How to choose an optometry EMR: a checklist

Every optometry EMR demo looks good for the first twenty minutes. The differences show up later: in how long a routine exam takes to chart, whether the prescription reaches the optical without retyping, and what happens to your records if you leave. Use this checklist to test the things that matter before you sign.

1. Exam charting and speed

The exam room is where the software earns or loses its keep.

• Templates. Are there templates for a routine exam, contact lens fitting, red eye, glaucoma follow-up and diabetic exam? Can you edit them, or only the vendor?
• Clicks per exam. Ask the vendor to chart a complete routine exam live, start to finish, and count the clicks and screens.
• Carry-forward. Can last visit's findings be brought forward and edited, rather than re-entered?
• Drawings. Can you sketch the fundus or anterior segment on a tablet?
• Dictation and AI scribes. If you plan to use one, ask whether it's built in or a third-party add-on, where the audio and transcripts are stored, and how long they're kept. In Ontario, the privacy commissioner's guidance on AI scribes covers vendor assessment, contracts and patient consent.

2. Coding and billing

• Ontario. The system should know the OHIP Schedule of Benefits for optometry, check eligibility rules such as exam frequency by age, and submit claims electronically. OHIP claims go through the ministry's MC EDT service; ask whether the software connects directly or relies on a billing agent. Ask how quickly fee code changes are updated.
• Private plans in Canada. Ask how vision and extended health claims are handled, for example through TELUS eClaims, and whether the software tracks what was billed to each plan.
• United States. You need both vision plans (VSP, EyeMed and others) and medical billing with diagnosis codes. Ask which vision plans are integrated, which clearinghouse is used for medical claims, and whether the system suggests codes from the exam findings.

3. E-prescribing

• United States. Ask whether e-prescribing is included or a per-provider add-on, and whether it supports controlled substances if you need it.
• Canada. The national PrescribeIT service shut down on May 29, 2026, replaced by an open standard that vendors implement themselves. Ask what the software uses now, whether it can send prescriptions electronically to pharmacies in your province, or whether it prints and faxes.

4. Instruments and imaging

• List every instrument you own: autorefractor, lensometer, phoropter, tonometer, OCT, fundus camera, visual field unit.
• Ask which ones connect today, by model, and whether results land in the right exam fields or only as attached files.
• Ask where images are stored, whether there's a size limit, and what an integration costs per device.
• See one connection working in the demo, ideally with a device you own.

5. Recalls and reminders

• Can recalls be set automatically from the exam (annual, six-month glaucoma follow-up, contact lens check)?
• Are reminders by text and email included or extra?
• Can you see who is overdue and contact them in a batch?

6. The optical side

If you have a dispensary, this is where many exam-first systems are weakest.

• Does the final prescription flow into the optical sale and the lab order without retyping?
• Can the optical track frames inventory, jobs at the lab, deposits and pickups?
• Does it handle split billing, where part of the eyewear is paid by a plan and part by the patient?
• Are lab orders sent electronically, and to which labs?

7. Multiple locations and travelling doctors

• Is one patient record shared across all locations?
• Can a doctor who works at two clinics see their schedule in one place?
• How is a locum or part-time doctor licensed and priced?
• Can reports be run by location and by doctor?

8. Patient portal and intake

• Can patients complete intake forms and medical history online before the visit, with answers landing in the chart?
• Can they book online, see their prescription, and pay a balance?
• Is the portal included or a separate subscription?

9. Where your data is stored

• Ontario and Canada. Clinics in Ontario are health information custodians under the Personal Health Information Protection Act (PHIPA), and remain responsible for records a vendor holds for them. Ask in which country the data and its backups are stored, who at the vendor can access it, and for a written agreement covering privacy and breaches. Many clinics prefer Canadian hosting; get the location in the contract, not just the brochure.
• United States. A vendor that stores patient records for you is a business associate under HIPAA and must sign a business associate agreement. No BAA, no deal.

10. Audit logs and security

• Does the system record who viewed, changed or printed each record, and when? Can you run that report yourself?
• In the US, HIPAA requires audit controls on systems holding patient information.
• In Ontario, section 10.1 of PHIPA will require custodians to keep electronic audit logs once it comes into force. As of October 2026, the official consolidation still lists it as not in force, but a system that logs every view and change is ready either way.
• Is two-factor sign-in available, and can you set user roles so front-desk staff don't see full clinical notes?

11. Getting your data out

This is the question most clinics forget until they want to leave.

• What format is the export in? Spreadsheet (CSV) or structured files are useful. PDFs of every chart are a backup, not a migration.
• Does it include exam findings, prescriptions, images, billing history and documents, or only demographics?
• What does it cost, and how long does it take?
• In the US, certified EHRs must offer an export of all patient electronic health information in a computable format. You can check a product's certification on the ONC Certified Health IT Product List.

12. Support and contract terms

• What are the support hours, in your time zone? Is there phone support or only tickets?
• Is support included in the price, and are there limits?
• What is the contract length, the cancellation notice, and any early-termination fee?
• How much can the price rise each year?
• Who owns the data, in writing?

Questions to ask in the demo

• Chart a full routine exam for me now, start to finish.
• Show me a prescription going from the exam to the optical sale to the lab order.
• Show me one of my instruments sending results into the chart.
• Submit a test claim for my province or my main vision plan.
• Run the audit log for one patient.
• Export one patient's full record and show me the file.
• Where is my data stored, and can you put that in the contract?
• What will I pay in year three, all in?

If a vendor can't show these live, ask for a trial with your own data. The demo is the best behaviour the software will ever be on.