 77.3% of physical exam key elements, 40.0% of care management and 68.0% of patient education key elements were documented. While the physical exam component scores were 87% in the EMR group compared to 75% in the standard paper charting group (P<0.0001), the between-group difference in total scores (70.49% vs. 66.81%) was not statistically significant (P=0.19). The physical exam component scores were also highest in the other specialists group (81.09%) compared to the comprehensive ophthalmologist group (73.27%) (P=0.03) and the cornea trained specialists (73.48%) (P=0.015), but the total scores did not differ significantly (P=0.43).
Conformance to the dry eye PPP in total score did not differ in our pilot study by use of an electronic medical record or by specialty status. However, while use of an EMR has the potential to allow better documentation within the medical record, the benefit seen in the pilot study was limited to the area of physical exam. Additional data are needed from other practice settings to further evaluate the impact of the physician subspecialty and the use of EMRs on the quality of dry eye care and eye care in general.
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