Eye Exam

These Wiki documents will provide an in depth look into the OpenEMR: Eye Exam form, from installation to usage.

General overview

The Eye Exam is an OpenEMR form for ophthalmology and optometry providers to document their encounters with patients, from the Chief Complaint to the Impression and Plan, and ends with an optional printable report.

What makes this different?

• The Eye Exam form remembers your preferences as you use it.
• Users can document their findings in a variety of ways, allowing for maximum flexibility and usability.
• The form is intelligent - the more you use it the more personalized it becomes.
• It will adapt to each provider's commonly used terms such as medication lists and surgical nomenclature, showing these high frequency items for rapid entry on future patients.
• There is no save button. As you work through the form, it is automatically saved in the background.
• Undo features are present to backtrack, not only in text fields but also in the drawings.

Install

At the time of this article, the Eye Exam form has not been through a code review and is not part of the base installation. The OpenEMR maintainers wish to make certain features available to any developer to add to their own forms. They have extracted certain libraries from the form and moved them to the OpenEMR library, with the intention of adding them to the base install library upon code review. Until then, the Eye Exam form can be installed like any other OpenEMR form, but you will have to add these files into your library area if they are not already present:

• /openemr/library/css/pure-min.css
• /openemr/library/css/bootstrap-3-2-0.min.css
• /openemr/library/css/font-awesome-4.2.0/css/font-awesome.css
• /openemr/library/js/jquery.min.js
• /openemr/library/js/bootstrap.min.js

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Documentation Options

Different users interact with EMRs in different ways. Sometimes we want to draw a picture, other times we need to write out our findings in detail. With the OpenEMR: Eye Exam, you can use a number of different methods to document your exam.

• TEXT: fill in anatomic-specific fields with text by typing
• PULL FORWARD: pull-forward values from an earlier encounter
• DRAW: draw your findings
• QUICK PICKS: select from a dynamic list of clinical findings
• SHORTHAND: a rapid method for entering findings via the keyboard based on traditional shorthand used with paper charts.
• DEFAULTS: populate the form with default values.

Text

Using the tab key or mouse you can select a field and type in your findings. Tab or click to move through the fields.

Draw

Each portion of the form has a Draw Component. Choose the color and size and Draw away. Redo and Clear Functions extend the range of this feature.

Quick Picks

Commonly used findings can be clicked on to fill the fields.

KeyBoard (Shorthand)

Introduction

What if you could document electronically using your shorthand?
We converted the standard clinical fields and common shorthand terms into Eye Shorthand, an electronic lingua franca oculī.
It is not a new language - it should already be very familiar.
You can customize it to match your brain, but you may not need to.
It is based on the shorthand we all learned in training.
Using this shorthand method, all your findings are entered in one area,

and OpenEMR knows how to display it.

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Paper vs. EHR:
You know what RUL: 2mm ptosis means.
With a typical EHR, you need to find and click on the field for the right upper lid and type in 2mm ptosis.
Then click on the next field, or maybe even tab to it, and type your findings for the next field. And on it goes.

Consider another example: Right C/D 0.6Vx0.4H with inferior notch. Left C/D 0.5?
OK, find the correct fields to click. Enter the appropriate text into each field. Two mouse clicks at least. Type.
Lots of hand movement going on.

How can we speed up this process?

Look at this example in shorthand, based on a simple structure: Field.text;Field.text;Field.text

rcup.0.6Vx0.4H w/ inf notch;lcup.0.5

Type this shorthand text into the Keyboard Entry area in the form, and the fields are automatically filled.
Done. No extra clicks.
Even a slow typist will find the Eye Exam Shorthand can speed up EHR documentation time.
It is easy to learn.
The Fields and text parts look just like our handwritten shorthand!
Type the abbreviation for a clinical field, a period/fullstop, followed by your finding, in your shorthand.
If your shorthand doesn't match ours, your shorthand text will be displayed.
It is easy to add your shorthand if you need customization - add them to your copy of /forms/eye_mag/js/js_my_base.js
Consider sharing your shorthand back to the community for future users.

The explanation below centers around four lines of typing which document normal findings and more than 40 different clinical issues.
That's a lot to document and one mighty complicated patient!
Many more issues than we would see on a routine day with routine patients, but it could happen...
Documenting this many findings would take a little bit of time on paper, and a lifetime in an EHR.
With the openEMR Shorthand, the average typist can do it in less than a minute.

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Go ahead and paste the lines below into a test patient's chart. Fiddle with them.

