In September 2007, our office in Sacramento, California converted to electronic medical records (EMRs) with the expectation of going "paperless." Ideally, an EMR system can allow offices to function without creating paper charts and mandates that all of the examination findings, diagnostic testing, laboratory studies, insurance communications, etc, be entered electronically or scanned to become a part of the patient's EMR. The daunting task of using a paperless system has revealed some very interesting implications about the collection of data in today's highly sophisticated, computerized medical office.
Ophthalmic technicians perform most of my preliminary examination. They record the patient's medical history, as well as list his medications and allergies. In addition to testing the patient with a lensometer, autorefractor, keratometer, tonometer, and perimetry, we also obtain an image of his optic disc and perform an IOL calculation if a cataract is present. On occasion, the preexamination testing may include angle photographs and anterior segment imaging. The data are entered and organized in the EMR system and/or paper chart, and I review them before entering the examination room. This scenario was not the case a few years ago. The number of tests available and the quality and quantity of the information is far more sophisticated today. In fact, before actually meeting the patient, I often have sufficient clinical and personal information to make a diagnosis and plan.
To say that the role of technology in the assessment of glaucoma is expanding would be an understatement. Why should we do gonioscopy when we have ultrasound and photographic imaging that is superior? Why bother to pick up your ophthalmoscope to look at the optic disc when optic nerve imaging is easier, quicker, and often quantitative? What or who is better at detecting visual field progression—a progression analysis program or a clinician? Is much of our time-honored "hands-on" examination going the way of the tangent screen?
This issue of Glaucoma Today is devoted to the expanding role of diagnostic testing in the management of glaucoma. In the future, it would be interesting to compare diagnoses of glaucoma determined by clinicians with those based on data collected by a technician.
