Inside the EHR Black Box: What’s Helping, What’s Hurting, and What’s Next for Optometric Tech

Summary

Inside the EHR Black Box: What’s Helping, What’s Hurting, and What’s Next for Optometric Tech

Power Hour Optometry
Host: The Power Practice
Release Date: June 12, 2025
Panelists:

• Eugene Shotsman (Host)
• Kelly Kirkcsik (Director of Professional Affairs at Revolution)
• Charlie Beagle (President of iFinity)
• Dr. Anthony Sesto (Practicing Optometrist in Michigan and Tech Innovator)

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Introduction and Panel Overview

In this enlightening episode of Power Hour Optometry, host Eugene Shotsman facilitates a comprehensive panel discussion with industry experts Kelly Kirkcsik, Charlie Beagle, and Dr. Anthony Sesto. The focus is on Electronic Health Records (EHR) systems within optometric practices—exploring their evolution, current challenges, and future innovations.

Eugene Shotsman sets the stage by highlighting the episode's aim: to synthesize common frustrations with EHR systems into insightful discussions without any commercial bias. He introduces the panelists and outlines the wide range of topics to be covered, including AI integration, workflow automation, and the true costs associated with EHR platforms.

Evolution of EHRs in Optometric Practices

Charlie Beagle kicks off the conversation by tracing the dramatic transformation of EHRs over the past five years. He notes that EHRs have shifted from being mere documentation tools to becoming the operational backbone of modern practices.

“EHRs in the past have been primarily documentation tools, digital filing cabinets, if you will, and today they're really the operational backbone that determines whether a practice thrives or struggles.”
— Charlie Beagle [02:48]

Charlie emphasizes the growing expectations of practices, which now demand comprehensive systems capable of handling patient engagement, business intelligence, compliance management, and revenue optimization. He introduces the concept of invisible integration, where technology seamlessly integrates into daily workflows without disrupting the practice's operations.

Kelly Kirkcsik adds that the COVID-19 pandemic significantly accelerated the integration of technology within practices. The necessity for remote operations, efficient communication, and flexible staffing models pushed EHR systems to the forefront of practice management solutions.

“The COVID pandemic certainly played a really large role. It triggered a huge push where technology implanted itself in the center of the practice to help with all the communication pieces.”
— Kelly Kirkcsik [05:09]

The Impact of COVID-19 on EHR Adoption

Kelly Kirkcsik elaborates on how the pandemic unveiled unforeseen needs within medical practices. She points out that technologies enabling remote work, efficient communication, and flexible staffing became critical overnight, reshaping the traditional operational paradigms of optometric practices.

“Practices had to transition to the way they operate as a result of the technology that was needed during that time.”
— Kelly Kirkcsik [06:50]

This shift underscored the importance of adaptable and integrated EHR systems that could support not only clinical functions but also administrative and operational efficiencies.

Communication and Integration Challenges

The panel delves into the persistent challenges of communication between different healthcare entities. Kelly Kirkcsik highlights the difficulties in inter-office communications, especially when referring patients to specialists or collaborating with hospitals and laboratories. She advocates for a unified system where all EHR platforms can communicate seamlessly, eliminating the need for manual processes.

“It would be nice to get to a point where even if all systems look different and have unique features, we're all speaking the same language.”
— Kelly Kirkcsik [08:50]

Charlie Beagle echoes these sentiments, emphasizing that poor communication not only hampers efficiency but also impacts patient care. He stresses the need for EHR systems to support both external referrals and internal patient interactions effectively.

Human Factors: Training and Utilization

A significant portion of the discussion centers on the human element—how staff interact with EHR systems. Dr. Anthony Sesto shares his firsthand experiences, identifying system slowdowns and inadequate training as major sources of frustration within practices. He criticizes the "telephone game" training approach, where knowledge is diluted as it passes through multiple layers of staff, leading to misunderstandings and underutilization of EHR features.

“A lot of those frustrations... are about the training that the provider's office assigns someone who's not the doctor to do the training on it.”
— Dr. Anthony Sesto [16:35]

Kelly Kirkcsik concurs, noting that as EHR systems become more sophisticated, the learning curve steepens. She compares EHR updates to smartphone operating system updates, where continuous learning is essential to fully leverage new functionalities.

“A lot of times it's just a challenge for practices to keep up with the pace of innovation.”
— Kelly Kirkcsik [14:43]

Underutilized Features and Efficiency Gains

The panel sheds light on the often-overlooked features within EHR systems that can drive significant value if properly utilized. Kelly Kirkcsik points out that many practitioners remain unaware of the full capabilities of their EHR systems, missing out on features that could enhance efficiency and patient care.

“Many of our EHR customers don't realize that they're not utilizing all the features available to them.”
— Kelly Kirkcsik [24:10]

Charlie Beagle advises practices to conduct quick audits of their workflows to identify areas where EHR integrations can eliminate inefficiencies, such as automating data entry from medical equipment or streamlining claims processing.

The Role of AI in EHRs

AI integration is a hot topic, with the panel discussing its potential to revolutionize EHR functionalities. Charlie Beagle introduces iFinity’s AI-assisted scribe, designed to reduce documentation time by 50% while improving note quality. He emphasizes that AI should augment, not replace, practice staff, enhancing their efficiency in tasks like claims assistance and patient readiness.

“Our scribe agent is an AI-assisted scribe that really goes beyond transcription. It's ambient listening that understands optometric workflows and suggests structured note elements.”
— Charlie Beagle [30:31]

Kelly Kirkcsik echoes this perspective, highlighting AI’s role in minimizing administrative burdens and enhancing patient interactions through features like automated documentation during exams and streamlined letter generation.

Dr. Anthony Sesto envisions a future where AI automates routine administrative tasks, such as eligibility checks and claims processing, allowing practitioners to focus more on patient care.

“AI integration... could just talk and then you're basically talking to the patient and it's backfilling the chart for you.”
— Dr. Anthony Sesto [33:13]

Change Management and Best Practices

Implementing new EHR systems requires effective change management. Charlie Beagle underscores the importance of training and continuous education to help staff adapt to new technologies and workflows.

“Change management is a huge issue for practices. It's difficult for all of us.”
— Charlie Beagle [26:28]

Dr. Anthony Sesto shares his approach to fostering a culture of continuous improvement, encouraging staff to stay engaged and proactive in learning new system functionalities to prevent complacency and frustration.

