EMR software can keep our dry eye evaluation organized and identify at-risk patients.
|Electronic Health Records and
Dry Eye: What’s Available
800.456.4522 | CompulinkAdvantage.com
Eyecare Advantage allows you to assess and document dry eye in the Workup tab, including documenting results from tear osmolarity testing. The company’s web registration feature also has questions to help assess dry eye.
877.481.4455 | Eyefinity.com
Eyefinity EHR lets you document all your dry eye findings in the Ocular Exam area and recently expanded its ability to document details of ocular surface disease, such as grading TBUT, Schirmer’s and more.
800.920.1940 | First-Insight.com
MaximEyes EHR offers comprehensive data entry for all parts of the eye plus the ability to customize and build your own dry eye or other disease template. There’s also a customizable and build-your-own document system.
877.738.3471 | RevolutionEHR.com
RevolutionEHR lets you track patients’ progress and document treatments and other dry eye protocols, including tear meibography, anterior segment photos and other tests specific to dry eye management.
Dry eye disease (DED) is one of the most common reasons for a patient to present for a problem-focused eye exam. The recently released report from the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II offers evidence-based criteria to help us properly diagnose this disease, while electronic medical record (EMR) software can help keep our dry eye evaluation organized, gathering the important data points and increasing efficiency of each exam.
TFOS DEWS II recommends starting with a series of triage questions to help narrow the diagnosis and rule out dry eye masqueraders, such as recurrent corneal erosion or epithelial basement membrane dystrophy. You can build these questions into the history of present illness (HPI) as screening questions:
• How severe is the eye discomfort?
• Do you have mouth dryness?
• How long have your symptoms lasted, and was there any triggering event?
• Are the symptoms or any redness much worse in one eye than the other?
• Are the eyes itchy, swollen or crusty, or has there been any discharge?
• Do you wear contact lenses?
• Have you been diagnosed with any general health conditions (including recent respiratory infections)?
Your software can prompt you or your technician through the preset triage questions, and the answers could populate the HPI section of the patient chart.
RISK FACTOR ANALYSIS
The next step is to determine any medications, systemic diseases and even prior ocular surgeries that increase the risk for DED. This is presently part of EMR systems, and use of technology to generate an “at risk” patient or a dry eye suspect could prevent us from under-diagnosing.
Evaluation of symptoms can be done with in-office questionnaires, such as the Dry Eye Questionnaire 5 or the Ocular Surface Disease Index. We can also build these surveys into an EMR so that the EMR rates the severity of DED or flags that patient as having an increased likelihood of DED.
Evaluation of clinical signs should include one of the following for diagnosing DED:
• Non-invasive tear break up time of less than 10 seconds.
• Osmolarity of 308mOsm/L or an interocular difference of 8mOsm/L.
• Ocular surface staining that shows more than five corneal spots, more than nine conjunctival spots, or a lid margin that’s 2mm or greater in length and 25% width.
By customizing EMRs to allow better data entry for a dry eye patient or dry eye suspects, we can improve patient outcomes. That’s because we’ll be able to identify at-risk groups and introduce treatments to restore homeostatsis. As the diagnosis and treatment of DED improves, we should let technology revolutionize the patient encounter.
Leslie E. O’Dell, OD, FAAO, is the director of the Dry Eye Center of PA at Wheatlyn Eye Care, Manchester, PA.