Philadelphia Regional Ophthalmic Society
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Sean Patrick Murphy

 

 

 Items of Interest


Risk Management Issues with EHR Efficiency Tools
Kathleen Santa Maria

Many of the software programs used for electronic records include time saving features such as “copy forward,” bringing the last note to the current visit, prewritten “standard” procedure notes and prepopulated text when a box is checked. While these tools save time in a busy patient day, they should be used with care. Records that have identical entries can raise the question of whether the care was actually performed.

When copying and pasting information, always review and make changes based on the patient's comments today. Only copy and paste information relevant to today’s visit. Problems from a previous visit that are resolved should not be in the chief complaint of the next visit.
Standard procedure notes should be reviewed to ensure any deviations from the norm are included. 
Never copy from another patient. 
If review of systems has an “all normal" option, be sure to change the relevant items to abnormal. Failure to accurately document problems could be an issue in defending a malpractice claim.
Changing a record after it is finalized can be a problem. The physician can be accused of making changes to cover up a problem. Remember most changes are date and time stamped. 
Patients often receive copies of the record as they leave the office and then changes are made prior to finalizing the document. Multiple versions of the same document can create an issue in a malpractice case. If significant changes are made the patient should be sent a revised note.

In addition to the issues created in defending malpractice claims, Medicare is also auditing for cloning of records as potential fraud. The work value and payment is based on performing the elements of the history and examination. They have developed software that can identify blocks of identical text in patient records. On audit they can deny the claim, requiring refund of payments and possible fines. Review the chart note that prints out and is sent for an audit to make sure all the relevant documentation is included. Down coding can occur based on missing exam or history elements that don’t appear in the printed chart note even though they are documented in the record.


Volunteers Needed for Blind Sports Organization (BSO)
BSO programs are open to blind or visually impaired ages 7 and up who can follow directions, be fairly independent and handle some strenuous physical activity.
Can you help with coaching, fund raising, tandem bike piloting, youth activities, softball pitching or catching?
Contact info@blindsports.org or call 302-836-5784
www.blindsports.org


E-Learning for eye care professionals made quick and easy.
* Earn IJCAHPO Credits
* Take Online Quizzes and Tests
* Track Earned CE Credits
Get in on the ACTION at:
https://eyecarece.jcahpo.org/


Tips for Taking Fundus Photos
By Julia Monsonego

1) Communicate with your patient!
The more direction you give them, the less confused they’ll be, and the more cooperative they’ll be for you.

2) If you see something of interest - photograph it! Document everything!
Make sure to photograph the ENTIRE lesion/hemorrhage. Find the edge.

3) Let your patients know that they can blink as needed, BUT to open eyes wide between blinks. If you don’t tell them they can blink, they will try not to. This will cause stress on the patient, strain, squinting, tearing, and poor image quality. Let your patients blink!

4) Use the fixation pointer if the patient has a difficult time seeing the fixation light. However, if the patient is cooperative, since the pointer may distract from the photograph, pull it out of the lens at the last moment before clicking the shutter.

5) For light sensitive patients, turn the viewing light down low. Try to line up the eye as best you can peeking through their squinted eyes. You should be able to line up their vessels, find their optic nerve, etc. Try to obtain the best focus possible like this. Once you have everything lined up, have the patient blink, and then lift their lid with a Q Tip and shoot. You may need to make a few adjustments, but you’ll definitely get a better photo than if you held their eye up through the entire process.

6) When taking stereo optic nerve photographs, focus the first image on the rim of the optic nerve head and the second image on the cup. This will give the pair a much more appreciative three dimensional view.

7) When shooting images for a montage, photograph the fields in a clockwise or counter-clockwise direction beginning always with the posterior pole. This will help you to make sure you have obtained all necessary fields and the order helps the computer software match up the images more accurately.

8) If you’re having a difficult time getting a clear view of the eye, pull the camera back a bit and set the focus lens on A. This will give you a view of the opacity and how to get around it to obtain a clearer fundus image. And while you’re at it, take a photograph of the opacity. Document everything!



Links

Online Portal for Ophthalmic Technicians

Wills Eye Hospital® Annual Alumni Conference Technicians' Program

American Academy of Ophthalmology

American Society of Cataract & Refractive Surgery and American Society of Ophthalmic Administrators

The National Eye Institute

Macular Degeneration Foundation

American Printing House for the Blind

The Glaucoma Foundation

Centers for Medicare & Medicaid Services (CMS)
(formerly Healthcare Finance Administration - HCFA)

IJCAHPO

American Society of Ophthalmic Administrators

Find PROS on Facebook here


Associated Services for the Blind

Our thanks to Diane Brash of the Associated Services for the Blind.  Diane has provided us with resources to assist our visually impaired patients:

Associated Services for the Blind
919 Walnut St
Philadelphia,PA
215-627-0600 ext 3254

Library for the Blind, GED programs: 
215-683-3213

PA Bureau of Blindness and Visual Services:
215-560-5700

PA Association for the Blind:
Bucks County: 215-968-4731
Chester County: 610-384-2767
Delaware County: 610-874-1476
Montgomery County: 215-661-9800

 

PROS MESSAGE CENTER 215-825-4725
Email: mmassini@willseye.org