“I like to keep changing things so that staff don't get complacent. It keeps them really engaged.”
— Dr. Anthony Sesto [27:30]

Evaluating and Selecting an EHR System

When considering an EHR upgrade, the panel advises practices to look beyond initial costs and evaluate the total cost of ownership, including training, integration, and scalability. Charlie Beagle warns against focusing solely on price, as cheaper solutions may incur hidden costs related to inefficiencies and compliance risks.

“They focus on price instead of total cost of ownership. The real cost isn't the monthly subscription, it's the opportunity cost of inefficient workflows.”
— Charlie Beagle [47:00]

Kelly Kirkcsik and Dr. Anthony Sesto add that practices should assess whether an EHR system can accommodate future growth and evolving practice needs. They recommend asking potential vendors about their financial stability, security measures, and support for change management.

Key Questions to Ask EHR Vendors:

1. Financial Stability:
   “What's the company's financial stability and staying power?”
   — Charlie Beagle [51:11]

2. Security and Compliance:
   “How will the system protect my practice if something goes wrong?”
   — Charlie Beagle [51:40]

3. Scalability and Support for Growth:
   “What happens when my practice grows?”
   — Charlie Beagle [52:38]

4. Change Management Support:
   “How can you help my team adapt to the change?”
   — Charlie Beagle [52:38]

Future Trends and Innovations

Looking ahead, the panel discusses emerging trends that will shape the future of EHR systems in optometry. Charlie Beagle highlights the shift towards patient-owned data, where healthcare information becomes more accessible and portable through smartphone apps like Apple Health. This approach aims to enhance patient experience and outcomes by facilitating seamless data sharing across different providers.

“We're looking at how other industries have transformed customer experiences while maintaining security and compliance.”
— Charlie Beagle [36:22]

Kelly Kirkcsik envisions AI playing a pivotal role in enhancing doctor-patient interactions by automating documentation and administrative tasks, thereby allowing practitioners to focus more on patient care.

“We give that power back to the doctor... AI is taking the information that the doctor's saying to the patient and backfilling the chart.”
— Kelly Kirkcsik [43:11]

Dr. Anthony Sesto anticipates AI-driven solutions that manage claims and billing automatically, reducing denial rates and improving cash flow for practices.

“AI that's going to help a practice take care of its revenue management and stuff like that and get it paid.”
— Dr. Anthony Sesto [35:09]

Key Takeaways

1. EHRs as Operational Backbones: Modern EHR systems are integral to the success of optometric practices, handling everything from clinical documentation to business operations.

2. Importance of Integration: Seamless communication between different healthcare systems and internal workflows is crucial for efficiency and patient care.

3. Underutilized Features: Many practices do not fully leverage their EHR systems’ capabilities, often due to inadequate training and awareness.

4. AI as an Augmenting Tool: Artificial Intelligence holds significant potential to streamline administrative tasks, enhance documentation, and improve overall practice efficiency without replacing staff.

5. Comprehensive Evaluation for EHR Selection: When choosing or upgrading an EHR system, practices should consider total cost of ownership, security, scalability, and vendor support beyond initial pricing.

6. Future-Oriented Innovations: Patient-owned data and advanced AI integrations are set to revolutionize how EHR systems support both practitioners and patients in the coming years.

Conclusion

The panel concludes by encouraging practices to delve deeper into their current EHR systems, exploring available features and staying informed about upcoming innovations. By doing so, optometric practices can harness the full potential of EHR technology to enhance both operational efficiency and patient care.

“Every practice that's listening to the show is using an EHR in some capacity every single day. I'm hoping that some of the nuggets that you heard today help you at least look a little bit deeper.”
— Eugene Shotsman [57:11]

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This episode of Power Hour Optometry provides invaluable insights into the evolving landscape of EHR systems, offering actionable advice for practices looking to optimize their technological infrastructure for better efficiency and patient outcomes.

Transcript

[Dr. Anthony Sesto]

Foreign.

[Eugene Shotsman]

Welcome to the Power Hour, Optometry's.

[Kelly Kirkcsik]

Biggest and longest running show.

[Eugene Shotsman]

We're now in our 13th season. I'm your host, Eugene Shotsman. And today's episode is something our audience has been specifically asking for. A real panel discussion with executives from EHR companies talking about technology and what it actually takes to run a modern optometric practice. To be clear, this is not a sponsored episode. There are no sales pitches. This is literally me trying to synthesize the frustrations I hear from my clients with their EHRs into a bunch of questions that help provide some insights and maybe clarity to the audience as you listen to the show. So who's joining me on this panel? Kelly Kirkcsik. She is the director of professional affairs at Revolution, Charlie Beagle. He's the president of ifinity and and Dr. Anthony Sesto. He's a practicing optometrist in Michigan, and he now helps shape some of the tech he actually uses in clinic every day. So what do we cover? It's a lot. We talk about how EHRs have evolved. Also, what's next for EHRs? What features are most overlooked? Why are doctors often not using some of the features they're already paying for? Up to 30%. Maybe we talk about AI scribes, automation, workflows, bottlenecks, and the true cost of switching platforms and why so many practices are still operating with blind spots in their technology stack. So if you've ever wondered if your system is actually helping you grow or maybe holding you back, listen to this episode and decide whether maybe there are some systems that you already have access to that you might not be using. That was a big insight for me. Before we dive in, quick reminder to subscribe on YouTube, Spotify, Apple Podcasts, or wherever you get your shows. And if you've got ideas for future panel topics or guests that you want on the show, go to Eugene Shotsman.com drop me a line. I read every single one of your messages and even if you just want to reach out, Eugene shotsman.com and now.

[Kelly Kirkcsik]

Let'S go to the show. All right, Anthony, Kelly, and Charlie, welcome to the Power Hour. Excited to have you all on the show.

[Charlie Beagle]

Thanks, Eugene.

[Dr. Anthony Sesto]

Thanks for inviting us.

[Kelly Kirkcsik]

All right, so I'm going to jump right into it and I think, you know, we got an action packed episode. We're going to talk about technology. We're going to talk about kind of the human side of technology. We're going to talk about what's coming up from a technology that we all use every single day. But let's start with a little bit of the history. So, Charlie, I'm going to have you kick it off and tell us a little bit about from your vantage point. How has the role of EHRs evolved in the last five years in private practice? And you know, what are practices really expecting now from the technology that they use in every day that they didn't necessarily expect before?

