Questions and Answers for EMR Decision Process Print

The question list is based on publications by the American Academy of Ophthalmology (AAO) and International Ophthalmic Technology Association (IOTA)

Vendor: ifa systems AG, 50226 Frechen

1. Company information

Q: How long is the company in business?
A: The ifa group of companies has approximately 25 years of experience in developing, distributing and supporting EMR and other IT solutions for eye care specialists worldwide.
Q: How many fulltime team members does the vendor have?
A: The ifa group of companies has more than 90 team members. Approximately 35 are dedicated to the US market. The ifa team has approximately 1,800 joint people years of experience in eye care IT.
Q: How many eye care providers are using the software?
A: Over 10.000 eye care professionals (ophthalmologists, techs, and administrators) are using ifa every day. Per day 200.000 patient visits are stored and managed by ifa systems worldwide. All together more than 80 Million eye care patients are stored in ifa systems since 1994.
Q: What are the financial parameters of the company?
A: ifa is a public company listed at Frankfurt Stock Market. All financial data are public. Based on a stable profit margin the company pays dividend since 10 years.
Q: Who are the owners or shareholders of the company?
A: Approximately 76 % of the shares are owned by management and team. Another 12 % are hold by ifa users and the remaining approximately 12 % are free float (Frankfurt Stock Market symbol IS8).
Q: What is the largest patient data base in use?
A: The largest database is managed by an eye clinic in Germany which uses the system approx. 18 years and has 160,000 active patient charts stored in their ifa system. In the USA the average MD is managing between 3,500 and 6,000 active patient charts (depending on the sub specialty).
Q: What is the largest project (no. of users/workstations)?
A: The largest project is an Eye Clinic with 200+ users and 5 locations connected with terminal server architecture (e.g. CITRIX). The system is used since 10 years with approx. 80,000 active patient records.
Q: Is the vendor the author and owner of the software?
A: Yes, the ifa group of company did develop the entire software applications for eye care professionals with a dedicated team of SW engineers and is the exclusive owner of all software rights.
Q: What are the USPs (unique elements compared with competitors)?
A: Below you will find an extract of the USPs

  • Connectivity to 450+ instruments
  • Unlimited connectivity guarantee
  • Structured data model (for meaningful use)
  • Ergonomic user interface (3G Software)
  • Subspecialty versions for retina, glaucoma, cataract and refractive surgery, ocular plastics etc.
  • Integrated open standards (HL7, DICOM, IHE, SNOMED, LOINC) (see also conformance statements)

2. Connectivity
2.1 Equipment Connectivity
Q: How many test and diagnostic devices can be connected?
A: 450+ instruments are connected (see actual list January 2010)2.1.02
Q: What is the strategy for future connectivity?
A: Part of the ifa license agreement is connectivity guarantee for all devices of international vendors (devices with digital output).
Q: Which standards are used?
A: HL7 and DICOM interfaces are supported (see conformance statements). As only 5% of all equipment which is in use support standards the ifa group of companies has peer to peer vendor related standards with the major players in eye care technology (e.g. Zeiss, Topcon, Heidelberg Engineering, Oculus, Nidek etc.)
Q: Which instruments can be connected?
A: See actual list (update every month). More than 450 instruments and applications are connected with the ifa system.

2.2 Connectivity to other EHR applications
Q: Does the system connect to practice management systems (PMS)?
A: Yes. As ifa is a specialized EMR system the software provides interfaces e.g. HL7 to existing PM systems.
Q: Can the EMR software be connected to optical software?
A: Yes. Optical shop software can be connected with HL7 interfaces (e.g. ezzone)
Q: Can patient education software be connected?
A: Yes. Dedicated and integrated interfaces can be provided e.g. for eyemaginations (the patient education encounter is automatically stored within the EMR).
Q: What other software packages can be connected within the EMR system?
A: The ifa software provides interfaces to all kind of specialized eye care software e.g. in the field of perimetry (Peridata), surgical outcome (datagraph, surgivision, ASSORT etc.), image management software (e.g. Topcon, Heidelberg Engineering, OIS (via DICOM) etc.).
Q: What kind of conformance statements (DICOM, IHE etc.) can be provided?
A: The ifa group of companies published DICOM conformance statements, IHE Eye care actor documentation and HL7 conformance statements (see attachments).

