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Practice Managers | Mar/Apr '14

The Automated Practice

I really want to buy a Roomba. For those of you who have been living under a less-nerdy rock than I, a Roomba is an automated vacuum cleaner that will clean your floors BY ITSELF. My wife and I have been talking about it for a long time, but we just haven’t pulled the trigger yet. Why? Well … because we are skeptical that it will work as advertised. What if it doesn’t vacuum anything? What if it runs into the walls? What if the dog decides it is an expensive chew toy? However, the flip side of this equation is fantastic. This is a vacuum that you can set to clean your floors at predictable intervals, at preset times, with consistent results. How cool is that? I have a 7-year-old son with borderline ADD, and there is absolutely nothing predictable, preset, or consistent about him, so this premise is somewhat utopian. But if it can be accomplished with a vacuum cleaner, it would be awesome.

Launching EMR was similar to buying a Roomba. No one thought it would work as advertised. In fact, everyone was predicting doom from the moment we signed the contract. We were prepared to lose income, to lay people off, and to basically have a lousy year. We were very skeptical that EMR could do anything to speed up or better our already-“perfect” process. Instead, what we learned is that, by itself, EMR could not do all these things, but by invoking the power of “what if” we managed to incorporate multiple offerings from different vendors to truly move toward automating the office.

The premise was simple. We wanted to streamline our process—from call center, to check-in, to clinical, and beyond the patient visit—so that a majority of steps and correspondence were done automatically, limiting human detailed intervention and, therefore, human error. I specify “detailed intervention” because we did not want to take away from the cordial relationship Nina had with Mrs. Liotta at the front desk. Instead, we wanted to enhance those interactions by limiting the detail work that Nina had to do within her job. We wanted Nina to not be worried about errors, but instead be conscious of the entire patient experience.


Kiosks, implemented to automate the check-in process, have helped to improve the patient experience and increase practice efficiency.

First, we moved to enhance the check-in process. We had way too much paper and a confusing protocol. EMR looming in the background was a good excuse to button that up and streamline the process, but we needed an easy interface for patients. For this, we instituted kiosks at all of our locations that automated the check-in process with little intervention from the front desk staff. We set out to capture accurate data by using optical character recognition and a scanner. We consented. We collected balances and copays at the kiosk. We had patients agree to their potential refraction charge, and, most important, we captured accurate demographic data that we have been able to use for data mining, marketing, and overall patient correspondence. For instance, we were forced to close the office due to snow this winter, and, at the click of a button, I was able to email all patients scheduled in all locations on that day letting them know of the closure.

The “email” part of that example above came from a different vendor and program altogether. We knew we needed a more efficient way to communicate with patients in today’s smartphone age. We wanted to correspond quickly with patients by text and email, so we ended up interfacing another program to our Practice Management system that would monitor our schedule, send reminders 2 days prior to scheduled visits, and mine the data so that patients who were overdue for their annual exams would be gently prodded by email or text (depending on HOW they wanted to be contacted), rather than by robo-call.

The service also has the added advantage of sending out a patient satisfaction survey 1 day after each visit. It asks basic questions and allows for a free text review. Amazingly, we are getting about a 17% response rate on the surveys, and the results are truly eye-opening. Since implementation, we have been able to make some internal changes strictly based on the review feedback. If you are not currently taking an introspective look at your practice, I highly suggest this approach. It’s automated, nonintrusive, and extremely helpful.

After the kiosks and correspondence were implemented, we started to make way for EMR implementation. We decided long ago to commit to a terminal services application. In layman’s terms, this means that all of your important patient data are housed in a secure, off-site data center that you access via a small, free app that is compatible with both Windows and Mac OS. This does make you victim to your Internet connection; however, we have found that even nondedicated connections have become extremely reliable.

I will spare you the details of our journey to implement EMR, as it is long and tedious, but it ends well. We have monitors and computers accessible to all lanes and patient flow areas. We also have implemented these in our LASIK OR so that refractive surgery has become totally paperless.


There are two more pieces of software that we have committed to, which are scheduled to launch in the next 2 months. The first is the implementation of an electronic signature platform, so that surgical consents and Advance Beneficiary Notices can be captured on a tablet and immediately imported into the electronic record. This should be the last piece of paper that we successfully eliminate.

The second is an auto-indexing client that accepts faxes and scans that come in and automatically attaches them to the patient chart based on optical character recognition. Along with being automated and VERY cool, this software will allow us to reduce our full-time employees by two.


The automated processes that we have established have helped to enhance the patient experience and have also made us a more efficient practice. The goal is consistency. Prior to the implementation of these items, we could always count on our physicians to do their part. They maintained consistency in a high level of patient care. It was administration that faltered. Now, I believe that by automating much of the process, without eliminating the personal touch, we are committed to providing every patient with a professional consistent experience from stem to stern.

Roberto Conte

Roberto Conte is the Business Manager of Eye Doctors of Washington. He may be reached at rconte@edow.com.