[Charlie Beagle]

Right, yeah, the evolution has been pretty dramatic, I think. EHRs in the past have been primarily documentation tools, digital filing cabinets, if you will, and today they're really the operational backbone that determines whether a practice thrives or struggles. And you know, we've seen this firsthand across our thousands of practices. The expectations have really fundamentally changed. Practices are now expecting systems that can handle everything from patient engagement to business intelligence, from compliance management to revenue optimization. And we're really seeing a move towards what I would call invisible integration where the technology disappears into the workflow. And that's what we've really focused on in terms of designing our platform around a single ecosystem where everything works together seamlessly.

[Kelly Kirkcsik]

And Anthony, what do you think has prompted in the day to day operations of a practice, what do you think has prompted this need towards moving towards, I guess, this sort of invisible technology type of platform? What's happening in the practice over the last five years?

[Dr. Anthony Sesto]

There's just more need for the practice to do that because there's literally more, I guess basically pressures on the practice to stay in touch with patients, to, you know, communicate with patients and in our aspect, like reminding of the appointment because a lot of people will forget or recall on the patients, eyewear notifications, things like that. A lot of that is getting put into the systems just kind of be one complete solution. And then running a practice, all that aspect of it with the financial reportings and how are we doing compared to industry norms as far as like, like sales wise or exam wise. And then also on top of that, then the billing aspect of it all, with all the different claims and all the different rules that all the different insurance carriers carry, I mean, it's all becoming a lot of pressure on the practice. And that's why I feel like a lot of the practices are putting more pressure on the EHR systems to help us relieve some of that so we don't have to have this massive staff just making sure that everything's working properly.

[Kelly Kirkcsik]

Right. And the staffing pressures on the practice since, you know, the, I would say 20, 20, 2021 have been massive in general.

[Dr. Anthony Sesto]

Right.

[Kelly Kirkcsik]

You're constantly trying to balance the right number of people and the right way to leverage those people and also keeping those people happy. Because I Im that doing data entry repetitively over and over again is maybe not the most desirable job when it comes to medicine or getting started in the medical field in general.

[Dr. Anthony Sesto]

Exactly.

[Kelly Kirkcsik]

Kelly, what's your take?

I would agree. I mean, I think that, you know, as I look at kind of where we are today, I think that the COVID pandemic certainly played a really large role. I think there were some needs that doctors quite honestly didn't even realize they had. And I think that that really kind of triggered this huge push that we've seen where technology kind of implanted itself really in the center of the practice to help with all of the communication pieces. And then two, just staffing and being able to do things more efficiently and have the flexibility to do things. Maybe not just one way. Being able to work from home or being able to do things from multiple locations or have staffing that's not necessarily physically present and on the premises. I think all of those things were things that weren't necessarily really thought of or at the forefront of everybody's mind until Covid hit. And I think that we've just seen, not just with our industry, but just across the board, that many businesses have really kind of transitioned to the way they operate as a result of. As a result of that and the technology that that was needed during that time.

So, Kelly, I'm going to stay with you and just kind of. Let's examine. Let's examine this a little bit deeper. And if you think about EHRs from a few years ago versus where EHRs will be a few years from now, and we're not quite ready to talk about full innovation standpoint. But like, think of where there's the biggest misalignment that you still see between how practices are using EHRs and how they wish they were using EHRs or how EHRs could help them more in the practices that they currently have to serve patients.

I think the biggest kind of hurdle right now or mountain that we have to climb where that's concerned, is going to be not just what I'll say, integrations, but taking that one step further. You know, being able to communicate effectively with other offices oftentimes, I think is something that is kind of a setback, especially if we have practitioners. We don't necessarily always see that as much in optometry. But you know, it's hard when you're trying to communicate with a hospital or with laboratory or anything like that. A lot of times it still requires a paper component or some sort of a manual process to get that information into the system. So it would be nice, I think, to get to a point where even if all systems look different and they have their unique features, if at the end of the day we're all kind of speaking the same language, where that communication can just be shared from one platform to another.

Yeah, I'm thinking like optometry referring to ophthalmology and then ophthalmology referring back or something like that. Right. And being able to make sure that nothing is missed on that patient. I agree with you. Lots of, lots of manual processes. Charlie, what's your take on that?

[Charlie Beagle]

Yeah, I agree. Communication both externally in terms of referrals, but also I think a big gap is how EHR systems either interfere with or support communications with the patients. You think about this not just in optometry, but also in primary care. I think a lot of EHR systems force staff to turn their back to patients while they document care on their desktop computers. And that creates a patient interaction barrier at the exact moment when the connections matter the most. And so I think we've tried to address that through a focus on mobility and tablet design. So that whether you're documenting an exam or you're bringing out a sale, you can have a face to face interaction with that patient versus turning and typing.

[Kelly Kirkcsik]

Meaning, I mean, that's a really valid problem. And a couple, couple weeks ago on the show we had Kayla Ashley from Speccy who talked a lot about the power of body language both in the exam room and in the optical, and how we're genuinely sending signals to our patients, whether they're good signals or not good signals about how much we care about them and how much we want to support their well being. And, and I agree with you, I think body language is a problem that EHRs can solve. So you said you guys solved that through tablets, right? That's one. How else do you. So do you. By the way, Dr. Sesto, I know you're a user of ifinity. Do you use tablets in your practice? How is that going?

[Dr. Anthony Sesto]

Yeah, so all the doctors, we have iPads, we don't even have any desktops in the exam rooms. The program that we were on previously was all desktop based. And that was one of the things that I hated it, hate about it is like, yeah, you had to be facing away from the patient, documenting everything. They just saw your back. You could not see. You're trying to communicate with them, turning, you know, and going back to your desktop, clicking in maybe the wrong spot and all that stuff like that. And it's actually since switching over to affinity, we've been actually changing and upgrading our exam rooms and making the desks actually different shaped so we can, they're more of on an angle and stuff like that. This way we can actually even have the tablet in front of us, in front of us and actually be seeing the patient at the exact same time and communicating with them that way. So that's even actually changed how we lay out our exam rooms. And then like what Kelly said there too. I was just talking about this the other day with somebody like the, the systems, the EHRs in the referrals over with the direct mail addresses. I mean I have people who use like our system who don't even use the direct mail addresses who I'm referring over to. And I'm like, guys, if you just use that, I could refer the patient over to you and it can go right into your program a lot easier.