3. Guarantees and certifications
Q: What guarantees are integrated into the legal license agreement?
A: The following guarantees are part of the license contract for the users:

Q: Which certifications can be provided?
A: The following certifications and registrations are provided:

Q: Which references and testimonials can be provided?
A: Testimonials of ifa users USA can be found in the Testimonials and Publications section
Q: How can the patient data be converted into another system if the customer wants to change the EMR system?
A: The ifa system has a standard export data interface which allows transferring the data into another system without any support of ifa. The standard export structure is public (published e.g. by IOTA) and can be used by any importing system.

4. Training and support
Q: How is the training organized and who provides training on site?
A: The ifa team did develop a comprehensive training concept which is provided by the dedicated ifa academy. The ifa trainers are qualified and specialized in eye care only. The on site training is supported by comprehensive training documentation.
Q: Does the vendor provide web based training?
A: Yes. The ifa team provides webinars for initial and follow up training. The dates and access data are published on the user portal.
Q: How is the support organized and who is providing the support?
A: The ifa team provides support 24 hours 7 days a week around the world (24/7). For the US market 12 training and support specialists are available.
Q: Where is the US support based?
A: The support teams are working out of Fort Lauderdale, Florida, Charlotte, North Carolina and Los Angeles, California. The international second line support is based in Cologne and Berlin Germany and Lima, Peru.
Q: How can the hotline be contacted (phone, email etc.)?
A: The ifa support team can be contacted via phone and per email communication.
Q: How can the hardware service be provided?
A: The local hardware and network partner can get second line support by the ifa specialist’s team 24/7.
Q: Who supports the hardware and the network?
A: The local dealer and HW service partner supports the complete IT network. A second level support is provided by ifa.

5. Hardware and IT infrastructure
Q: Which hardware and which network components are required for running the software?
A: The software is developed on the latest information technology using standard PCs and MS operating systems (server and clients). The actual requirements are published on the web and the actual list is also attached.
Q: Is the software available as a web application?
A: The ifa group of companies provides web based EMR components for registries and clinical study database. However the comprehensive EMR package is designed as a local application. There are 2 reasons:

  • Most of the instruments in an eye care environment cannot be connected to web applications.
  • The performance of an application which runs on a local server is much higher and safer.

Q: How can remote sites / satellite offices be connected?
A: There are 3 alternatives to connect multiple locations:

  • Direct and dedicated communications lines
  • Terminal server solutions
  • Local use with offline synchronization

The individual customer solution is based a detailed project analysis (see standard forms).
Q: Does the vendor require specific hardware?
A: The user can choose the hardware and the IT partner independently. Hardware requirements and specifications are published by ifa depending on the project volume and performance needs. Based on a detailed project profile the ifa specialists provide a comprehensive quotation compendium with all relevant details.
Q: Does the system have any specific wired network requirements?
A: All wiring specifications for the system are standard. Also wireless networks are utilized with standard requirements.

