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One of today’s business buzzwords—innovation—is nothing new in the world of ophthalmology. Historically, ophthalmology has been a specialty of great innovation. For instance, the American Board of Ophthalmology, created in 1916, was the first medical specialty board. And in a bold move for the times, the Academy was the first medical society to create practice guidelines, and now most medical societies have followed our lead.
Today, our specialty continues to lead by shaping ophthalmic education, quality care, practice patterns and technology. Consider cataract surgery: In 1987, cataract surgery was frequently performed in the hospital, involved a “can-opener” capsulotomy and took about an hour. The Medicare reimbursement was $1,640. Ophthalmologists now deliver a surgical product that has better outcomes, takes less time, is more predictable and costs less.
And ophthalmic innovation continues. We are now discussing femtosecond capsulotomies and imagining remotely controlled liquid crystal IOLs with variable focal lengths. Recent advances in other subspecialties are equally remarkable.
Health care policy is also changing, with even CMS jumping on the innovation bandwagon. The Affordable Care Act established a new entity: the Center for Medicare and Medicaid Innovation. Styled “The Innovation Center,” its website pledges to “rapidly test innovative care and payment models.” Reimbursement compression is certain, and new payment models will likely be implemented. Although the anticipated decrease in reimbursements can be disheartening, it is important to note that, even without the current economic pressures, the expected influx of aging patients into our practices in the decades ahead will create tremendous demand for ophthalmic services. We must develop practice models that can provide quality eye care more efficiently and with fewer resources.
The informatics revolution is affecting how ophthalmologists communicate. For instance, the EyeWiki (www.aao.org/eyewiki) provides accurate and timely content, written by the global ophthalmic community. For Academy members, the Academy Online Community (www.aao.org/community) is a private and secure site where colleagues can discuss ideas and share cases. As for patients and the public, EyeSmart (www.geteyesmart.org) provides public education about eye care.
While 98 percent of ophthalmologists still attend meetings for continuing medical education, the ONE Network (www.aao.org/one ) has become increasingly valuable in this arena. Nearly 70 percent of international Academy members and over half of U.S. members use the ONE Network to obtain medical information and to report CME. The vision is to develop educational tools that are accessible in real time as we see patients. With these point-of-care decision tools, we will be able to embed evidence-based ophthalmic information into the process of recording in the electronic health record.
Most recently, at the 2011 Annual Meeting, Academy leadership introduced the concept of an ophthalmic registry that will collect data points directly from EHRs, creating a body of information that can be used for benchmarking, identifying deficiencies and reporting quality metrics.
When you consider all of these developments together, there is no question that we ophthalmologists are practicing in an era of accelerated change. We are being presented with an extraordinary opportunity to combine innovations in technology with innovations in how we deliver care and how we obtain and use medical information. But ophthalmologists have always been leaders in health care. We will continue to lead.