[Kelly Kirkcsik]

Yeah. And, and I've heard both you guys, Kelly and Charlie talk about the word integrations. So someone who's listening to the show probably doesn't really get the context of what you do every single day as you're both trying to build integrations. So talk a little bit about that. What do these EHRs need to be integrated with and what do they not need to be integrated with? Kelly?

I would say the short answer is that the sky's the limit in terms of integrations because it's been my experience that doctors need simplicity. I mean it's, it's complicated enough to just manage the day to day with staffing and insurance companies. You know, and you, when I talk to doctors, and certainly when I was, when I had my practice, those are the two number one, you know, I would say black clouds that kind of loomed every day. That, that required a lot of time and energy from our team and it was really important that we manage those things well so that the practice was, was thriving. So I think that simplicity is very important. Creating something where even if you are integrated with a variety of things, it could be maybe you have a time clock integration or you have, you know, your, your, your clearinghouse integrations, you have equipment integrations, all of these things. I would say certainly I wouldn't want to put any type of a limitation on any integration just if their things are integrated. I think doctors really are looking for it to be simple, streamline it, make the process easy, make it, you know, where it really is. They go to one place to access that Information. And, and I would say integrate whatever, whatever you possibly can because it will ultimately, I think, benefit the practice at the end of the day.

And Charlie, from your vantage point, what are the top three integrations that you think are a must for any EHR system?

[Charlie Beagle]

Yeah, look, integrations are really all about workflow. And I like to coin the term invisible integrations, because it's really about the workflow. So when I think about the most powerful integrations, insurance eligibility and benefits verification, rise to the top, right. Equipment integrations, where I avoid re keying information from equipment into my ehr. Really important, right? Not only for efficiency, but also to avoid, you know, mistakes which could result in remakes and other things that cost a practice money. And, you know, I think about, you know, claim filing, right. And you know, making sure that the claims are, are clean and get filed automatically. And so that just streamlines revenue recognition for practice. So those are, those are a few that bubble up from my perspective. But it's really all about ensuring seamless workflow.

[Kelly Kirkcsik]

Yeah, and we'll, we'll talk a little bit about workflow automations in maybe in the what's Next segment. But you know, Anthony, from your perspective, you know, and I think about how an EHR is designed to support the things the practice does. Now, there are lots of interruptions that are caused by technology every single day, right. And you think about what is a necessary interruption in the workflow, what are the not necessary interruptions of the workflow, what do you think contributes most to staff frustration? And how, and how can you avoid some of these issues? You know, if I'm thinking about the audience, they're probably experiencing a lot of the same stuff that you're experiencing in clinic. And if anybody's watching this on video, they'll see that Anthony is sitting in clinic, probably ready to see patients in a little bit here. So, you know, talk a little bit about what you've observed in your own clinic. And given the fact that you, you've had a hand in at least feature development to some extent at ifinity, I'm really curious what your, what your take is on what are some of those interruptions and frustrations that are super clunky that you think people are experiencing every day and how do you avoid them?

[Dr. Anthony Sesto]

So, you know, a lot of, basically what's the biggest interruption of the day is when, you know, the system will like slow down or bog down a little bit and stuff like that. And that's usually just because some users are, you know, it's, you can Literally almost see when things slow down is like when the next time zone starts coming online because I'm in the eastern time zone. And then it picks back up a little bit. So like the servers kind of ramp up and go like that. You could kind of almost see that in a way. But as far as like major interruptions in, in clinic and I, and I kind of answer a lot of the questions, like on the Facebook page where people are like, I wish it could do this or I wish it could do that. And it's like, well, it can you just. You click over here or you go here. A lot of those frustrations to me is like, about the training that the people I unfortunately see a lot of times maybe the provider's office assigning somebody who's not the doctor to do the training on it. And so then they're, you know, they'll telephone game. This person trains this person, which trains this person, which trains this person. And then eventually the doctor, you know, gets their own, you know, half training of it and stuff like that. And then they're the ones, you know, sending emails in saying, how come this doesn't work? And that doesn't do this? And it's like, well, it actually does do that. So here, let me show you how to do it and, and things like that. It's from my experience, that's a lot of the calls that I get from other providers and stuff like that about how come this doesn't work or this doesn't do that. It's like, well, here, let me show you how to actually do it. And then they're like, oh, okay, I wish I would have known that earlier to save myself tons of time.

[Kelly Kirkcsik]

Yeah. And I'm curious because you have multiple providers, multiple locations, right?

[Dr. Anthony Sesto]

Yeah.

[Kelly Kirkcsik]

So how does that work? And where do you. Where do some systems fall? And like, like, what are some use cases where some systems fall flat on their face and then some systems shine.

[Dr. Anthony Sesto]

So I'll tell you, when I bought this practice we had, we were only at four offices. We had about four and a half doctors. We had four systems running independently on different servers at each location. And we had one biller at the time. And that biller was literally having to hop around from each location to bill out all the claims, reconcile everything. And so she'd spend Mondays here, you yada, yada, yada. And if a patient was seen at this office today and then this office tomorrow, we were re putting in all their information into this other system. It was just chaos. So when I bought the practice we took all four of those systems, mashed them all together, created our one currently with iFinity and everything, and it's just made our efficiencies just skyrocket. As far as just claim management goes, we saw faster payments, better turnaround time on claims. If they're denied, the biller is able to see that right away. You know, fix that claim, get it out right away. Way better cash flow. A lot better as far as that goes. And then seeing patients from one location to another, you could continue that care or from one provider to another, which. One thing I absolutely love about REHR is we can send messages inside of the company to each other. Like, I do it all the time. If I'm having one of my patients follow up with one of the other doctors, like, hey. And it attaches the patient's chart right into the intermail. It's like, hey, having them see you next Tuesday, you know, this is what's going on. And then they can just tap the hyperlink and it goes right into the chart and they can see exactly what they're going to be seeing them and what I did and, you know, and everything like that.

