Lets face it: Theres plenty of high-tech out there. Look around any exhibit hall, and youll see the latest fundus cameras, imaging devicesyou name it. The sales rep guarantees it will make you a better doctor and increase your bottom line by at least 50%, so you buy it. Now that its yours, you have to figure out how to integrate it into your practice routine without disrupting your entire office.
Before I buy new technology for my office, I will ask myself: Will it help me serve my patients better, and does it have income potential? Once you satisfy those reasons and decide to buy the new equipment, integrating it into your regular exam routine can be a complex task.
Screening Technology
Some new instruments are designed as screening tools, and it is appropriate to test every patient. Take the Optomap Retinal Exam (Optos) for example. The Optomap was designed to be used on every patient. It is non-invasive, easy to perform and age appropriate for any of your patients.
Screening tests need to be part of your regular exam sequence and offered to every patient to justify the expenditure. We present this option to patients during the intake process using scripted language so that we are consistent. Because it is a screening test, we assume that it will not be reimbursed by insurance, so we charge a fee.
This is similar to what I call the Microsoft financial model. Microsoft Windows is a very complex software package with millions of lines of code. It is worth much more than the company charges for it; but, when you make it available to billions of people, even at a small charge, it generates significant income. Make screening tests available at a low cost for nearly all your patients, and the equipment will more than pay for itself.
Many other instruments offer screening modes to detect otherwise hidden disease. Most retinal scanning/imaging devices have some type of quick screening modality that you can offer to all your patients. And, almost all corneal topographers can screen for corneal deformity and abnormality quickly and painlessly.
But, there is a limit as to how many such tests a patient will agree to. If you offer more than a few screening tests, no matter how important they are or how much you believe in them, your patients will begin to decline the tests. So, if you have a few screening tools in your office, consider incorporating them into your regular exam and set your fees accordingly.
Where you place these tools in your exam sequence depends on each test itself. If the patient must be dilated prior to a particular test, it must go somewhere in the middle of your examination. Other tests can be done at the end or beginning, depending upon any prerequisites for the test and who will perform it.
To determine whether you or your employees will be the primary operator of any new technology, consider how complex the instrument is to use and how much training is necessary to operate it. Also consider the validity of the results. Are they operator dependent? If the staff will be using this instrument, will that include everyone or only a select, trained few? And, lastly, who will have the time in the exam sequence to perform the test? Most, if not all screening tests, should be performed by staff, allowing you to continue seeing patients.
Imaging Technology
Other types of new technology should only be used when the diagnosis supports the procedure. Retinal scanning, or imaging, devices are good examples here. Unlike screening technology, they are appropriate for only a few patients with supporting diagnoses.
Performing specialized testing on every patient is not appropriate or ethical. For example, a GDxVCC (Carl Zeiss Meditec), Heidelberg Retina Tomograph (Heidelberg Engineering), optical coherence tomographer or other retinal imaging device could be considered standard of care for glaucoma patients or glaucoma suspects.
Set fees appropriate with the level of testing and office visit. If they are medical in nature, you can assume that the patients medical insurance will cover the tests.
We do not perform these tests at the regular exam visit. Instead, we schedule them for a later date unless an immediate diagnosis is necessary for the patients health and well-being. An example would be any type of trauma or disease that could cause permanent vision loss, or loss of function if not treated immediately. For those patients, we perform whatever testing is necessary to ensure proper diagnosis and treatment.
For most other patients, I like to mimic the medical model of patient encounters. If a patient is seeing me for the first time, or if this is the first time I suspect a medical problem, I order the tests I deem necessary to confirm my preliminary diagnosis. Some doctors feel the need to perform the tests at the same visit; but, doing so puts your whole days schedule into disarray and places undo stress on you and your staff to make critical decisions quickly.
In most cases, having the patient come back for specialized testing not only allows you the proper time to perform the test, but also affords you the ability to make those critical diagnoses.
Imagine visiting your internist for an annual physical. During that encounter, your doctor suspects that you may have high cholesterol or diabetes. The doctor orders the appropriate tests, many of which may not even be performed at the practice. When testing is complete, you schedule another appointment to review the test results and discuss necessary therapy.
Testing Routines
We need to approach our testing routines the same way, whether we are using new technology or existing technology. The best way to handle specialized tests is to designate time separate from your general schedule to perform the test. Ideally, you will have trained staff to do the testing while you continue to see patients. Then, when the testing is complete, the patient will see you for consultation and interpretation of the test results.
The follow-up appointment should be integrated into your regular schedule, but it can be shorter than other types of examinations. Your office visit charge should be appropriate for the level of history, examination and decision-making needed at this visit.
Sometimes you can schedule more than one test per visit. This is especially true when the tests compliment each other or if the patient desires it for other reasons. In some cases, however, especially with the elderly, too many tests in one visit may fatigue the patient and lead to erroneous results and patient frustration.
Generally speaking, any new technology you bring into your office will require some changes to your exam routine to incorporate the new instrument. Initially, time may need to be set aside for staff and doctor training to properly operate the instrument and interpret the results. Your appointment schedule may need to be modified to allow time for the new test. And, you may need to add more employees to accommodate the technology.
Electronic Medical Records
Electronic medical records (EMR) are one type of technology that we all think aboutone that some consider a necessary evil while others consider it a Godsend. Of all the new technology you can bring into your office, the one that has the most potential to disrupt your entire office routine is your office software.
Gone are the days of the computer-less practice or even single computer offices. To keep pace with the health-care system in this country, most, if not all of us, need our own computer networks to stay competitive and to practice competently in this country. Eventually, those of us without computers will have limited, if any, access to many of our patients. Furthermore, President Bush has set a goal that by 2014, all Americans should have access to their electronic medical records. Because of this national mandate, you will need to supply those records to your patients.
Many forward-thinking O.D.s are now beginning to adopt EMR as a replacement for traditional paper records. The adoption of EMR is necessary, and the sooner you take this step, the better.
Incorporating EMR into your practice will force you to change your exam routine and possibly your office layout. You must give a lot of thought to this technology, as it will affect everything you do in your office, especially your patient exams. My advice to most O.D.s: Think this transition out carefully, as it will be something you will live with for a long time.
To integrate EMR into your office, you will need to have a computer everywhere you (or your staff) would normally write examination data, including exam rooms, contact lens rooms, pre-testing rooms, dispensary, etc. That may mean a desktop computer, or, if you dont have the space, a notebook or tablet-PC. And, they all need to be networked to a server in your office.
I always recommend hiring an information technology (IT) person to set up your computers and networks. These are not tasks you want to perform yourself. Also, considering that you will need that IT person to maintain and upgrade your network in the future, do some research and find someone dependable.
The software you choose will most likely change your examination routine. In most cases, these changes are for the better. The software may force you to code better (thus maximizing your reimbursements) and may help you either perform more appropriate testing or record data you may have forgotten. It will also affect how your employees operate and record patient data. You may encounter staff resistance to new technology, but this can be overcome by proper training and involving your staff in the in the decision-making.
No matter how you view it, most new technology will change how you do things and examine patients. Hopefully the changes will be for the better. Nonetheless, change in the health-care profession is inevitable. The sooner we embrace change, the better our great profession will be.
Dr. Diecidue is in private practice in
