Ophthalmology practices of the future will be much more efficient, and
they will need to be. “Due to the aging population, the demand for
eye-care services is increasing by about 5 percent per year, while the
number of practicing ophthalmologists is only increasing by 1 percent
per year,” says
Shareef Mahdavi, president of
SM2 Strategic. They will
have to do more in less time, because someone over the age of 65
consumes 10 times more eye-care services than someone younger than 65.”
The first step in the transition to a mostly paperless, more efficient
office is using electronic health records. “It’s not just doctors who
the government wants to move away from paper. Effective this month,
there will be no more Social Security checks. Money must be direct
deposited, or the government will work with you to set up a special bank
account,” Mr. Mahdavi says.
In the future, instead of moving paper, practices will be moving
information. “When we move information and the information is all
aggregated in an electronic form, it puts the doctor in a much more
powerful position to act. This means that the patient’s eye history is
all in one place. That’s very good for the patient, the doctor, society
and billing,” he adds.
Beyond EHRs, here are some of the other ways that technology may alter current medical practices.
The Internet
The Internet is an important component of a more efficient office, and
the use of new technology can begin in the patient’s home with
pre-encounter scheduling.
Sophrana Solutions, based in North Oaks,
Minn., offers a secure online patient portal for ophthalmology practice
websites that allows patients to schedule appointments and to upload
their medical history if they are a new patient.
“Information technology has allowed us to decentralize and delegate some
of the processes,” Mr. Mahdavi says. “Shifting labor to the patient is
great because we save the staff time and we also reduce the possibility
of data entry error. Rather than a patient hand writing information on
a clipboard and then a staff member inputting that information, let’s
have patients do it either at home before they come to the office or by
using a computer or kiosk in the office. This should help consumers be
more interested and be partners in their own health care because they
are more engaged.”
Requiring patients to input their own data frees up the staff and the ophthalmologist to spend more time with the patient. “Our hope is that
the doctor has more time to have eye contact and to have a meaningful
discussion, because nothing replaces the doctor/patient discussion,”
says Mr. Mahdavi. “In addition, receptionists shouldn’t be typing when
the patient walks in. Instead, the receptionist should be greeting the
patient because all of the data have already been entered.”
It is also imperative to have a presence on the Internet. A practice’s
website needs to be dynamic and constantly updated, and it needs to
provide feedback to the practice through post-encounter surveys,
according to Mr. Mahdavi. Staff resources will need to be adjusted
accordingly. As an example, staff members no longer dedicated to
inputting patients’ information will need to constantly update the
website and respond to e-mails and texts.
Patient/Physician Education
Practices are also moving away from paper in the way they educate
patients. Rather than having pamphlets, brochures, and videos on a TV
screen, patients can be given an iPad with relevant reading material and
videos to educate them about their condition while they are in the
office.
Ophthalmologists are being educated in new ways, too. They can now
participate in continuing education through webinars, and they can do
consults over the Internet. “This will revolutionize education, because
we are no longer bound by place,” says Mr. Mahdavi. “In other words,
we don’t all have to be in the same place in order to get quality
education. There’s nothing like meeting face-to-face, but, with
webinars and real-time videoconferencing that can be done for free via
Skype or Apple’s FaceTime and iChat, it gets pretty close. If we can
get 80 percent of the way there with 10 percent or 20 percent of the
overall effort because we didn’t have to get on a plane or book a hotel
and we’ve avoided that expense, that’s progress.”
Putting Technology to Work
One practice that is already incorporating new information technology is
the
Eye Center of Central Pennsylvania, which employs three
ophthalmologists and was the first ophthalmology practice to receive
payments under meaningful use. The practice is located in a somewhat
rural area and includes 10 locations and a free-standing surgery center.
Scott Peterson is the director of information technology for the
practice. “A lot of our focus has been on the implementation of
meaningful use and EHRs,” he says. “Additionally, as we beefed up our
network to support our 10 offices in these various locations, we
switched to voiceover IP. Every office has four-digit dialing to every
other office. If you are a single practice, this may not be that big of
a deal, but with 10 offices, having the ability to four-digit dial
without it being a long distance call is a big advantage.”
