NEW YORK—Eyecare practitioners rely increasingly on an array of
new technologies to help them provide superior patient care and give
them an edge over competitors. From diagnostic equipment to electronic
medical records and Web-based ordering systems, tech-savvy ECPs are
implementing these technologies to boost productivity, efficiency and
profits.
All areas of the eyecare practice are benefiting from the
infusion of new technologies, from the exam lane to the dispensary, from
the in-office lab to back office operations. To better understand their
impact, VM asked a cross-section of practitioners to describe the
products, programs and systems they are using and explain how they are
making a difference in their delivery of eyecare.
EYE EXAMS
What technologies are having the
biggest impact on eye examinations in your practice?
Jones: “Our practice offers digital retinal imaging so the
retina, blood vessels and optic nerve are documented by high-resolution
digital image, giving the doctor an enhanced view often without having
to dilate. The type of camera Dr. Spaeth uses is a Canon Digital Retinal
Camera, using a 15 megapixel camera back for retinal imaging with high
resolution.”
Dr. Rozenberg: “I use the Nidek 5100 refracting system with
folded optics in the patient’s ssc chart. The lane is only five feet in
length. It also has the Nidek RKT 7700 combined
autorefractor/autokeratometer/autotonometer attached to it. For those
who went to traditional practice software, all the data can download
into the appropriate fields; e.g., pressures and time of day go into the
tonometry field, and k readings appear neatly in the field for
keratometry.
“I also have a topographer that lets me design rigid lenses,
with all designs, changes and orders visible on my computer. Lenses are
ordered by clicking on my design.”
Dr. Lee: “Having the MaximEyes EMR system, I would say, is the
most vital part of practice. We can have any patients’ file at our
fingertips and are able to “go green” using e-mail systems to
communicate with our patients. Examinations end up being more efficient
with the EMR system. Our prescriptions for contacts and glasses can be
e-mailed to patients, which ends up being more efficient and useful for
the patients. The transition from the doctor to the staff ends up being
more seamless when multiple prescriptions are written in the system
already. Also, internal communication or external communications are
easily seen in the system so that communication improves between the
staff and patients. The practice management portion of the program
allows me to see the production of the staff and doctors so we can
analyze statistics of the office effectively. I could not go back to a
paper system at all!”
Dr. Nasser: “We’ve had the iProfiler from Zeiss for about eight
months, and it’s having a major impact because for the first time, I
feel, we can enable patients to see better by correcting some of the
higher order aberrations. The results are amazing. Patients, including
myself, see better than we have in the past.
“The iProfiler measures the patient’s higher order abberations,
and incorporates their subjective refraction with an objective reading
from the Zeiss iTerminal. It’s accurate to within 1/100 of a diopter. We
use Zeiss lenses, because as far as I know, it’s the only lens that can
be made to that degree of accuracy.
“The iProfiler changes your astigmatism reading, and may also
change the axis, depending upon the patient’s prescription. I’ve found
that this can help patients see well, especially at night when their
pupils get larger.”
Dr. Yee: “At our clinics, we use many different instruments
during our eye examinations like retinal cameras, field analyzers, and
optic nerve tomography instruments, but the technology that’s made the
biggest impact in the last year has been our practice management and EMR
software.
“We converted to OfficeMate Enterprise and Examwriter a year
ago, and we now have faster and easier access to our examinations from
each office. If our colleagues need a consultation or if our staff
members have questions regarding a patient, the exam records are readily
available. If we need remote access to our system via computer or
iPhone, that is also available. I can work on chart notes from home, for
example.
“Another benefit of the program is that we’re using less paper.
There’s also more consistency with billing and coding, which is
important for us because we do a lot of Medicare billing, and everything
needs to be within Medicare guidelines. Within the program, we’ll be
able to e-prescribe, so we can send prescriptions directly to the
patient’s pharmacy.”
“Examwriter also allows us to construct exam templates to use
for more complete and consistent documentation, for example a diabetic
eye exam versus a one-day cataract post-op visit. After we complete
those medical visits, the program also guides us in coding those visits
and setting up the recall dates for their next vision and medical
visits. Then we often utilize the program to write letters to primary
care physicians and specialists to ensure continuity of care.”
Dr. Oosting: “I purchased a Zeiss Visucam Pro NM digital retinal
camera late in 2006 to help me monitor my diabetic patients. I practice
in a rural county in Michigan, and the diabetic population is quite
large. Not only am I able to show the patient who needs better control
of their blood sugars what is happening or can happen to their eyes, but
I can also keep their primary care doctor in the loop. I have received
many referrals from the local MDs, and the camera paid for itself in two
years. It is also useful when patients are quite photophobic and resist
ophthalmoscopy or fundus examination.”
Jehling: “Our in-house developed practice management software
(CMS) and EMR (eCMS) as well as the use of Doctors First e-prescribing
software has streamlined our patient process for the doctor in the exam
lane and has allowed quicker file review with more information available
in a better organized fashion.
“The addition and improvements made to our digital retinal
photography (that we added years ago) have given the doctors immediate
review in the exam lane in full color for explanation of diagnosis with
the patient.”
IN-OFFICE LAB
How are new technologies affecting your in-office lab in terms of speed, productivity and efficiency?
Dr. Lee: “Our internal lab allows for higher profit margins when
insurances have fair to poor reimbursements for the examination. We’ll
try to do private or multiple pair jobs in-house. Having the lab allows
for quick turn-around of the job.”
