Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR). Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912) than before (mean = $411,420; SD = $39,366) (P = 0.746). Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05%) for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world.

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Purpose. To compare anterior chamber depth (ACD), representing the distance between the anterior corneal surface and anterior lens surface measurements between the Galilei Dual Scheimpflug Analyzer and the IOLMaster. Methods. A retrospective review of 65 individual patient eyes with normal anterior segments, and no prior ocular surgery was performed. Patients underwent ACD measurements with both devices during the same session by a trained examiner. Interdevice agreement was evaluated using paired two-tailed t-tests, Pearson correlation coefficient, and Bland-Altman analysis. Results. The mean ± standard deviation (SD) ACD for the Galilei and IOLMaster was 3.37 ± 0.36 mm (range from 2.62 to 4.13) and 3.25 ± 0.38 mm (range from 2.34 to 3.92), respectively (Pearson correlation coefficient = 0.96). ACD mean difference was 0.12 mm (P < 0.0001); 95% limits of agreement was from −0.09 to 0.34. The Galilei measured slightly longer ACD values than the IOLMaster. There was no relationship between axial length and interdevice difference. Conclusion. ACD measurements correlate well between the Galilei and IOLMaster, with Galilei values on average 0.12 mm longer than the IOLMaster.

Objective: There are no safety or absorption studies to guide topical timolol therapy for treatment of chronic wounds. This study was undertaken to address this gap. Approach: A prospective, observational, cross-sectional comparative study of timolol plasma levels in patients after topical administration to a chronic wound, compared with levels in patients after timolol ocular administration for the indication of glaucoma. Results: There was no statistically significant difference in the average plasma level of timolol in wound as compared with glaucoma patients. No bradycardia or wheezing was observed after administration. Innovation: We determined the single time point concentration of timolol in plasma 1 h after application of timolol 0.5% gel-forming solution to debrided chronic wounds, providing insight as to the safety of this emerging off-label treatment. Conclusion:The topical application of timolol for chronic wounds shares the same safety profile as the widely used application of ocular administration for glaucoma.