D;bll.+2 meibomitis;rll.frank ect, 7x6mm lid margin bcc lat.a;bul.2mm ptosis;rul.+3 dermato.a; bc.+2 inj;bk.med pter;rk.mod endo gut.a;bac.+1 fc, +1 pig cells; bd.+2 bowtie pallor;rc.0.6Vx0.4H w/ inf notch;lc.0.5;rmac.+2 BDR, +CSME;lmac.flat, tr BDR;v.+PPDR, ++venous beading;rp.ht 1 o,no vh; scDist;5.8ix 1rht;4.10ix;6.6ix;2.15xt;8.5ix;ccDist;4.5ix;5.ortho;6.ortho

The following sections will explain each line in detail.
If you are already an eyedoc, this is simple and intuitive.
It's time to plug the EHR into your brain, and to start working at the speed of your brain.

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Key point: Only use the "D;" once and only at the start. It is very powerful. The D; tells Eye Exam to ERASE EVERY field and replace them with your default values (defined in /eye_mag/js/js_my_base.js). D; will replace everything with its default value.

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Basic Structure

Usage: field.text(.a)(;)

where:

Field is the shorthand term for the clinical field.
text is the complete or shorthand data to enter into this field.
field and text are separated by a "." period/fullstop.
The trailing ".a" is optional and will append the text to the data already in the field, instead of replacing it.
The semi-colon ";" is used to divide entries, allowing multiple field entries simultaneously.
The semi-colon separates entries and cannot be used within a text field.
After pressing Enter/Return, the data is submitted.
Pressing TAB will jump to the next clinical area's Keyboard/Shorthand entry field.

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External: Shorthand Walk Through

Keyboard Entry

D;bll.+2 meibomitis;rll.frank ect, 7x6mm lid margin bcc lat.a;bul.2mm ptosis;rul.+3 dermato.a

This line will be recorded in OpenEMR: Eye Exam as:

This is how this shorthand will appear in a Printable Report:

External: Field Codes and Shorthand/Abbreviations

Clinical Field	Shorthand* Field	Example Keyboard Entry**	EMR: Field text
Default values	D or d	d; D;	All fields with defined default values are erased and filled with default values. Fields without defined default values are not affected.
Right Brow	rb or RB	rb.1cm lat ptosis rb.med 2cm SCC	1cm lateral ptosis medial 2cm SCC
Left Brow	rb or RB	rb.loss of lat brow follicles lb.no rhytids from VIIth nerve palsy	loss of lateral brow follicles no rhytids from VIIth nerve palsy
Both Brows/Forehead	fh or FH bb or BB	fh.+3 fh rhytids BB.+3 glab rhytids	+3 forehead rhytids +3 glabellar rhytids
Right Upper Lid	rul or RUL	RUL.1cm lat ptosis rul.med 2cm SCC	1cm lateral ptosis medial 2cm SCC
Left Upper Lid	lul or LUL	LUL.1cm lat ptosis lul.med 2cm SCC	1cm lateral ptosis medial 2cm SCC
Right Lower Lid	rll or RLL	rll.1cm lat ptosis rll.med 2cm SCC	1cm lateral ptosis medial 2cm SCC
Left Lower Lid	lll or LLL	lll.0.5cm lat ptosis LLL.med 2cm SCC	1cm lateral ptosis medial 2cm SCC
Right Medial Canthus	rmc or RMC	rmc.1cm bcc RMC.healed dcr scar	1cm BCC healed DCR scar
Left Medial Canthus	lmc or LMC	lmc.acute dacryo, tender w/ purulent drainage lmc.1.2cm x 8mm mass	acute dacryo, tender with purulent drainage 1.2cm x 8mm mass
Right Adnexa	rad or RAD	rad.1.8x2.0cm bcc lat RAD.healed DCR scar	1cm BCC healed DCR scar
Left Adnexa	lad or LAD	lad.1cm lacr cyst protruding under lid LAD.1.2cm x 8mm mass	1cm lacrimal cyst protruding under lid 1.2cm x 8mm mass

*case insensitive
**The default action is to replace the field with the new text.
Adding ".a" at the end of a text section will append the current text instead of replacing it.
For example, entering "4xL.+2 meibomitis.a" will append "+2 meibomitis" to each of the eyelid fields, RUL/RLL/LUL/LLL.

