Consider this scenario. During the middle of a busy, 80-patient day, you sit down in your office to take a break and glance at your iPad to find the following:
- An image sent from a local primary care physician, who is treating a case of severe ocular trauma that needs to be seen immediately;
- A Facebook notification for a post from a disgruntled employee who’s airing complaints online;
- Emails from a new patient who tracked down your private contact information to explain why WebMD assures him that he’s somehow contracted the rarest, deadliest eye disease on the planet.
What happened to the house call?
With the advent of smartphones, tablets, electronic health records, patient-facing websites and social networking, medicine has entered the digital age. Given the promise and challenge any innovation brings, how can today’s physician provide optimal patient care in an increasingly device-mediated world?
This month, YO Info talks with three ophthalmologists about their own unique integration of digital technology into practice. They also discuss the challenges that technology poses for patients and fellow colleagues, and offer tips on how young ophthalmologists can practice e-medicine wisely.
A High-Tech Education
“If you are interested in technology, it doesn’t begin and end in the operating room,” said George O. Waring IV, MD. “It extends to patient education and the entire patient experience.” As the medical director at the Magill Vision Center, Dr. Waring uses tablets to educate patients about their options for laser-assisted cataract surgery and IOLs. During dilation, for example, his staff will hand patients an iPad preloaded with all of the necessary educational information for them to peruse.
Dr. Waring also takes pride in developing and optimizing the newest technologies in therapeutics and diagnostics. At the Medical University of South Carolina Storm Eye Institute, where he’s an assistant professor and director of refractive surgery, all of his patients are offered a high-end diagnostic exam that includes a digital quality assessment. Physicians present patients’ biomechanical data via tablet, giving them a digital tour of their eye in the palm of their hand.
“Embracing technology really adds to the actual building of your practice because you can better educate your patients on why they are not seeing well and show them in real time how you can help them,” Dr. Waring said.
Don’t Turn Your Back on Me
Even as laptops, smartphones and iPads improve the patient experience, however, they can bring some inherent complications. One of the most significant challenges for physicians who have implemented EHRs, for example, is maintaining face time and a personal touch with their patients.
When solo practitioner David A. Goldman, MD, founder of Goldman Eye, first started his practice, he deliberately chose an EHR system with a native iPad app. “I found this format to be ideal for working with patients,” he said. “In most situations where a computer is being used, the computer is on the desk and the doctor is sitting at the desk with their body away from the patient when they are taking notes, and this really breaks up the communication.”
With use of the iPad, Dr. Goldman can look up and down at the device, and his body is still positioned to allow him to maintain eye contact when needed. And because patients are able to see the iPad screen, the whole experience takes on a more inclusive feel. Patients not only can view what the doctor is reading and entering, but in Dr. Goldman’s case, his EHR system allows him to pull up OCT images directly on the iPad for patients to view.
“What’s really nice is that the patient comes away with the feeling that this is a really high-tech interactive practice and that is important to them,” he said. Dr. Goldman’s EHR system also reduces his costs, savings he uses to run a practice that allows him more quality time with each patient. He no longer needs extra space for medical records, billing or even his own office—with his cloud-based EHR, he has access to records anytime, anywhere. He only has three staff members and doesn’t have to run a practice that sees 80 patients a day.
As a result, he now has the extra time to answer more questions. “Even though I might lose some time looking down at the iPad and typing away, everyone feels like they received more than enough time with me,” he said. “I even have time to discuss things that aren’t related to their eyes, and this really helps establish a human connection.”
Pick Up the Phone
Older technologies still retain their importance. Although many physicians use the Internet to interact with current or prospective patients, the ophthalmologists interviewed agreed that a physician should never shy away from picking up the telephone and making a call.
For Dr. Waring, superior patient interaction is based on a hotel model. “We want the patient to feel like they have had a five-star experience,” he said. In his practice, all communication with patients is personal, whether it involves a phone call from one of his staff members or a call from the physician himself. “I call every patient after surgery as well just to check in with them, and they really appreciate that.”