6. Software
Q: Can the user customize the EMR to provide a single screen snapshot of patient data to include information such as allergies, patient photo, chief complaint etc.?
A: Yes. That’s part of the dashboard functionality. The dashboard can be preset.
Q: Can the user have templates for types of visits such as red eye, complete exam, flashes/floaters?
A: Yes. It is recommended by ifa to have a workflow for e.g. a red eye. This can be done for any type of encounter/visit type. If the user provides ifa with a list of the exam, all these templates will be set up by the ifa team during the customization process before the installation.
After a train-the-trainer session, the doctor can even customize his/her own templates (approx. half a day of training).
Q: Can the user change from one template to another on the fly?
A: Yes of course, this can be done with just a button click.
Q: Does the vendor offer a contact lens module to allow the user to order contacts for a patient in the office?
A: ifa does not have a contact lens module, but an interface to all contact lens applications that are based on HL7.
Q: Is there a way to remind the user to check tech data after the patient has been dilated?
A: If the user defines the decision tree in an exam form, the doctor will see the blanks where the tech forgot to enter the data.
Q: Can the user order tests (VF, photos)? How does the tech know what needs to be done?
A: There are different approaches for ordering tests. The tech can either just enter “VF” in the chart or the internal message system can be used. Also the organization tool “work flow management” can be used and the order is entered into the task list for the patient’s visit of today.
Another possibility is the use of the infobox. This works like a sticky note where the staff member can see what needs to be done next. When the patient’s record is opened, the” infobox” pops up. A further possibility is the so-called print-basket within the ifa system.
The approach that should be used depends on the method that has been used before the introduction of the EMR.
Q: Can users limit each chart to one user at a time?
A: If they are in a different area, yes. If they are in the same data entry area, no (consistency).
Q: Can the user easily generate a letter to PCP for diabetic patients to be faxed automatically by the system at the end of the visit?
A: Yes, ifa has predefined letters which are transferred to the to-do-list.
Q: If the PCP is not in the system, will the unsent faxed go to a “to do” list for the staff?
A: Yes, ifa has a to-do-list so that at the end of the day, everyone can see what still needs to be done.
Q: Is patient tracking done in the office by the system?
A: Yes, of course. ifa also has a room list showing where the patient is located right now.
Q: Can the user make specific dilation orders for different patients?
A: Please see above.
Q: Can the user use a tablet PC?
A: Yes all tablet technologies are supported by ifa.
Q: Does the system support handwriting recognition software?
A: Yes. But it does not make sense as ifa has all the information in a structured format. Only 10% should be entered as free text. Software recognizing the handwriting can be used for this.
Q: Does the system use voice recognition software?
A: Yes. For dictation this can be used, but it is not needed within the EMR application. For example ifa recommends Dragons.
Q: How are referral letters generated?
A: Preset standard referral letters can be defined. All the information such as patient demographics, findings etc. are automatically pulled into MS Word from the ifa system. The user can create very simple letters as well as very comprehensive reports.
ifa provides approx 20+ standard letters which can be modified. There are 3 categories: patient education letters, standard referral letters, comprehensive reports which can even contain images.
Q: Can the letter be customized to appear like the stationery of the office?
A: Yes, of course, that is the idea behind the Word for ifa interface. This also increases benefits in marketing, patient communication etc.
Q: Is there a section in the chart to document patient phone calls?
A: Yes, phone calls can be added as an encounter/visit type. A full template for standard phone calls can be used where all the information is entered.
Q: Is an audit trail generated of all edits of chart data?
A: ifa has a data locking functionality. The user decides after which period of time the data should be locked. The data can be locked in a way that it can never be changed again. If a correction needs to be made, an additional line can be entered starting with “correction” and the staff member’s name.
Q: Does the system perform E/M evaluations and recommendations?
A: Yes, it can be defined by the office. The ifa system filters the data that has been entered and tells the user how many more points are needed to get to the next level. This is critical because the user needs to be careful. That is why it is not preset by ifa, but by the users who need to define it themselves. Depending on the region it does always make sense to get to the next level as this may provoke more audits.
Q: Does the ifa system allow for internal messaging between the doctor and his/her staff?
A: Yes, an easy to use communication system is integrated.
Q: Is the time stamped on all tonometry?
A: Yes, all IOP values are time stamped. There is also the functionality of IOP graphs so that the doctor can check the relationship between certain medication and the IOP.
Q: How is the system secured if a tech steps away from the PC and forgets to log out?
A: ifa has a black screen function – it defines after how much time the screen goes black. The office can also have its own screensaver (all HIPPA compliant).
Q: Is there a shortcut to a macro for common phrases?
A: ifa is based on phrases (codes). More than 15,000 codes and terms are provided by ifa.
Q: Can the user make an addendum to a chart note?
A: Yes, ifa provides two functions for that. The user can either enter a comment line or a text box for longer comments.
Q: Can the user define and use macros for easy and fast data entries?
A: Yes, the system allows data entries with clicking buttons (SmartScreen technology) which store complete text macros (e.g. for “all normal” or “no change”).