[Kelly Kirkcsik]

Yeah. And, you know, I guess if I think about it, you're. What you're saying is the right system can kind of make or break a practice and its profitability. And as you're thinking about like making up for where the software is missing in human workflow, and then you're just kind of moving humans place to place to try to, to try to play whack a mole with. With the gaps. It makes a lot of sense. Kelly, I'll turn it over to you. And when you think about the human processes that lead to the most amount of frustration, that EHRs, or particularly maybe there's some innovative thing that Rev has done that's helped. That. That's helped solve some of these issues. What are some of those greatest points of frustration? And then what are some of the real problems that are like, hey, the old way of doing it, this is this way, but the new way of doing it is actually really cool.

Agree. A lot of times the point of frustration is easily fixed just through education. And I think that as EHRs evolve, we've certainly seen that at revolution. And I would say I probably speak for all of the. Any EHR vendor and that as they evolve and they get better, that also adds more complexity and it just expands the learning curve too. So I always give the example. I think about my iPhone and, you know, all of the updates and the changes and the 10 years that I've owned an iPhone, it's a lot different. And anymore when I get a new phone or the operating system gets updated, I typically have to give it to my 12 year old and say help me, you know, or my 12 year old will point out six months later and say mom, you do it this way, you know. And so, but we see that too where a lot of times it's, and that's one of my favorite things is when I get to work with a customer that's frustrated and I say, hey, Christmas is coming early for you today because it's right here, let me show you how. And I love it when that aha moment that you know, you can tell that you've truly made an impact, you know, for that practice, just with their efficiency and their workflow. So I would say that that's probably one of the biggest things that's just a challenge that we see every day. And it's one that I don't think it's, we can, it's going to go away. It's always going to be there because these, the software is going to continue to get more and more robust and get better and better.

Yeah. Well, it's interesting you bring up that example. My 10 year old daughter recently taught me how to edit away like little things that I don't want in pictures on my, on my phone. And I said how did you even know that? Because you don't really have a phone.

Right.

And she's like, and she's like I saw an ad on TV about this particular feature and I wanted to try it on your phone and it actually works. And I was like, wow. So they're like educating the consumer but they totally missed the consumer. Right? They educated, they educated the consumer's daughter, I guess, and whatever TV ad targeted her. So what's interesting in, in what you're saying is that there are probably every single person who's had their ehr for some period of time that may be like longer than a few years, probably may not be using all the features. Is that a fair statement?

Absolutely.

[Eugene Shotsman]

So what are some of the features.

[Kelly Kirkcsik]

That are most overlooked? And Charlie, we'll go to you next but Kelly, on your end, what are some of the features that are most overlooked that you like help people find Christmas? I guess as you put it.

Well, for revolution, one of the things that happens is that when updates are released, updates get released and system enhancements continually. Our engineering team has kind of an ongoing cadence for when those things happen. So a lot of times the customer might go through training and they get trained and they really understand the system well. And then they've used that system for two or three years and they haven't evolved with the changes that we've made. They haven't paid any attention to, you know, any of the messaging or if we set, we'll send out notifications to let them know, hey, this is a new feature enhancement. Practices people get busy, so sometimes they don't always read those things. And I'll have users, generally, that's the user. It's the user that's used the system for a while, that's still using it really to its fullest capacity of what it was two or three years ago, not to what its fullest capacity is today.

Got it, got it. Charlie, what's your take?

[Charlie Beagle]

Yeah, no, I fully agree with Kelly. It's just a challenge for practices to keep up with the pace of innovation. And I think a lot of a mistake that a lot of practices make is they think of like their EHR platforms is really just technology, when successful adoption of EHR is really about bringing together people, process and technology. And, you know, we've learned this from managing, you know, hundreds of, you know, independent practices and retail locations across the board and implementations that practices that succeed don't just implement the software, they are actually reimagining their workflows around better patient experiences. I think Dr. Sesto touched a little bit on that when he gave the example of how he's actually reconfiguring his exam room to create a better patient experience. I think it's not just about keeping up with the technology, it's about how do you leverage that in a way, with people in the process to bring about the type of experience you want for your patients.

[Kelly Kirkcsik]

That's interesting. So it's not just being aware of what the technology now is capable of, but it's also how am I going to change to be able to take advantage of that potential benefit.

[Charlie Beagle]

Yeah. And I think change management is a huge. A huge issue for practices. It's difficult. Change is difficult for all of us. Right. And so we've really put an emphasis on change management support and technical training and continuing education to try to help practices adapt, you know, new processes. And, you know, with today's staffing, turnover and practices is as difficult as ever. Right. Having that ongoing education isn't really a nice to have anymore. It's. It's essential.

[Kelly Kirkcsik]

Yeah. And Anthony, in your. As you sit there in clinic, what are some examples of change management that you've had to oversee recently that have gone well or could have gone really badly. What are your lessons?

[Dr. Anthony Sesto]

Yeah, so I like to, as I tell my staff, I'm like, I like to just keep changing things this way that they don't get complacent. It keeps them really engaged in hating me. I don't want them to, you know, to start doing, like, me at all. No, it's, you know, in, in this is like, so, for example, the release notes that come out of any update and stuff like that, you know, I send it out to the managers of all my offices and stuff like that, and I say, read this, like, and I'll call them every once in a while. It's like, hey, did you notice? You know, whatever. And they're like, what are you talking about? I'm like, well, I sent you the, the release notes and I told you to, to read it. To read it, understand it. If you don't understand it, please let me know. Because if you don't understand it, then how are you going to help the rest of the, your office staff and things like that? And, you know, as far as changing things and stuff like that, it's not for us since we're kind of beta testing a lot of the things and kind of going through all that stuff like that. It's. We, we're always changing things. So it's almost like in a way that it's never not changing around here. It's just to what degree and if it's going to, you know, and what we give our feedback, if it's going to help or not and things like that or what they need to change about the change that's going to make a bigger impact and stuff like that in people's lives. But, yeah, I like change. If I was not changing, I think I'd just get too bored and then I'd start, I don't know, doing something else.

[Kelly Kirkcsik]

All right, well, I think if we pause here, I'd like to come back and talk a little bit about the innovations and the two types of things that are on the horizon that people need to be watching out for and just making sure that as technology kind of, I think as technology really expedites the way that it can serve the end user, whether that end user is the practice owner or any staff member in that practice, that we actually take a deep dive into all the innovations that could potentially accommodate those users. We'll be right back on the Power Hour. All right, we're back on the Power Hour and my panel On EHR technology and innovation. Charlie, Kelly and Anthony, thanks for being here. We're going to jump right into the last thing I said, which was innovation. So let's talk about what innovation really looks like in the EHR space. And I have to start with the obvious. You know, I, I keep hearing about things like AI scribes and AI feature sets and AI workflows. How does that fit into an ehr? Charlie, start with you?

