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Startup Spotlight | April '13

What I Have Learned From Starting My Own Practice

A look at choosing an EMR system.

It has been almost 3 months since I started my own practice. Though the practice of ophthalmology has always been familiar to me, the business side was a completely different language. The landlord handed me keys to my new office and told me where to put my occupancy license. I responded, “What’s an occupancy license?”

Goldman Eye

Fortunately, most startup issues in your practice only need to be set up once and renewals are pretty automated. Making sure your infrastructure is sound is the most important step. Whether it’s your staff, the equipment, or marketing, you need to spend some time deciding what is most important. Your budget will not allow you to start out having it all.


In this column, I will discuss different aspects of practice startup, and what I chose (or did not choose) to maximize efficiency. For this article I will focus on electronic medical records (EMR) and my choice: Electronic Medical Assistant (EMA Ophthalmology) by Modernizing Medicine

EMA Ophthalmology by Modernizing Medicine

Choosing an EMR system is one of the most important—if not the most important—steps in setting up a practice. A bad EMR system can decimate a practice, slowing productivity by as much as 75% some experts have said. A good EMR, however, can provide many benefits to your practice. In my opinion, any EMR you purchase should be cloud based. With client server-based EMR, you will spend much more money up front on things like new computer purchases and electrical upgrades. Furthermore, you will likely have to upgrade your system multiple times, each time running the risk of having your system crash. If a virus gets into your system, your entire practice is demolished.

Cloud-based systems can be accessed anywhere, so if you decide to expand to a satellite office, you do not need to buy a second system. Upgrades are done automatically, seamlessly, and typically, without charge. I love the fact that when a patient calls me during a weekend, I can access all of their records from my iPhone (Apple, Inc.) instantly. Most cloud-based systems charge a monthly service fee as opposed to the one-time fee of many client server-based programs, but it is foolish to think that the latter will save you money. Ask yourself one question: “How long have I ever kept a version of Microsoft Office that I purchased once the new version was released?”

In the world of cloud-based EMRs there are only a few big players. Modernizing Medicine, a relative newcomer to ophthalmology, started in dermatology and quickly became one of the most used products in the field. The company followed the same formula in ophthalmology, recruiting ophthalmologists to build the system from the ground up. The result is an intuitive iPad-based (Apple, Inc.) format that allows complete eye exams to be drawn up rapidly.

It is worth mentioning the iPad interface a little further, as this was one of the deciding factors that led me to choose this EMR system. Using an iPad in the clinic has many benefits: (1) less space is needed (who needs desks when you don’t need computers?); (2) patients can sign all consent forms right on the screen; (3) equipment costs are very low, (4) I can face my patients while documenting an exam and (5) patients love the technology. A simple upgrade I put into my practice was wall mounting flat screen TVs in my exam rooms. Connected to Apple TV (Apple, Inc.; approximately $90), I am now able to select “Airplay” on my iPad to mirror any testing I want on the big screen. Whether it’s a slit-lamp photo or optical coherence tomography scans, patients are amazed by the high-tech aspects and feel they are in a next-generation practice.


Of course, EMR has to make your practice efficient, and that has certainly been the case for me. Although nothing will be faster than a paper note, once I’ve performed an exam using my EMR (anywhere from 1 to 2 minutes), everything is complete. By everything, I mean patient-counseling handouts, prescriptions (which have been sent to the patient’s pharmacy of choice), consult letters to referring physicians, and billing. In addition, the records are kept in a professional legible format, which is easy for me to access at any time, anywhere. When starting my practice I chose Modernizing Medicine’s EMA Ophthalmology for my EMR, and have been very happy with that decision ever since.

David A. Goldman, MD

David A. Goldman, MD, is the founder of Goldman Eye in Palm Beach Gardens, Florida. Dr.Goldman may be reached at (561)630-7120;david@goldmaneye.com.

April '13