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Anterior Segment: Shorthand Walk Through

Keyboard Entry

D;bc.+2 inj;bk.med pter;rk.moderate endo gut.a;bac.+1 fc, +1 pig cells

This line will be recorded in OpenEMR: Eye Exam as:

This is how this shorthand will appear in a Printable Report:

Anterior Segment: Field Codes and Shorthand/Abbreviations

Clinical Field	Shorthand* Field	Example Keyboard Entry**	EMR: Field text
Default values	D or d	d; D;	All fields with defined default values are erased and filled with default values. Fields without defined default values are not affected.
Conjunctiva	Right = rc Left = lc Both = bc or c	rc.+1 inj c.med pter	"+1 injection" (right conj only) "medial pterygium" (both right and left fields are filled)
Cornea	Right = rc Left = lc Both = bk or k	rk.+3 spk k.+2 end gut; rk.+1 str edema.a	"+3 SPK" (right cornea only) "+2 endothelial guttatae" (both cornea fields) AND "+1 stromal edema" (appended to Right cornea field)
Anterior Chamber	Right = rac Left = lac Both = bac or ac	rac.+1 fc ac.+2 flare	"+1 flare/cell" (right A/C field only) "+2 flare" (both A/C fields)
Lens	Right = rl Left = ll Both = bl or l	RL.+2 NS ll.+2 NS; l.+3 ant cort spokes.a	"+2 NS" (right lens only) "+2 NS" (both lens fields) AND "+3 anterior cortical spokes" (appended to both lenses)
Iris	Right = ri Left = li Both = bi or i	bi.12 0 iridotomy ri.+2 TI defects.a; li.round	"12 o'clock iriditomy" (both iris fields) ", +2 TI defects" (right iris field AND "round" (left iris field only)
Gonio	Right = rg Left = lg Both = bg or g	rg.ss 360 lg.3-5 o angle rec	SS 360 3-5 o'clock angle recession
Pachymetry	Right = rp Left = lp Both = bp or p	lp.625 um p.550 um	"625 um" (left pachymetry field) "500 um" (both pachymetry fields)
Schirmer I	Right = rsch1 Left = lsch1 Both = bsch1 or sch1	rsch1.5mm sch1.> 10mm/5 minutes	"5mm" (right field only) > 10mm/5 minutes" (both fields)
Schirmer II	Right = rsch2 Left = lsch2 Both = bsch2 or sch2	rsch2.9 mm sch2.> 10mm/5 minutes	"9 mm" (right field only) > 10mm/5 minutes" (both fields)
Tear Break-up Time	Right = RTBUT Left = LTBUT Both = BTBUT or tbut	tbut.> 10 seconds Rtbut.5 secs;ltbut.9 seconds;	"10 seconds" (both fields) "5 seconds" (right) AND "9 seconds" (left)

*case insensitive
**The default action is to replace the field with the new text.
Adding ".a" at the end of a text section will append the current text instead of replacing it.
For example, entering "bk.+2 str scarring.a" will <class="underline bold">append</class> "+2 stromal scarring" to both the right (rc) and left cornea fields (lc).

External Shorthand Abbreviations:

The following terms will be expanded from their shorthand to full expression in the EMR fields:

Enter this:	Get this:
inf	inferior
sup	superior
nas	nasal
temp	temporal
med	medial
lat	lateral
dermato	dematochalasis
w/	with
lac	laceration
lacr	lacrimal
dcr	DCR
bcc	BCC
scc	SCC
sebca	sebaceous cell
tr	trace

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Retina: Shorthand Walk Through

Keyboard Entry

D;bd.+2 bowtie pallor;rc.0.6Vx0.4H w/ inf notch;lc.0.5;rmac.+2 BDR, +CSME;lmac.flat, tr BDR;v.+PPDR, ++venous beading;rp.ht 1 o,no vh;

This line will be recorded in OpenEMR: Eye Exam as:

This is how this shorthand will appear in a Printable Report:

