ENT clinic software in India: what an ENT EMR has to handle

Most clinic software in India is built for a general physician: a complaint, a few vitals, a free-text examination, a diagnosis and a prescription. An ENT consultation does not fit that shape. The examination happens in four regions, on two sides, with a few structures in the middle that belong to neither. Half the useful data comes from tests the nurse runs before the doctor sees the patient. And a good share of visits end with a procedure in the room rather than a prescription.

This article sets out what ENT clinic software has to handle, written for clinic owners and ENT surgeons comparing options. At the end is a short list of things to ask in any demo, including ours.

1. The examination is charted by region and by side

An ENT examination covers the ear, the nose and sinuses, the throat and larynx, and the neck. Almost every finding has a side. A dull, retracted eardrum on the right and a normal one on the left is a different patient from the reverse, and a note that says “TM retracted” without a side is not much use at the next visit.

Some structures have no side at all: the septum, the posterior pharyngeal wall, parts of the larynx, the thyroid. Software that only offers “right” and “left” columns forces the doctor to pick one or to type the finding into a comment.

What to look for:

• An examination laid out by region, with right and left columns, and a single cell for midline structures.
• Normal by default, abnormal by exception. Most of an ENT examination is normal, and the doctor should be able to mark a region normal in one action and then record only what differs.
• A vocabulary of findings to pick from, with the option to type anything the list does not have. A closed list ends up with findings recorded in the wrong place.
• The order of the regions should follow the reason for the visit. A vertigo patient is examined ear first, a snoring patient nose and throat first.

2. Hearing tests are data, not attachments

Pure-tone audiometry, tympanometry and tuning fork tests are the backbone of otology. In many clinics they live as a printed report stapled to the file, or a scanned PDF in the software.

A scan can be looked at. It cannot be compared, averaged or printed in a summary. When the thresholds are recorded as numbers, per ear and per pitch, the software can:

• work out the pure-tone average for each ear and show the air-bone gap, which tells conductive from sensorineural loss;
• put the result on the visit summary the patient takes home;
• show the change since the last audiogram, which is the question in most follow-up visits;
• carry the result into a hearing-aid prescription, so the aid is fitted against a recorded test.

The same applies to the tympanogram type and ear canal volume, the Rinne and Weber results, and questionnaires such as SNOT-22 for sinus symptoms or a dizziness handicap score for vertigo.

3. The nurse’s desk comes before the doctor

In a busy ENT OPD, a lot happens before the doctor walks in: history and complaints, vitals, symptom scores, the hearing tests, and, before a nasal endoscopy, a decongestant and anaesthetic spray that needs several minutes to work.

Software should give the nurse a place to record all of this, in the order it happens, and hand the patient to the doctor with the work-up already on screen. The nasal spray deserves a mention of its own: a timer that shows when the nose was sprayed and when it will be ready saves the doctor walking in too early, or the patient waiting longer than needed.

4. Images belong next to the finding

Otoscopy and endoscopy images are how ENT findings are explained to patients and compared between visits. They are most useful attached to the region and side they show, not in a general “documents” folder. If your clinic uses a video otoscope or endoscope, ask how stills reach the chart, and whether they print on the summary.

5. Prescriptions include more than medicine

An ENT prescription often has two parts: the medicines, and a hearing-aid prescription that says which ear, what kind of aid and which test it was fitted for. The two are issued, printed and sometimes sent to different places, so they should be separate documents that live in the same visit.

6. Procedures in the room, and the bill that follows

Ear wax removal, microsuction, foreign body removal, nasal endoscopy, cautery for a nosebleed, a laryngoscopy: many ENT visits include a procedure. Each needs to be recorded in the visit and added to the bill without the doctor writing it on a slip for the front desk. Packages for courses of treatment, and the ability to bill a procedure at the counter after the consult, both matter here.

7. Surgery is a separate journey

Tonsillectomy, septoplasty, sinus surgery and ear surgery start as a recommendation in the OPD and become a counselling conversation, an estimate, an admission and a discharge. Ask how the software carries a case from the consult to the theatre list, and how the estimate, the advance and the final bill stay connected.

8. The rest of the clinic

An ENT clinic is still a clinic. It needs a queue and appointments, a front desk that registers walk-ins quickly, billing and payment collection, and often an in-house pharmacy. Records should link to the patient’s ABHA where they have one. Software that does the ENT examination well but sends you to three other systems for the rest is a cost you will pay every day.

Questions to ask in any ENT EMR demo

Ask the vendor to do these on screen, with you watching:

1. Chart a different finding in the right and left ear, and a deviated septum.
2. Mark the throat normal in one action, then record one abnormal finding.
3. Enter an audiogram and show the pure-tone average and air-bone gap for each ear.
4. Issue a hearing-aid prescription linked to that test.
5. Record a procedure during the visit and show it on the bill at the front desk.
6. Print the visit summary the patient takes home.
7. Open the same patient’s previous visit and compare.
8. Show how a returning patient from your existing register is found by phone number or patient ID.

Where 92health fits

92health is an EMR used by clinics, eye hospitals, pharmacies, labs and optical shops in India. It runs the whole clinic: registration and the OPD queue, consultations, e-prescriptions, the pharmacy counter, lab orders, billing and payment collection, with records that can be linked to the patient’s ABHA.

Its ENT workspace is built around the points above:

• Ear, nose, throat and larynx, and neck as regions, each with right and left columns and single midline cells. Exam presets (otology, rhinology, laryngology, head and neck, vertigo, sleep) reorder the regions; nothing is ever hidden.
• A findings list for each structure, with free text recorded on the same cell when the list has no word for it.
• A nurse’s work-up with history, symptom scores, vitals, a nasal prep timer, smell and tuning fork tests, audiometry with a pure-tone average, tympanometry, and vertigo and sleep questionnaires.
• Diagnoses with a side (right, left, both or midline), a clinician’s note, and planned procedures.
• Medicine and hearing-aid prescriptions as separate documents in the same visit, printed from the same screen.
• A visit summary with right and left columns, including the pure-tone average a hearing aid was fitted for.

If you run an ENT clinic in Chennai, Coimbatore, Madurai, Salem, Visakhapatnam, Vijayawada or anywhere else in India and want to see this on your own cases, book a demo. Bring the questions above.