[Charlie Beagle]

Sure. Thanks, Eugene. Yeah, we're focused on AI that, that solves real problems. There's a lot of. AI has become a huge marketing.

[Kelly Kirkcsik]

Term.

[Charlie Beagle]

That'S used throughout many industries now, but we're trying to keep it focused on solving real world challenges. And our scribe agent, which we'll soon be piloting, is an AI assisted scribe that really goes beyond transcription. It's an ambient listening that understands optometric workflows and suggests structured note elements. Right. So our goal is to reduce the documentation time in terms of touches and swipes that are needed to document an eye exam by 50% while actually improving the note quality. You know, we're also looking at other AI agents that augment practice staff, helping them become more efficient, like, you know, office assistance, claims assistance, patient readiness assistance. So, you know, we, I see a big opportunity for AI not to supplant practice staff, but to help make them more efficient at their, at their jobs. And so that's where we're focused. It's very much human in the loop approach to AI.

[Kelly Kirkcsik]

Okay. Kelly, what about you guys at Rev?

Oh, absolutely. AI is a hot topic at Revolution for sure. And one of the things that we're doing right now is really trying to be very, very thoughtful and intentional with how AI can help our, help our customers and help the user experience. What we don't want is to make something more cumbersome or make it complex. We're really trying to make it easy and kind of similar to what Charlie had said, I think that there's opportunity to use it with exam room documentation where, you know, as conversations are had between the doctor and the patient, that, that data it needs to go directly into the patient chart in the appropriate spots, certainly like letter generation. And I think there's an opportunity there as well to help practices with some of the administrative tasks that happen after the patient leaves, like, you know, letter generation and referrals to make sure that those processes are smooth and easy as well.

Yeah. And you know, Anthony, from your vantage point, what is the practice of the future, you know, one, two, three years from now? What does that practice look like, and what does it need from a technology standpoint, whether the EHR companies can or cannot support it exactly at this exact moment. But what does that look like?

[Dr. Anthony Sesto]

So as far as, like what the practice needs, as far as like AI integration and you know, the, all the administrative little tasks that is required upon a practice that you're having a staff member do, you know, maybe once a week or a couple times a week and things like that to get that, you know, if you can have it just automated and stuff like that. Like for example, me and my partners, we talk about how it'd be nice just to have some type of system that pulls skims through everything and checks all the eligibilities, make sure all those are gone. I mean, there's some that have maybe like another insurance that those things can already grab for you that, you know, we don't even know about in the exam lane, the documentation thing kind of just, you could just talk and then you're just basically talking to the patient and it's backfilling the chart for you. So this way you don't have to type anything in later on and you can do that. And the biggest aspect of it, and, and I know this just because I serve on state committees and all that stuff like that is claims and billing aspects of things. These insurance companies like to change these rules without notifying you and things like that. And if you could have some artificial intelligence that's going to help a practice take care of its, you know, revenue management and stuff like that and get it paid. And if it claims rejected, it's automatically reading the rejection, fixing it, getting it right back out and then it can, you know, even do maybe it's like form letters and stuff like that to combat denials and things like that. It's, it's going to change the landscape and I think it's going to shift the. And everybody talks about how the insurance companies just do routine denials and things like that, but it's going to hopefully change that landscaping back to where the doctors more can control of their own practice and stuff.

[Kelly Kirkcsik]

Well, and hopefully the AIs just fight it out. Denied. Oh, no.

[Charlie Beagle]

Approve it?

[Dr. Anthony Sesto]

No, Denied.

[Kelly Kirkcsik]

Eventually somebody wins.

[Dr. Anthony Sesto]

Those two computer systems battle each other. Right?

[Kelly Kirkcsik]

Exactly. As you're thinking about this though, when you guys are thinking up new features and Kelly and Charlie, this is back to you guys. So maybe Charlie, I'll start with you. But when you're thinking of new features, where does it. When you look at the future and innovation and what's possible, obviously there's this foundational. Under that, there's this foundational piece of AI that's underlying everything of what's possible now. But as we can expedite some of these, bringing some of these things to market, and also as we can kind of expedite the ability to help practices with some of these repetitive workflows that Anthony is talking about. Where are you guys drawing your inspiration? What else is guiding you when you're thinking about the next innovation or the next software release or the next partnership or feature set that you want to make available to your customers?

[Charlie Beagle]

Yeah, great question. I think the biggest inspiration comes from recognizing that patients are consumers first. Right. They expect the same seamless experience they get from Amazon or Apple or their banking apps. And the question isn't whether ICARE will adopt these consumer type experiences, it's how quickly we can get there. I'm also really excited about the future where patients can own more of their healthcare data through smartphone apps like Apple Health. Today, patient records are locked in the various EHR systems. And I see a future where patients can seamlessly carry their complete health profile across providers. Right. And this is going to require EHRs to become more open and more patient centric. So we're really looking at how other industries have transformed customer experiences while maintaining security and compliance. And I think banking's a great example. They've made complex financial transactions feel simple while actually increasing security behind the scenes. And we're applying that thinking to icare and I think, you know, how we make the patient journey feel effortless while giving practices better tools to maintain, you know, the highest levels of data protection is really where we're focused.

[Kelly Kirkcsik]

So, Charlie, I want to ask you about the what happens when the patient owns their own health information, so to speak, and has it in their Apple Health or whatever, whatever personal lockbox they choose to carry it in. Because you're absolutely right. Right now it's some the data is owned by. The data is technically available to the patient, but owned by the practice protected by the ehr. There's all these third parties. And how will that impact the industry when the patient actually owns their own data?

[Charlie Beagle]

Yeah, I personally feel it's going to be a big unlock right across all specialties, including primary care. You think about it as a patient, if you're moving, whether you move from an optometrist to an ophthalmologist or you move from your primary care to another specialty care, just getting everything coordinated is such a hassle. And getting information to the care team that's coordinating your Care, it takes time, and it's often transmitted in paper format. And I think it results in overall, not only a poorer patient experience, but poorer outcomes for patients who are trying to coordinate care across multiple specialties.

