Recently, when discussing EMR with a colleague, I was asked about customization of different electronic medical records systems. Some of the systems available today highlight ease of use, or perhaps that templates aren’t required. This more modular approach could be sufficient within some special practices, but overall this solution seeks simplicity at the expense of ability. Sure, it would be great to have patient records in electronic format, but it may not be any easier to derive valuable meaning from the information, or use it practically.

The field of ophthalmology requires a robust EMR system able to document both SOAP-notes and high resolution drawings and images. Several years ago we talked with an IT firm developing an ophthalmology EMR system; we ended up working with them in developing a beta test site, thinking that if the system would work in ophthalmology it could also function within other specialties. Unfortunately, the system wasn’t quite ready for prime-time then, and as a result we became immersed in growing amounts of basic programming work. Unfortunately, our previous EPM vendor didn’t have another appropriate product available for the field of ophthalmology then, although a strong competitor in the overall market.

When customizing, the consequence to consider is the need to apply more time and effort to system modifications. Many systems are ready for basic set-up out of the box; however, the true potential of these systems resides in their ability to modify overall operations to the individual needs of the physicians and practice. To move the basic EMR system into an enhanced work flow tool at the practice, some modifications are necessary. The best way to do this, we have found, is through the use of mind-mapping software.

Mind-mapping software allows members of a group to ‘think out loud’ in the visual sense. Participants can actually see the workflow diagram, from the entering of patient info, to the selection of an open examination room, to billing and check-out. By examining the overall flow of the examination process, we have been able to modify the electronic medical records to better fulfill our needs. This process has helped up find places where workflow can be improved, streamlining the process and creating a more efficient system at the practice.