Dr. Nasser: “Frame tracing has really made a difference. We have
been able to get the lenses faster and allow patients to use their own
frames. That is awesome. In the last couple of years, our numbers show
that we have more patients using their own frames and getting only
lenses instead of getting new frames, so this has been beneficial.”
Jehling: “We opened a 12,000 sq. ft. central facility to serve
our 49 locations within the past year. Our lab is now running over 400
jobs per day and ever increasing. We have added robotic edging, cell
manufacturing and six sigma process control techniques. These have
resulted in lower breakage and increased turn-around time. Digital
surfacing is coming in ‘11.”
ELECTRONIC ORDERING
What technologies are changing the way you or your staff order products and services from vendors?
Jones: “When ordering frames, contacts or supplies, our office
uses various groups including Eyefinity, ODG (Optical Distributing
Group), Safilo.net, and Brothers Optical lab. Electronic ordering has
definitely allowed our office to be more time efficient. Ordering
contacts electronically also allows us to save money since we order in
larger quantities and are able to view what is in stock and what is on
back order.”
Matthews: “We use Contact Lens Express or ‘CLX’ from
Opti-Port.com to order all our disposable contact lenses. The system is a
desktop computer in our practice that interfaces with a large contact
lens distributor. We get next day service on over 95 percent of our
orders and we no longer have boxes and boxes of contact lens inventory
that tie up our cash. Many of our patients love the convenience of
direct ship to home or office. The system is particularly effective for
multi-office practices because it features a ‘dashboard’ that monitors
contact lens ordering activity in all our offices. We can look up order
status on-line from anywhere to monitor how quickly our patient orders
are input at the practice and when the order will ship. It’s a great
system and we have saved a lot of money using it.”
Dr. Lee: “Ordering online for contacts and uncut lenses have made
tracking of the products ordered easier. You can create the shopping
cart and add along the way which makes it more efficient.”
Dr. Nasser: “We use VisionWeb pretty extensively. The interface
between the EMR and the labs has been great. We use DVI’s Remo to
transmit the patient’s PD, seg height, frame size and other information
to the lab. Our EMR is Maximize.”
Dr. Yee: “Our OfficeMate system has an interface with the
Eyefinity website, through which our staff members process orders for
products. This eliminates the need for multiple faxes and phone calls to
and from our labs and vendors. It’s much faster for the people who work
in our dispensary.”
Dr. Oosting: “We use DVI (Digital Vision) on the Internet to
place orders with our two primary labs. The software checks for errors
and inconsistencies, so orders are more accurate and require fewer calls
from the lab to clarify. You really need to have high-speed cable
Internet, though, since there are several screens to work through. The
same is true for VSP orders.”
PRACTICE MANAGEMENT
How is technology changing your
eyecare practice or business in terms
of administration, marketing, patient
communication and medical record management?
Jones: “Recently, our office started using Websystem2 Patient
Communication System. It allows us to send our patients not only
recalls, but newsletters, back-to-school announcements, various specials
and any other personalized information we need to relay in a
cost-effective matter.”
Dr. Rozenberg: “I like Macpractice because using Macs is so easy.
I needed to have my Windows server tinkered with at least twice a week,
and the software was always giving me trouble. With Macpractice, one of
the Macs acts as the server. You do not need a dedicated server. All
computers just naturally link together and problems went from twice a
week to virtually zero. Macpractice is growing rapidly. They make
software for all health professions and are getting close to all the
features of the big Windows-based guys.”
Dr. Lee: “MaximEyes has allowed us to create much more targeted
marketing tools since the patient data is available to us to use. We
have integrated other systems to MaximEyes to improve our recall system
via phone, e-mail, etc. which is only possible with the data in the EMR
system. It helps free the staff for other tasks and duties.”
Dr. Nasser: “Web System patient surveys has helped me understand
the patient perspectives. Also email has made it very inexpensive to
market to our patients, whether it’s sending them a newsletter or a
trunk show announcement.
“For every patient that gives us an email address, we send them a
survey within a couple of days. The survey consists of about 10 to 12
questions which cover everything from the front desk to insurance, the
optician, the doctor’s assistant and doctors to overall satisfaction. We
ask the patient if they would return to us or refer us to new patients.
We get about an 8 percent to 10 percent response rate. It gives us a
good gauge rather than [making us] play guessing games. We operate three
offices, and we learn how each location is performing, how long we’re
making patients wait, whether they’re unhappy with the frame selection,
that sort of thing. We track their responses with Maximize software.”
Dr. Oosting: “I am using a clearinghouse for my Medicare and Blue
Cross billing. You can access their online billing form and their
software will ‘talk’ to the insurance companies. I have unlimited
e-billing for under $30 per month. I have not upgraded to EMRs yet. I’m
waiting for HHS to figure out what they are going to do.
“I created a Web site using VSP’s consultants. It’s not real
flashy, but it helps me get an Internet presence, and I can highlight my
retinal camera, my dispensary, and what makes my practice special.”
Jehling: “For us, again, our CMS; this amazing software has
allowed us to centralize all processes that are not needed for patient
care in the office. In the office, we concentrate on the patient and all
other activities have been removed: Ordering and fulfillment, filing,
insurance verification, posting, outgoing calls and the appointment
desk. We can harvest a huge amount of patient data for specific
marketing and trend analysis.”
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