[Kelly Kirkcsik]

Yeah. And I also wonder if, you know, if my primary care doc identifies an issue, if I am not the kind of patient who immediately chooses to take action on that issue. Right. If there's a universal database that prompts me. Right. If my. If my iPhone says, hey, you know, it might be something you want to get checked out. Right. Then maybe we get more compliance from patients. Because I think about if a patient has their own health information, then the patient also can use some of these same apps that keep us engaged in playing games or working out or, you know, I don't know, whatever other compliance, diet compliance that people have. Maybe there's treatment compliance that these same apps can support and get patients both the care they need and also gamify it a little bit, like they tend to do so well.

[Charlie Beagle]

Yeah, I think it's a great insight.

[Kelly Kirkcsik]

Kelly, what about you? What do you think is. Is on that same. In that same area where you look at the ways that features get developed for a future and what's inspiring those features, at least for you guys at Rev or maybe in the EHR community.

I would say absolutely. Making sure that we're doing protecting data in a safe way is first and foremost trying to do what we can to leverage all of the integrations and all of the opportunity that exists with AI. But. But again, just making sure that we don't stray from, you know, protecting that very precious information. So that would be one thing. The other thing, too is I think in the exam room, I would, you know, one of the things that I'm always kind of talking with our engineering team about is encouraging them to look at things from the perspective of the doctor. And that is sometimes when you're in the middle of an eye exam, again, And I think Dr. Sesto, he touched on that earlier where he said that you don't want to feel bogged down when you've got a tablet in your hand or when you're sitting at a desktop computer. And sometimes that ehr, while it's great, it's very, very restrictive in terms of a doctor's creativity or the doctor's ability to. I think there's a little bit of a hindrance to what they can and can't do because they've got to make sure that they're getting that information documented. So one of the things that I would like to see is that we give that power back to the doctor. And maybe it's through. Maybe the AI is taking the information that the doctor's saying to the patient, or it's really paying careful attention to the conversation that's taking place in the exam room, and it's doing good with that information so that the doctor doesn't have to constantly stop what they're doing and enter that information. You know, certainly, I think, you know, there's elements of optometry where that would be extremely beneficial, especially at the pediatric realm, where, you know, sometimes I know when I was seeing patients, I spent, you know, half of an exam chasing toddlers around an exam room rather than examining them in the chair. And if we could give them tools to help them be successful while that chasing is going on, I think that it would be really, really good just for, you know, better outcomes for both the practice and the patient.

Yeah. So I'm going to try to do a little bit of rapid fire just to make sure that our audience has some meaningful, just like quick, quick hitters, takeaways. So I'm going to start here in terms of the first rock you should look under just to make sure that you're using. We talked a little bit about underutilized features in EHRs that can drive a lot of value. If I'm running a practice and I'm not keeping up on my updates like Dr. Sesto, then which rock should I lift up and just check under to make sure that there isn't a little pile of gold under there? What are some of the features that I should definitely make sure that I'm looking at? And I'm just going to go down the line. Charlie Kelly then Anthony will just say, what are the most valuable things that an EHR can now offer? That's a relatively recent thing that maybe not everyone's aware of. Charlie?

[Charlie Beagle]

Yeah, I mean, I'd say I go back to work flow again. And I'd say if I were a practice, I would want to audit, just do a quick audit of where I'm tracking things and managing information that's outside of the system. And is there a opportunity through an integration to eliminate that? And so just a real quick win for practices.

[Kelly Kirkcsik]

Got it. Great Kelly feature.

I would say just equipment integration. More specific is with some of the. We've seen so much change with technology, but certainly, you know, in that just if you look at the technology landscape for optometric equipment, making sure that you're utilizing those integrations and documenting appropriately, because a lot of times those updates will exist in the system, and then customers don't necessarily realize that they're there.

Yeah, those. That integration word again from both of you guys, Anthony, what do you think?

[Dr. Anthony Sesto]

I would say simplicity as far as from the doctor standpoint, getting or reading and analyzing all that information from the equipment integrations. Like, is it from the medication imports that are imported? Is it the testing that's automatically uploaded? Is it the previous chart notes and like for a glaucoma patient? What was their tmax? Was my target pressure? Here's the testing. Here's their historical testings. This is the drop set they've tried. Can I see that all within, like one or two pages and make a decision how to either continue care or change care. That's where the biggest, biggest changes in all that's gone for me.

[Kelly Kirkcsik]

Okay, that's great. I want to ask a little bit of a different question. So if I. Obviously you all are aware of newer solutions that are available to. That are available to your prospective practices and prospective clients. So as people evaluate whether they need a new ehr, as people think and say, okay, yeah, I think it's time to. And it would be an upgrade. Right. Move from my current state to my future state. What are the number. What's the number one thing people get wrong first of all? And then we'll come back and do another round and what are the top three questions they should ask that ehr, that new EHR provider, to make sure they get it right? So what's the number one mistake people make when they start thinking about they're upgrading their ehr? Charlie, start with you?

[Charlie Beagle]

Yeah. I think they focus on price instead of total cost of ownership. I see practices that often will gravitate towards the cheapest option without considering the training time, the integration costs, the security risks, the cost of switching again when they outgrow the platform? The real cost isn't the monthly subscription. It's the opportunity cost of inefficient workflows and the risk of compliance failure and disruption of changing systems as you grow. So, you know, I think that's. That's probably the biggest thing that I see.

[Kelly Kirkcsik]

I like that insight, Kelly.

I certainly agree with you, Charlie there. I also think that oftentimes practices get too limited where they're only looking at documentation. So they need to really look at, you know, what other things would you. Would you want your EHR to be able to assist you with? So that might be, you know, recall management, maybe it's patient engagement, all of those things. So Again, evaluating the system as a whole, equipment integrations, you know, where do you think you'll be in five years? Will you have multiple locations? And can, can the system, you know, accommodate that? What would that look like? I think all of those are really, really important questions to ask and pay attention to.

[Dr. Anthony Sesto]

Got it.

[Kelly Kirkcsik]

Anthony.