Q: Is there a summary page showing all previous visits and the type of visit?
A: Yes, the user can define his/her own reports and decides what should appear in the report. Standard reports are preset.
Q: Is there a quick fill for a normal visit?
A: Yes. There are two alternatives.
Firstly, the macros can be used: e.g. the complete medical history can be preset with “all normal”. All the findings are then entered automatically.
Furthermore, ifa offers the “idem-button” functionality. With one click, all entries from the last visit are re-entered. The doctor can directly go to the area where changes are to be made.
Q: Is there a spell checker?
A: It is not necessary because ifa uses structured data which are stored in the data bases and have a correct spelling.
Q: Can the system provide a list of charts needing follow ups?
A: Yes, a comprehensive “To-Do-List” is integrated which can filter and sort the tasks for physicians, techs, admin people etc.
Q: How are patient signatures appended to the chart for authorization for payment, for consents etc.?
A: ifa can provide a digital signature pad so that the signature is automatically imported into the patient file. The standard form can be signed digitally. For more complex procedures, a print out is recommended because of legal requirements.
Q: What templates are preloaded on the system?
A: The system comes with preset templates for all kind of standards in eye care such as 8 part history and 8 part eye exam. In addition to that subspecialty versions are available with templates specific for retina specialists, ophthalmic surgeons, glaucoma specialists etc.
Q: When the software is upgraded to the next version, what happens to the templates? Do they work or need to be redone?
A: The ifa system is upgraded/updated in certain areas only. The global files (abbreviations, codes etc.) are only touched by updates/upgrades. No user specific data are touched during an update/upgrade process.
Q: Is there a quick fill for a normal visit?
A: Yes. There are two alternatives.
Firstly, the macros can be used: e.g. the complete medical history can be preset with “all normal”. All the findings are then entered automatically.
Furthermore, ifa offers the “idem-button” functionality. With one click, all entries from the last visit are re-entered. The doctor can directly go to the area where changes are to be made.
Q: Can the system assign patient specific and unique identifying numbers (ID) that cannot be changed?
A: Yes, the system assigns an unchangeable identifier to the individual patient. Another external identifier can be entered by the user. That guarantees the consistency of the patient data base.
Q: What is the largest patient data base in use?
A: The largest database is managed by an eye clinic in Germany which uses the system approx. 18 years and has 160,000 active patient charts stored in their ifa system. In the USA the average MD is managing between 3,500 and 6,000 active patient charts (depending on the sub specialty).
Q: Are all relevant data including dates noted, diagnosed, changed problem specifications and resolutions stored?
A: Yes, the complete data and case history is stored with structured and retrievable data. All legal requirements-also for the data management for clinical studies-are covered.
Q: Is the entire history and problem list viewable?
A: Yes, all kind of global or filtered views are provided (e.g. history list, medication list, problem list, treatment list etc.). A specific module provides the overview of all lists on the fly (dashboard).
Q: Does the system allow for a one page summary of all relevant data of the last visit?
A: Yes, The summary review is pre-defined in the system. Another summary can show all data of the last 2 or 3 visits.
Q: Can clinical documents and notes be structured documents that result in the capture of codes and standard terms?
A: Yes, all data can be entered in a structured format. More than 15,000 codes and terms are available in a SNOMED (Standardized Nomenclature in medicine) or LOINC (Logical Observations, Information and Codes) compatible format.
Q: Can clinical documents be created as templates?
A: Yes, the system provides a user friendly template generator system and has already more than 30 templates for the most important work flows/clinical pathways in eye care.
Q: Can the user change the structure of the templates to meet the individual needs?
A: Yes, all kind of modifications are possible without any support by ifa (easy to use manual)
Q: Does the system label each clinical data entry with the time, date and the individual (physician, tech)?
A: Yes, all data entries are logged by the system so the documentation is approved for legal audits and clinical studies.
Q: Can the system be used for clinical studies?
A: Yes, with the structured data model (for meaningful use of clinical data) the system is designed also for comprehensive clinical studies. The user can define individual data variables with the existing terminology data base or define dedicated data variables.
Q: Does the system allow drawings?
A: Yes, the special drawing module “eye draw” allows all kind of graphical documentation including freehand drawing with a wide range of different colors.
Q: Are symbols and pre-defined graphical elements present?
A: Yes, symbols and graphical elements allow user friendly drawing documentation for all sub specialties (retina, glaucoma, oculoplastics/trauma, surgery, cornea etc.). The user can also define and create own symbols in different sizes easily.
Q: Does the system allow the all kind of letters to be e-mailed or faxed?
A: Yes, the system provides interfaces for fax and e-mail communication. For fax communication a fax with an API is required. For e-mail communication an e-mail client (e.g. outlook) has to be installed in the local network
Q: Does the system have all the required privacy rules built in?
A: Yes, the system is approved for all required privacy rules integrated into the SW.
Q: Does the system allow changes on data base level?
A: No, all data entries are logged and protected (3 level security) to meet all legal requirements for paperless documentation.
Q: Does the system require users to be authenticated when attempting to use the EMR system.
A: Yes, the system comes with a structured entity authentication concept.

