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February 2011:
Dr. Montzka: Changing Ophthalmic EHR

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Dr. Montzka: Changing Ophthalmic EHR (Feb 2011)

His physician-designed, cloud-based system attracts buyers.

By Jerry Helzner, Senior Editor

Florida-based retina specialist Dan Montzka, MD, 49, has always been something of a “techie.” At the University of Minnesota he was an engineering major. As a fellow at Wills Eye Hospital, he was instrumental in putting instructional material into a CD-ROM format. So it should not come as a surprise that when he looked at the available ophthalmic-specific EHR systems over seven years ago, he thought he could design something better and more physician-friendly.

“For example, as ophthalmologists, our patients are older and often present with significant pathology,” notes Dr. Montzka. “The EHR systems I looked at utilized static templates that were pre-defined or user defined,” which he found limiting in terms of clinical documentation. “It's impossible to anticipate the countless combinations and permutations of disease that patients may present with.” He addressed this issue with patient-specific adaptable templates that can significantly reduce typing while generating granular data. “It's not perfect but does allow for significant improvements in the speed and specificity of clinical documentation.”

Dr. Montzka's initial effort, first installed in his own practice, was good enough to attract five other practices that purchased the system. “I started with a client-server system, which was the only option at that time,” recalls Dr. Montzka. “But I was also talking to some venture capital groups who said that Web-based software was going to be the wave of the future.”

Dr. Montzka persisted with the client-server model for a while. “I did not believe that Web-based software was robust enough to handle the significant demands of EHR software. But conversely, I was becoming increasingly frustrated with the slow, costly development cycles on the client-server platform.” At just about that time, he found a kindred spirit and fellow innovator in Roland Feijoo, who had been developing his own company, Extensys, to achieve critical capabilities in managing IT infrastructure, providing system security and in Web hosting. Dr. Montzka and Mr. Feijoo soon merged their companies to form MDIntellesys.

MDIntellesys EHR system

“Dr. Montzka had deployed some absolutely ingenious solutions to complex issues, but it was on a legacy technology platform,” says Mr. Feijoo. “We agreed to partner with Dr. Montzka based on a move to cloud computing technologies and the development of a new business model.” After committing to the new direction, Dr. Montzka determined it was in the best interest of current and future customers to stop selling while they retooled everything to enable delivery on a secure cloud, including building out two data centers, a year-long risk that has “totally paid off,” Mr. Feijoo says.

“The merger with Extensys was our key to success,” asserts Dr. Montzka. “When medical practices run into problems with EHR, often it isn't the software. Quite frequently, it's the IT infrastructure that they struggle to manage. With Extensys, we have full control of the IT infrastructure.”

Plus, the merger with Extensys allowed MDIntellesys to offer its customers a cloud-based EHR that requires no big upfront investment for hardware, charges only monthly fees based on the number of practitioners using the system and operates with no contracts. The MDIntellesys EHR also has an HL-7 integration system and is compatible with many client-server EHRs and Web-based practice management systems.

“Essentially, we handle all security and support services,” Dr. Montzka says. “All the practice has to do is provide Web access. Our imaging module is very popular with our users and can handle multiple FAs and OCTs.” Due to bandwidth considerations, images are stored at resolutions optimized for computer display and not full-page high-resolution printing. However, clinics have access to their images from any computer with an Internet connection. Most users are very willing to accept this trade-off, he says. The ophthalmology-specific system has been attracting much interest, with inquiries growing exponentially and more than 50 systems currently installed, including Queen's Hospital in Ontario. The system is applicable to all ophthalmology practices.

Another benefit is that the system allows users to exchange new ideas, treatment approaches for difficult cases and basic insights through a proprietary database that has been likened to an ophthalmology-based Wikipedia — driven by the physicians who contribute the information.

“Our company is now working with the Drummond organization to have our system certified,” says Dr. Montzka. “We are fully committed to achieving and maintaining certification so that practices that use our system can receive full ‘meaningful use’ bonus payments. However, we view the bonuses as simply an added benefit and should only be one of many considerations when choosing an EHR.”

The primary reason to consider a cloud-based system is not cost savings but “the significant added value of an easily updated, collaborative solution,” asserts Dr. Montzka. “We are just beginning to tap into the potential of cloud-based EHR systems that leverage the combined resources of a community of users.” He asserts that “it is only a matter of time until all high-end EHR systems will be cloud-based.”

In any event, the cloud-based model is catching on quickly, with both GE Centricity and AthenaHealth indicating that they are planning to launch ophthalmology-specific cloud-based EHR in the next year. Established ophthalmic-specific EHR providers such as NextGen and Medflow will also be offering cloud-based alternatives to their client-server systems.

