Rebooting the Eyecare Practice

How new technologies give savvy ECPs an edge


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.

—The Editors

New Technology Gives ECPs an Edge

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.”

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.”

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),, 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 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.”

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.”