7. Licenses and Prices
7.1 Initial investment
Q: How are the licenses for the EMR investment priced?
A: The licenses depend on the number of workstations and the number instrument and software interfaces. Pricelist for the detailed licenses are attached.
Q: What are the terms of payment?
A: With signing the contract the first installment of 50% has to be paid. The other 50% has to be paid after the user approval of the software installation.
Q: What is the ratio of the initial investment and the EHR incentive payment?
A: The Medicare full incentive payment is 44.000 US$. For a single office the initial investment is higher per physician than for a group practice (per physician). Per workstation including standard interfaces the investment is approximately 3.000 – 3.500 US$ per station.

7.2 Prices for customization and training
Q: What are the prices for customizing the software for the individual office?
A: ifa provides solutions for which are already customized for subspecialties, e.g. versions for retina specialists, cataract and refractive surgeons, glaucoma specialists, ocular plastics specialists etc. In addition to the subspecialty versions the customization process takes between 1 and 3 days per physician. The customization is billed per day, see attached pricelist.
Q: How is the training priced?
A: The training depends on the number of team members and the training strategy. The user can choose between 2 alternatives:

  • The ifa trainer trains all the team members
  • The ifa trainer trains the supervisor and he / she trains the team (train the trainer concept)

The training is charged per day (see attached pricelist).

7.3 Runtime licenses and maintenance
Q: What are the ongoing costs?
A: The standard runtime licenses are 1.0 % per month based on the initial license investment. For higher service levels (including onsite consulting) the runtime licenses are 1.5% based on the initial license investment.
Q: What does the runtime license include?
A: The monthly license fee include software updates (minimum 2 per year), hotline service (phone and email 24/7) and user meetings (e.g. in conjunction with the annual meetings of the AAO, ASCRS and ARVO).
Q: Can the ongoing license and support fee be paid also yearly or for 2 or 3 years?
A: Yes. The users can choose service and support packages for periods between 12 and 36 months with an attractive interest bonus (depending on financial market rates).
Q: How does the runtime license increase over time?
A: The runtime license is linked to the US market index (as recommended by AAO and the Government for the STIMULUS calculation)

8. Compliance with certification for EHR Incentive Program (Stimulus)
Q: Can the vendor guarantee the certification or the “Meaningful Use” (Stimulus)?
A: Yes, ifa provides a detailed conformance statement and a certification guarantee for the EHR incentive Program (Stimulus). See attachments.
Q: Does the vendor provide CCHIT certification (Ambulatory Care)?
A: No, as this is of no value for eye care. CCHIT Ambulatory Care is for general primary physicians (see pregnancy management) and not for ophthalmologist (see also AAO statement). The requirements for the Stimulus Program are different (see attachment) to the old CCHIT certification for family doctors. As soon as specific certification criteria are defined for eye care ifa shall get all relevant approvals (see conformance statement)
Q: Which EHR modules are provided by the vendor?
A: ifa provides all EMR modules and interfaces to the other PMS modules (e.g. electronic claims, insurance checks, e-prescribing and PQRI). These EHR modules are provided by the PMS vendor or another specialized provider. Ifa guarantees the connectivity between the certified EHR modules (see attachment).
Q: Does the systems provide the required standards for the “meaningful use of electronic healthcare data”?
A: Yes, ifa software has a long history with open standards in eye care IT. All relevant standards are integrated into the EMR software:

  • SNOMED CT compatible terminology
  • ICD 9 CM and ICD 10 coding
  • LOINC codes (laboratory)
  • HL7 (2.3.1. and 2.5 1. +)
  • DICOM (Image Management)

Q: Does the system support structured data mining with lists of patient specific conditions?
A: Yes, a query module is integrated into the ifa EMR module. Queries can be defined with “human readable criteria”. The results can be exported to all types of spreadsheet analysis software (e.g. MS Excel).
Q: Does the software provide qualified clinical decision support?
A: Yes, clinical decision support rules can be implemented into the EMR software by the user (e.g. checking contraindications, monitoring potential therapy conflicts etc.). The CDS rule profiles can be defined and preset by the user without any support from ifa (human readable user interface).