With older patients, phone calls are often the preferred means on communication. For solo practitioner and YO Info Editorial Board Chair Natasha L. Herz, MD, many of her primarily elderly patients aren’t Internet savvy. “They call you with a problem and they expect a phone call back by the end of the day,” she said.
Dr. Herz uses the phone differently for communication with other physicians, however. With help from her local medical society, she is helping launch DocBooks, a mobile app that enhances the text messaging of medical charts, x-rays, images and lab work. The app will enable a primary care physician who is examining a patient with a possibly urgent eye condition to take a snapshot of the issue via smartphone and send it — along with all of the necessary medical information — directly to Dr. Herz’s iPhone. She can then assess the immediacy of the situation without leaving her office.
“This type of technology definitely helps facilitate communication between multiple doctors,” Dr. Herz said. “If I refer someone to another physician emergently or urgently, more often than not, I’ll have them text me back later that day to say, ‘Hey, that patient you sent me is doing well and here’s what I did for them.’”
Navigating the Digital Divide
In Dr. Herz’s experience, the gap between those who are plugged in and those who remain unplugged extends beyond just patients. As YOs leave residency and enter different sectors of practice, it’s also important to be aware of how the frantic pace of technological innovation has left rifts between staff as well as physicians.
Physicians. Many older ophthalmologists are of the mindset that they have “x” number of years left in practice. Consequently, they might prefer to take the associated penalties for not implementing an EHR system than to learn how to master a new trend. For these physicians, using a computer could be considered a nuisance; incorporating new technology into their practices at this point in their careers might not interest them.
Nor must you be an octogenarian to feel disconnected. “Even a five-year difference in age is light years in terms of how well technology is used in practice,” Dr. Herz said.
Dr. Waring also noted that differences in personality type among physicians can affect their use of technology. “There are plenty of people from prior generations — our predecessors and mentors, for example — who have taught us eye surgery and who have been on the cutting edge of innovation and technological advancement,” he noted. “These are people who believed in it, people who were genuinely interested in developing and perfecting these skills, people who were willing to invest the effort and time to excel in something new.”
Your own staff. As you begin making your first staffing decisions, you’ll likely lean toward a younger support network. For instance, millennials may be more computer savvy and comfortable solving your practice’s routine technical issues, from changing a print cartridge to setting up a fundus camera.
But proper training is always the best approach regardless of age. Dr. Waring said he cross-trains his staff for specific purposes and delegates technology-rich responsibilities to people who have demonstrated their know-how.
Despite that approach, he could recall a few instances when his practice had to reassign roles because of struggles with the social-media aspects of a job requirement or the intensive use of an EHR. “There’s always going to be a challenge training people from different generations that just aren’t comfortable, facile or efficient with computers,” he said.
I’m All In; What’s Next?
If you’re a young physician in training, your challenge is probably not technical know-how but what to do with it? What kind of innovative boundaries do you want to push?
Dr. Waring suggests finding mentors who’ve dedicated themselves to the world of innovation and who, for the rest of your career, will show a genuine interest in helping you achieve your specific goals.
He also recommends engaging with as many leaders in the field as you can: “At many ophthalmic meetings, you can attend programs for future thought leaders to see first-hand how people are changing the face of ophthalmology and how you can be a part of that change.”
Attending the Academy’s Annual Meeting has helped Dr. Goldman as well. Prior to opening his current practice, he combed the aisles of the Exhibit Hall to check out as many vendors as he could and find the system that was perfectly suited to his needs. “Better yet,” he noted, “visit a practice that uses certain technologies that you are interested in and get a good sense of how they are used in a day-to-day environment.”
As these ophthalmologists demonstrate, technological innovation is malleable — though, at times, it may seem daunting. To be sure, our digital age is defined by accelerating change, and the gaps between the latest hardware releases and the latest software updates are quickly diminishing. But today’s technology is built to take the shape of your practice. And, most importantly, it works best when it is harnessed and tailored to the needs of your patients.
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About the author: Mike Mott is a contributing writer for YO Info and a former assistant editor for EyeNet Magazine.