Eye hospital software in India: what an ophthalmology EMR has to handle

An eye hospital is not a general clinic with a different specialty. The visit moves through stations, almost every finding belongs to one eye or the other, much of the data comes from machines, and a cataract case runs for weeks from the first recommendation to the last review. Software built for a general practitioner’s consult handles very little of this.

This article sets out what an ophthalmology EMR has to do, for owners, medical directors and senior ophthalmologists comparing systems. At the end is a list of things to ask in any demo, including ours.

1. Everything by eye

Almost every finding in ophthalmology belongs to the right eye (OD) or the left eye (OS): visual acuity, refraction, intraocular pressure, lens status, cup-to-disc ratio, diagnoses. The record has to hold them as two columns, not one free-text box, so that the pressure in the left eye can be charted across five years of glaucoma follow-up, and a cataract can be coded against the eye it is in.

Look for:

• Per-eye tables for vision, refraction, pressure, the anterior segment and the fundus.
• Diagnoses coded to the eye, with ICD-10, so the patient’s history is searchable.
• Trends: pressure, vision and cup-to-disc ratio over time, per eye.

2. The work-up is a sequence of stations

A typical walk-in moves from registration to vision and refraction, to pressure, to dilation, and only then to the doctor. The software has to know where each patient is.

• A floor view that shows who is waiting at which station, and for how long.
• Hand-offs from the nurse or optometrist to the doctor without re-typing what was measured.
• Dilation with a clock. The drops, the time they went in, and a countdown to when the pupil is ready. Dilated patients are easy to forget, and a pupil examined too early is a wasted visit.
• Readings before and after dilation, kept apart, because a refraction or pressure after dilation is a different measurement.

3. Readings that come from machines

Autorefractors, keratometers, biometers and OCT machines produce numbers, and every number typed in by hand is a chance for a decimal slip. Ask which devices the software reads from directly. Where readings are typed, they should be checked as they are entered: a pressure or a lens power outside its usual range should be flagged, with the likely decimal slip suggested, without blocking a genuinely extreme reading.

4. Biometry and the lens power

For cataract surgery, the A-scan or optical biometry and the keratometry decide the intraocular lens (IOL) power, and the calculation depends on the lens model’s constant. A biometry unit computes a power for each lens model the hospital stocks. The software should record those per lens and per eye, carry the latest biometry into the surgery plan, and say clearly when the reading was taken, because a lens power calculated from an old measurement is a real risk.

5. Surgery: counselling, the case and the bill

A cataract case is a small project:

• Counselling. The surgery is explained, the package and lens options are discussed, and the patient decides, often after going home to think. The software should record the options offered, the price quoted and the decision.
• Booking and the advance. A surgery date, and an advance collected against it.
• The day of surgery. Consent, the safety checklist, the lens actually implanted with its serial number, the operation record.
• Discharge. A discharge summary, the post-operative drops as a schedule the patient can follow, and a bill that nets off the advance.
• Reviews. The first post-operative visit, and the reviews after it.

Each step should feed the next without re-typing, and the bill should match what was counselled.

6. Prescriptions, spectacles and the optical shop

An eye visit can end with three kinds of prescription: medicines, often eye drops with a tapering schedule; a spectacle prescription; and contact lenses. The spectacle prescription should go straight to the hospital’s optical shop or lab, so the powers are never copied by hand, and the shop should see exactly what the doctor wrote.

7. The rest of the hospital

An eye hospital still needs registration with one record per patient, appointments and a walk-in queue, a pharmacy, billing and collections, and records that can be linked to the patient’s ABHA. Software that charts the eye well but sends you elsewhere for billing or the optical shop costs time every day.

Questions to ask in any eye hospital software demo

1. Register a walk-in and follow them through vision, pressure and dilation to the doctor.
2. Record refraction for both eyes, then the same readings after dilation, and show both.
3. Chart a glaucoma patient’s pressure in each eye over the last five visits.
4. Enter an A-scan with several lens models, and choose a lens power for surgery from it.
5. Run a cataract case from counselling to discharge, with the advance netted off the final bill.
6. Send a spectacle prescription to the optical shop and show what the shop sees.
7. Type a pressure with a missing decimal point and see what happens.

Where 92health fits

92health is an EMR used by clinics, hospitals, pharmacies, labs and optical shops in India, and ophthalmology is one of its deepest specialty workspaces. It covers the points above:

• vision, refraction, pressure, anterior segment and fundus charted per eye, with diagnoses coded in ICD-10 and trends over time;
• a floor view of every station, with dilation timed from the drops to a ready pupil;
• readings checked as they are entered, with likely decimal slips suggested;
• A-scan biometry with a lens list per eye, carried into the surgery plan with its date;
• surgery from counselling and the advance through the day of surgery to discharge, the post-operative drops and an in-patient bill that nets the advance;
• spectacle prescriptions sent straight to the optical shop.

If you run an eye hospital in Chennai, Madurai, Coimbatore, Trichy, Tirunelveli, Visakhapatnam, Vijayawada, Guntur or anywhere else in India and want to see it on your own cases, book a demo. Bring the questions above.