[Dr. Anthony Sesto]

I would 100%, because I know some of my colleagues do this. It's, it's. They first look at the costs of everything, and then. And they don't really see, like, well, I don't need that. Well, I don't need that. Well, I don't need that, you know, and like, I'm not going to pay. I'm like, you don't even know what you're saying no to yet. Like, look at the actual full program. See what it can do. See how it can make your life easier. See what other integrations are already built into the system, what, you know, additional things that you can add later on down the road. You know, and I'm talking to prospective clients all the time. I'm like, this is my preference. This is what I do. I did it. I'm like, this is what I say you need. You make your decision, you analyze it, you do your own due diligence, and then, you know, look at it from there. But the don't go with the, you know, I guess the newest, shiniest thing and stuff like that, because you don't. If they don't have a proven track record, you're probably not going to get exactly what you want.

[Kelly Kirkcsik]

Yeah. And, you know, it's interesting. That's probably why it's so important to have conversations like this around the industry where people can understand that, you know, price is not the only. I mean, absent everything else, that's the key driver for decision making. Right. If I'm comparing this Apple to this Apple and they're both roughly the same size and this one's 30% cheaper, well, then, yeah, my, my, my cost is going to be the biggest decision driver for me. But in the context of, you know, I've got this box and inside of this box, I don't know, it's like roughly the same size as this box, but this box weighs more and I gotta, like, open it and I gotta understand what's in it. And I had to open this one, and this might be a box of iPhones or this might be a box of bricks. Like, I don't know. Like, can't just compare boxes based off of the outside. Right. So my, my next question, which I think is kind of to that point is okay, so let's narrow it down as quickly, as efficiently as we possibly can. Three questions that practices should absolutely ask themselves and they should also ask if they're ever thinking about switching an ehr, what they should be asking that vendor about that particular EHR to make sure that they can leverage your experience. Because everybody here has, on this, on this show has some experience and you know, probably way more experience than the average decision maker when they're thinking about a new hr. So three questions you should ask yourself and, or a vendor as you're thinking about switching, Charlie.

[Charlie Beagle]

Sure. Yeah, I think number one, what's the company's financial stability and staying power? Right. This isn't just about whether they'll be around next year. It's about their ability to invest in innovation, maintain security standards, support you through industry changes. So I'd say ask about their funding, their growth trajectory, their long term vision. You know, a cheap solution from.

[Kelly Kirkcsik]

An.

[Charlie Beagle]

Unknown or unstable vendor can become very expensive. Expensive especially, you know, if they go out of business or stop investing. Second, how will the system protect my practice if something goes wrong? This isn't just about backup, right? There's about security, certifications, compliance support, disaster recovery. A data breach or a system failure can put you out of business really quickly. So ask about their certifications, their built in redundancies and how they handle compliance updates. And third, what happens when my practice grows? You want a platform that's going to scale with you as you grow and evolve and ask to see examples from practices that have successfully grown on their platforms. And if I could add a fourth, I'd say change management, like how can you help my team adapt to the change? Right. It's bringing again that people process and technology together.

[Kelly Kirkcsik]

Yeah, I think it's great, great points, Kelly.

I would say I agree with so much of what you said. Well, I agree with everything that you said, Charlie, for sure. So definitely, I think one of the things that is often assumed but shouldn't be is that all EHRs are created equal in terms of your data and that the data is secure. I do think, I think a lot of times practices just assume that they think that, okay, if I'm going to go with an ehr, I don't really need to ask that question because they wouldn't be in business if my data wasn't secure. So I think that's a really, really important, very, very important point and one that can be extremely costly and devastating if, if that winds up not, not being what it should be. So that, that would be probably my number one. Yes. Like just what, ask around, find out, you know, our customers. What, what do, what do your colleagues have to say? Do they, you know, when you're evaluating vendor partners, I think that's a great way to kind of learn and get feedback and hear, you know, like, what's going on, what's good, what's bad. I think so many of the programs out there all have their strong sets and the, you know, things that, where they really, really shine. And I always, but I'm very quick to say there's no such thing as a perfect ehr. So it is important to, to ask those questions so that, you know, I think customer support is, is something that really, really also needs to be, you know, very, very closely evaluated. And that's that customer support is a part of the process that I think is probably the longest that they're there for the long term. So just as we had talked about earlier, in terms of those constant updates and enhancements that are made to the system with features, it's our customer support team that's making sure that our users are familiar. They're really the ones that are standing there on the front lines to assist customers and direct them to wherever they need to go in terms of, you know, company health. So I think a competent, very, you know, knowledgeable customer support team is something else that's going to, to just make any ehr, you know, much more easy for the practice.

[Dr. Anthony Sesto]

Got it.

[Kelly Kirkcsik]

Great, great points. Kelly and Anthony. I'll let you have the final word on this one.

[Dr. Anthony Sesto]

Well, I mean, they said mostly all of it, but one of the things that I would just say is how often are things getting updated? Ask that question. How often are things getting fixed that are maybe have not had the attention to. And then at the same point, how are you getting your ideas or what are you looking at from the current community that is using your product on issues that are there and where are you grabbing that from? Do you have some people who are your current users who are helping you guys develop your, you know, for the product, or do you just have a back room of developers who have no clinical experience developing things that aren't really necessary? Because I see that quite a bit in, in all really platforms and stuff like that. They'll come out with a release. And I'm like, who did you guys ask for this? Like what? That doesn't help anybody about anything, you know, and you hear it all the time. I mean, I don't. Developers are just developers. They don't have that clinical or front end experience and stuff like that that they need. They need to know that this has got to be tweaked this way or change this way or this has got to be made and stuff like that. So besides what they all said there, I think having the user influence on where things are going is the big, you know, is a big part of it all.

[Kelly Kirkcsik]

Yeah, that's great. All right, guys, well, thank you so much for sharing some of your wisdom. I think we've talked about where EHRs have been, what the evolving practice needs really look like, and ultimately where some of this technology is going. Every practice that's listening to the show is using an EHR in some capacity every single day. I'm hoping that some of the nuggets that you heard today throughout the show help you at least look a little bit deeper and maybe ask some questions of the software that you already have and possibly could be under serving you, maybe because you just need to read the release notes or maybe because there are some new features that are on the. On the horizon that you should be. You should be looking at. So hopefully it's given our audience a little bit to think about. And thank you all for sharing some time and for sharing your expertise with us today.

Thank you for having me.

[Dr. Anthony Sesto]

Thanks for having us.