They have also been concentrating on the convergence of technology, so
that all of the cameras, imaging devices and visual fields interface
into the EHR. The practice is also making use of patient portals.
Patients receive a secure e-mail message five days before their
appointment. When the patient opens the message, he is presented with a
button to push to confirm receipt of the e-mail. “Our practice is
pretty typical. It’s a little more on the senior side, and we are
seeing a 65 percent confirmation rate of e-mail reminders,” Mr. Peterson
says.
Another benefit of new information technology is medication
reconciliation. Surescripts operates the nation’s largest
e-prescription network. “When you see it work, it’s pretty amazing. If
patients come into our practice and can’t remember what medications
they are taking, which is common, Surescript can provide this
information if they have had a prescription filled through any kind of
prescription plan. Prescriptions from our office are sent
electronically to the pharmacy,” Mr. Peterson says.
He notes that all practices will need some level of IT support to fully
incorporate new information technology. An in-house staff member would
be ideal, but this may not be practical or affordable for smaller
practices. “These types of practices will clearly need some kind of
consulting service,” Mr. Peterson says. “We are still not hearing that
there is a significant amount of adoption in the ophthalmology
community. There is more awareness, but we are not seeing the
floodgates open yet.”
Concerns
While new IT can improve a practice’s efficiency, it also places
ophthalmologists in uncharted territory, such as social networking
sites.
“I work in the area of HIPAA compliance, and one of the aspects that
needs to be looked at is security, says
Joan M. Kiel, PhD, an associate
professor in the department of health management systems at Duquesne
University. “How is the new technology being implemented? Is the
physician using one Smartphone for both work and home? Does he have
both work messages and personal messages on the same phone? What is the
protection on that phone in terms of security? Some people have
separate phones and separate computers for home and work. Some doctors
are even using Facebook, and they really need to watch what they put on
there and how patients interact with them on their personal pages.
Typically, it’s not the doctors; it is the patients who will push the
envelope.”
Because patients want information quickly, they may ask about diagnoses
or symptoms on an ophthalmologist’s Facebook page, and she cautions
ophthalmologists about engaging in this type of communication with
patients.
Seeing into the Future
According to
John Pinto, eye centers of the future will look much
different than they do today. “Every single member of the practice is
going to be wirelessly connected to each other, and patients will
probably have little clipon detectors so that their location in the
clinic and their movement through the clinic can be tracked,” says Mr.
Pinto,
a practice management consultant located in San Diego.
Patients will check in at a kiosk rather than checking in with a
receptionist. Ophthalmologists will be seeing many more patients in a
day with the use of extenders, such as optometrists and technicians, and
they may only be involved in the most difficult cases. “These are just
the first few primitive baby steps on the way to what health care will
look like in the future. Ultimately, we will have subcutaneous Chips so
that if we faint on the sidewalk and are whisked to an emergency care
center, our entire record would be right there with us. Obviously,
there are all kinds of Orwellian overtones for that kind of
environment,” he adds.
He also notes that the transition to kiosks will be much slower in
medicine than it was in airports and that the transition in
ophthalmology will be slower than in emergency medicine.
Jeff Grant, a medical practice management consultant with
HCMA Inc.,
notes that in five years, the interface between the patient and the
practice is going to be via computer or kiosk only. “This means that
practices will need fewer staff members, and visits should be more
efficient and take less time. One concern is the quality of the
information because the data entered by patients is not always reliable,
so there will still need to be some data review. However, scanning
information coming from the Web should only take 30 seconds to review.
If it’s done right and it’s done once, it should reduce errors,” he
adds.
Mr. Mahdavi adds, “Five years from now, the practices that have adopted
new technology will be doing very well. They will be doing more with
less, which is important because reimbursements are only going to go
down. The practices that have digitized, that have gotten out of paper,
and that have become more efficient will be well-positioned.
Ultimately, [IT], used properly, means more effective care. Those
practices that don’t adopt EHRs and other tools are not going to
survive.”
According to him, the next step will be that the regulations will adjust
to be more in tune with technology. “The infrastructure is built, and
the regulations will change. Doctors don’t communicate with their
patients via e-mail because they don’t get paid for it. When the
Medicare rules were written 30 years ago, e-mail did not exist.
Eventually, the rules will catch up to the new paradigm,” he says.