Success Story
About the Client
The client is a leader in the field of ophthalmology, backed by years of industry experience and founded by a world-class surgeon. Operating the largest network of integrated ophthalmic service clinics in the United States, the organization has over 60 locations across California and brings together leading ophthalmologists and optometrists. With a strong commitment to excellence, the client supports both established practice owners and emerging professionals while delivering best-in-class patient care.
Business Situation and Requirements
Managing high patient volumes across multiple clinic locations requires a well-coordinated system to handle records, appointments, telehealth, billing, and insurance workflows. A robust EHR system is essential to ensure seamless data access, continuity of care, and compliance with HIPAA and ONC standards, enabling secure, interoperable, and high-quality patient care.
The eye care group sees hundreds of patients daily and uses a third-party EHR at each clinic to manage records, appointments, telehealth, billing, and related operations. As the network grew, the EHR struggled with workflows, and maintaining the system across multiple clinics became costly. To manage clinical workflows and reduce the EHR system’s costs across all clinics, the eye care group wanted to build a custom EHR.
Their key requirements included:
Discover & Frame (D&F) Workshop: Conduct a D&F workshop to define project scope, understand user needs, identify risks, and align the roadmap for a market-ready EHR solution.
Custom Solution: Develop a tailor-made EHR system to meet the specific needs of the eye care group.
One-Time Deployment solution: Implement the solution as a one-time deployment across all clinics.
Cost-Effective: Reduce recurring expenses by eliminating reliance on third-party EHR systems.
Scalability: Ensure the system can be used across multiple clinics while maintaining consistency and efficiency.
Workflow Integration: Manage and integrate workflows according to the eye care group’s clinical practices.
Productivity Enhancement: Streamline operations to improve overall staff and clinic productivity.
Solution
Our team designed the development roadmap using the Discover & Frame (D&F) workshop. This approach helps the business team understand the project concept, target users, competitors, revenue model, and technical risks. It also defines the project scope, user flow, timeline, and estimated cost for building a market-ready solution.
Appointment and Patient Management
The EHR system streamlines front-desk and call center operations by managing appointments, patient check-ins, and account balances. Front-desk users can track appointment status, create superbills, and record medical and procedural details. The call center can schedule appointments based on service type, location, doctor preference, and insurance, ensuring efficient patient flow across clinics.
Billing and Insurance Integration
Billing functionality allows users to generate and manage patient encounters, including details like insurance profiles, procedures, and authorizations. Generated bills are sent to the claims queue and clearinghouses, with remittance tracking and rejection management handled within the Insurance module. API integrations with insurance providers enable seamless access to patients’ financial information and faster claims processing.
Reporting and Analytics
Custom dashboards provide actionable insights for admins, doctors, and clinics. Admins can monitor revenue, claims, patient flow, cancellations, and feedback trends, while doctors can track patient load, appointments, and clinic visits. These reporting tools enable data-driven decision-making and improve operational efficiency across the network.
Data Protection and Compliance
The system is fully HIPAA-compliant, safeguarding patient data related to treatments, payments, and operations. ICD and CPT code integrations support accurate diagnosis and procedure documentation for insurance claims. A backend rule engine enforces NCCI PTP edits to prevent incorrect code combinations, ensuring seamless, compliant processing of claims.
Impact
The custom EHR system was deployed across all clinics, streamlining admin and patient management. Our team ensured smooth deployment and training, resulting in a 60% productivity boost and 80% reduction in recurring EHR costs.
A patient portal is in development to enhance engagement, allowing users to view documents, manage appointments, access clinical notes and medication history, and track insurance claims for a seamless, connected healthcare experience.
60+
clinics across the US
100,000+
appointments handled per annum
1000+
eye care practitioners