Retina: Field Codes and Shorthand/Abbreviations

Clinical Field	Shorthand* Field	Example Keyboard Entry**	EMR: Field text
Default values	D or d	d; D;	All fields with defined default values are erased and filled with default values. Fields without defined default values are not affected.
Disc	Right = rd Left = ld Both = bd or d	rd.temp pallor, PPA c.NVD at 5 o	"temporal pallor, PPA" (right disc only) "NVD at 5 o'clock" (both right and left disc fields)
Cup	Right = rc Left = lc Both = bc or c	rc.0.5 w/ inf notch c.temp scalloping, 0.5.a;rk.+1 str edema.a	"+3 SPK" (right cornea only) "temporal scalloping, 0.5" (appended to both cup fields)
Macula	Right = rmac Left = lmac Both = bmac or mac	rmac.central scar 500um mac.soft drusen, - heme.a	"central scar 500um" (right macular field only) "soft drusen, - heme" (appended to both macular fields)
Vessels	Right = rv Left = lv Both = bv or v	RV.1:2, +2 BDR lv.+CSME w/ hard exudate sup to fov (300um);v.narrow arterioles, 1:2.a;	"1:2, +2 BDR" (right vessels only) "+CSME with hard exudate superior to fovea (300um)" (left vessel field only) AND "narrow arterioles, 1:2" (appended to both vessel fields)
Periphery	Right = rp Left = lp Both = bp or p	rp.12 0 ht, no heme, amenable to bubble; bp.1 clock hour of lattice 2 o.a;li.round	"12 o'clock horseshoe tear, no heme, amenable to bubble" (right periphery field) "1 clock hour of lattice 2 o'clock" (appended to both periphery fields)
Central Macular Thickness	Right = rcmt Left = lcmt Both = bcmt or cmt	rcmt.254 cmt.flat	254 (right CMT only) flat (both CMT fields)

*case insensitive
**The default action is to replace the field with the new text.
Adding ".a" at the end of a text section will append the current text instead of replacing it.
For example, entering "bk.+2 str scarring.a" will <class="underline bold">append</class> "+2 stromal scarring" to both the right (rc) and left cornea fields (lc).

Retina Shorthand Abbreviations:

The following terms will be expanded from their shorthand to full expression in the EMR fields:

Enter this:	Get this:
inf	inferior
sup	superior
nas	nasal
temp	temporal
med	medial
lat	lateral
csme	CSME
w/	with
bdr	BDR
ppdr	PPDR
ht	horsheshoe tear
ab	air bubble
c3f8	C3F8
ma	macroaneurysm
tr	trace
mias	microaneurysm
ped	PED
1 o	1 o'clock
2 o	2 o'clock
3 o	3 o'clock
4 o	4 o'clock
5 o	5 o'clock
6 o	6 o'clock
7 o	7 o'clock
8 o	8 o'clock
9 o	9 o'clock
10 o	10 o'clock
11 o	11 o'clock
12 o	12 o'clock
mac	macula
fov	fovea
vh	vitreous hemorrhage

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Neuro-Physiology: Shorthand Walk Through

Keyboard Entry

scDist;5.8ix 1rht;4.10ix;6.6ix;2.15xt;8.5ix;ccDist;4.5ix;5.ortho;6.ortho

This line will be recorded in OpenEMR: Eye Exam as:

This is how this shorthand will appear in a Printable Report:

Neuro-Physiology: Field Codes and Shorthand/Abbreviations

Clinical Field	Shorthand* Field	Example Keyboard Entry**	EMR: Field text
Default values	D or d	d; D;	All fields with defined default values are erased and filled with default values. Fields without defined default values are not affected.
Without correction at Distance	scDist	scdist;	scDIST is selected for ensuing values.
With correction at Distance	scDist	ccdist;	ccDIST is selected for ensuing values.
Without correction at Near	scNear	scdist;	scDIST is selected for ensuing values.
With correction at Near	scNear	scdist;	scDIST is selected for ensuing values.

*case insensitive
**The default action is to replace the field with the new text.
Adding ".a" at the end of a text section will append the current text instead of replacing it.
For example, entering "bk.+2 str scarring.a" will <class="underline bold">append</class> "+2 stromal scarring" to both the right (rc) and left cornea fields (lc).

Neuro Shorthand Abbreviations:

The following terms will be expanded from their shorthand to full expression in the EMR fields:

Strabismus	Enter this:	Get this:
Exophoria	x	X
Intermittent Esotropia	ie or e(t)	E(T)
Esoptropia	et	ET
Esophoria	e	E
Intermittent Exotropia	ix or x(t)	X(T)
Exoptropia	xt	XT
Hyperphoria	h	H
Intermittent Hypertropia	H(T)	H(T)
Hypertropia	rht lht	RHT LHT
Hypotropia	hyt	HyT

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Side Panel

Expand the PMH window and click the PMSFH tab to open the right tab. This displays the PMSFH data

Full Screen Mode

Application-style Menu Bar

Chief Complaint and History of Present Illness

PMSFH/ROS

Visions/Refraction Panels

IOP/Amsler/CVF/Pupils

External

Anterior Segment

Retina

Neuro-Physiology

Images and OpenEMR

Impression/Plan

Printable Report

Conclusions =