Meanwhile, Dr. Montzka still maintains an active clinical practice but has found it necessary to reduce his clinical hours to keep up with his duties as CEO of MDIntellesys. “The shift is going to continue as the company grows,” says Dr. Montzka. “But my focus is on making our system more efficient for physicians and that can only happen if I continue to be involved in clinical practice.”

More information is available at

Omega-3 Fatty Acids Protect Eyes Against Retinopathy, Study Finds. (July 2007)

Retinopathies may be prevented or lessened by a change in diet. Omega-3 fatty acids protect against the development and progression of retinopathy, a deterioration of the retina, in mice. This is the major finding of a study that appears in the July 2007 issue of the journal Nature Medicine. The study was a collaborative effort by researchers at Children's Hospital Boston, the primary pediatric teaching affiliate of Harvard Medical School, Brigham and Woman's Hospital, Massachusetts General Hospital, the University of Goteborg in Sweden, and the National Eye Institute (NEI) of the National Institutes of Health (NIH).

The researchers found that increasing omega-3 fatty acids, and decreasing omega-6 fatty acids in the diet, reduced the area of vessel loss that ultimately causes the growth of the abnormal blood vessels and blindness. Omega-6 fatty acids contribute to the growth of abnormal blood vessels in the retina.

"Our finding represent new evidence suggesting the possiblility that omega-3 fatty acids act as protective factors in diseases that affect retinal blood vessels", said John Paul SanGiovani, ScD, NEI staff scientist, and the other lead author of the study.

Comparison of AMD Treatments Trial (CATT): Lucentis - Avastin Trial (Feb 2008)

The National Eye Institute (NEI) of the National Institutes of Health (NIH) announces the start of a multicenter clinical trial to compare the relative safety and effectiveness of two drugs currently used to treat advanced age-related macular degernation (AMD). The two drugs, Lucentis (ranibizumab) and Avastin (bevacizumab). AMD is a disease that damages the macula. The macul is the area of the retina responsible for central vision. AMD is a leading cause of blindness among older Americans. Nearly two million Americans are visually impaired by AMD, while more than seven million are at increased risk of vision loss from the disease.

Lucentis was approved by the US Food and Drug Administration (FDA) in June 2006 for the treatment of advanced, or wet, AMD. The approval was based on evidence from clinical trials showing that Lucentis slows the rate of progression of vision loss from wet AMD. In addition to a low rate of developing vision loss, approximately one-third of patients treated in these trials had some improvement in vision, as measured on an eye chart at 12 months.

Avastin is a drug closely related to Lucentis. It was FDA approved in 2004, as an intravenous treatment for patients with advanced colorectal cancer, and therefore has been available for what is called "off-label" use for other health conditions. It has been widely used "off-label" to treat AMD. Avastin is thought to remain in the eye longer than Lucentis, and therefore possibly allow for less frequent injections.

The Lucentis - Avastin trial will determine the relative safety and effectiveness of treating wet AMD in 1,200 patients. This clinical trial will be conducted at 47 clinical centers across the country. It is hoped the results of this study will improve the treatment of wet AMD. Reducing the frequency of treatments, without comprpomising effectiveness, would reduce the treatment burden for patients, and produce a potential cost savings.

Optical Coherence Tomography (OCT)

OCT retina_AMDOCT is a non-invasive technology used for imaging the retina. This is the first instrument that allows doctors to see cross-section images of the retina, and is revolutionizing the early detection and treatment of retinal conditions such as: macular edema, macular holes and optic nerve damage.

OCTOCT is similar to CT scans of internal organs. OCT uses optical backscattering of light to rapidly scan the eye and show a representation of the 10 anatomic layers in the retina, and measure the thickness of these layers. In certain conditions, the OCT procedure is able to reduce or eliminate the need for fluorescein angiography in some patients.

Age-Related Eye Disease Study (AREDS) - Results (2001)

NEI NIH logo

The Age-Related Eye Disease Study (AREDS) is a major clinical trial sponsored by the National Eye Institute (NEI), a part of the National Institutes of Health (NIH). The purpose of this study was to learn more about the natural history and risk factors of age-related macular degeneration (AMD) and to evaluate the effect of high doses of antioxidants and zinc, on the progression of AMD.

This clinical trial closely followed about 3,600 participants with varying stages of AMD. The results showed that the AREDS formulation, while not a cure for AMD, may play a key role in helping people at high risk for developing advanced AMD, keep their remaining vision.

Before taking these high levels of vitamins and minerals, you should consult with your eye care professional about your risk of developing advanced AMD, and whether taking the AREDS formulation is right for you.