WALKING A FINE LINE TOWARD EFFICIENCY

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By using technology to our advantage, we can see more patients without sacrificing care.

Many of us find ourselves walking a fine line as far as how many patients we see each day and for how long. Consider: To compensate for reduced reimbursements from managed-care plans, we want to be more efficient so that we can see more patients to make up for lost revenues. Also, I’ve found that many of my patients, who have busy schedules themselves, don’t want to be in the office for more than one hour. But, if you trim the exam time too much, patients may start to feel as though they aren’t getting the care they deserve.

My associates and I try to perform 18 complete exams a day as well as see patients whose visit is for a specific issue or a contact lens check. That means we had to become more efficient. Fortunately, technology has enabled us to do so in several ways.

AUTOMATED REFRACTION
In my practice, we use the CV-5000S Computerized Vision Tester (shown, right) from Topcon Medical Systems to perform refractions. The CV-5000S provides a complete 21-point refraction and includes such features as a high-speed fully enclosed lens chamber, a one-dial controller with color 10.4-inch LCD touch screen, simultaneous color-coded cross cylinder and up to five user-defined personalized refraction programs to ensure ease of use. Also, Topcon and M&S Technologies embedded M&S Smart System charts and tests, including LEA SYMBOLS, color testing and sine wave.

Some major advantages I’ve found when using this system: The lens disc rotation speed is more rapid with the CV-5000S than with manual phoropters. The CV-5000S shows the patient’s current prescription and the recommended one side by side, saving us from having to repeatedly ask, “Which is better: one or two?” Also, the exam results go directly into the patient’s electronic health record, reducing the risk of transcription errors.

Overall, we’ve found that automated refraction shaves the exam time by about four minutes, which adds up over the course of the day.

One note: While I try to delegate many tasks to my technicians, refraction isn’t one of them. As optometrists, this is an important skill that we bring to the exam room, and I believe there’s an art associated with refracting patients.

PAGING SYSTEM
We use the Optometry/Ophthalmology Office Paging Software from Comlite Systems, which tells us where patients are and which room the doctor needs to go to next.

The Comlite software uses light buttons and audible chimes to show which exam room patients are in and what tasks need to be done. The Comlite system lets you view eight messages at a glance, and dropdown messages are available. In the image shown above, for example, the screen to the left shows that doctor 1 (the white DR 1 button) has a patient waiting up front, is in exam room 1 (the red light on the Ex 1 button) and has a patient waiting in exam room 4 (the green light on the Ex 4 button). Doctor 1 has paged a tech to exam room (the red light on the white tech button).

Doctor 2, meanwhile, has three patients (the red light on the blue DR 2 button) waiting up front, is in exam room 2 with a patient (the red light on the blue Ex 2 button) and has paged an optician to exam room 2 (the blue OPT button with a red light). Dr. 2 also has a patient who is dilating and is in the dispensary.

SCRIBES
Other than refraction, we delegate many tasks to our technicians, allowing the doctor to focus on providing good care for our patients.

Besides delegating testing, we use scribes in the exam room. Our practice has used electronic health records since we opened in May 2003; we use Revolution EHR. That way, we can converse with our patients without having to constantly turn away to enter information into the computer. (An additional advantage: Revolution EHR allows us to link both our offices together in the cloud.)

DIAGNOSTIC TECHNOLOGY
We use diagnostic technology to provide optimal patient care without sacrificing efficiency. (We charge a nominal annual technology fee but incorporate these instruments in the patients prescreening.) Some examples:
Optical coherence tomography. Since 2009, we have offered optical coherence tomography at each location, using the CIRRUS 5000 HD-OCT from Zeiss at one office and Topcon’s 3-D OCT Maestro at the other. We do retinal imaging on every patient, particularly those older than 40. For example, I recently saw a patient in his late 70s who had not had an eye exam in 10 years. With the OCT images in hand at the start of the exam, I could already tell that he had glaucoma—which I found saved time rather than order OCT after the exam.
Meibography. We take a similar approach with our dry eye patients. We use Johnson & Johnson’s LipiView II Ocular Surface Interferometer with Dynamic Meibomian Imaging at each location and test patients who are contact lens wearers or who have a score of six or higher on the Standardized Patient Evaluation of Eye Dryness, or SPEED.
Retinal photography. We use Daytona ultra-widefield imaging from Optos, Inc. at one of our offices. This allows us to capture a 200° view, or 82% of the retina, in a single, high-resolution optomap image. Besides the time savings, it’s easy for the patient, as there is no flash of light.

In addition to these, we use large-screen televisions in the room so that we can show patients images as part of our patient education rather than have them look at the computer monitor. All these devices have indeed made that fine line easier to walk.

Sharokh Kapadia, OD, FAAO, graduated from Michigan College of Optometry and did a residency in ocular disease at Bascom Palmer Eye Institute. He is in private practice in the Greater Jacksonville, FL, area.

WHERE TO FIND IT
Carl Zeiss
800.341.6968 | Zeiss.com
Comlite Systems
800.426.5271 | ComliteInfo.com
Johnson & Johnson Vision
800.843.2020 | JJVIsion.com
Optos, Inc.
800.854.3039 | Optos.com
RevolutionEHR
877.738.3471 | RevolutionEHR.com
Topcon Medical Systems, Inc.
800.223.1130 | TopconMedical.com

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