8 Tips on How to Build an Efficient Diagnostic Ecosystem for Your Practice

When it comes to shopping for new equipment for your practice, it can be both exciting and daunting. The idea of being able to offer more to your patients and having the capabilities to manage ocular disease more comprehensively is enticing. However, there is still the need to be realistic and sensible, not to mention the overwhelming choice available when deciding on a piece of technology. Often, purchasing new equipment for your practice is a significant business decision requiring careful consideration. As every optometry practice and business is unique, here are some tips to consider when building an efficient diagnostic ecosystem.

1. Consider your typical or target demographic.

What sort of patient makes up most of your patient base? Perhaps you're in a part of town that naturally sees many paediatric patients, or maybe you have deliberately established your practice as one geared towards children. In this case, you're most likely already aware that the setup for a paediatric clinic is quite different from one that mainly manages senior citizens. In addition to choosing the wall decals and which toys and books to have in the waiting room, your diagnostic equipment needs to be kid-friendly. Whereas (most) adults can tolerate a Perkins or Goldmann applanation tonometer, a child is much less likely to cooperate with these techniques. Instead, an iCare tonometer can be much less intimidating. For slightly older children, non-contact intraocular pressure measurement techniques such as the HNT-7000 Huvitz Non-Contact Tonometer can be useful. Similarly, you may use an auto-refractor more often in a paediatric setting, such as the HRK-8000A Huvitz Auto Ref-keratometer.

Conversely, if you find yourself in a practice managing a lot of ocular diseases, it would be worthwhile investing in diagnostic equipment that will enable you to do this efficiently and accurately. Though a slit lamp is considered a basic necessity, you may want to consider one that enables anterior segment photography for monitoring conditions such as pterygium growth or corneal degenerations and dystrophies. Optical coherence tomography is also now considered by many to be part of baseline testing as its measurements are crucial for management of diseases such as glaucoma and age-related macular degeneration. OCT devices integrated with fundus photography and even angiography are particularly useful for managing retinal diseases, such as the Huvitz HOCT-1/1F.

2. Consider the physical space you have available.

Good real estate has always come at a premium. If you have enough room in your practice, you have the luxury of spreading out your diagnostic equipment. However, if you're like most Australian clinics, your technology's physical footprint needs to be considered.

One of the ways you can maximise your space without compromising your practice capabilities is to consider devices with multiple functions. It is not uncommon to find manufacturers who produce technology that combines OCT with fundus photography, angiography, biometry, and topography; refraction with keratometry, tonometry, and pachymetry; or corneal topography with pachymetry, tonometry, and fundus imaging. Nowadays, it's more uncommon to find a practice with technology that can only perform one function.

Don’t forget, if you’re hoping to fit a device next to your slit lamp on the table, it pays to take measurements and check the device specifications beforehand to ensure both pieces of equipment will fit safely.

3. Are you trying to expand your scope of practice or grow an area of interest?

Although you may not see many myopia management patients right now, is this an area of keen interest? If you’re committed to delving into a new scope of practice, it could be worthwhile investing in the appropriate equipment that will support you. There’s no point in advertising yourself as offering full-scope myopia control if your practice is not equipped with a topographer for orthokeratology or biometry for axial length measurement. The Huvitz HOCT-1 is fitted with both functions.

Similarly, the management of dry eye disease is an increasing area of interest for many practitioners. While the basic testing includes simple fluorescein strips or slit lamp assessment, comprehensive dry eye management now demands more. The Visionix VX120+ Dry Eye device is enabled to provide non-invasive tear film analysis, Meibomian gland imaging, and measurement of the tear prism. On the other hand, while artificial tears will always be a mainstay of dry eye management, optometrists wishing to offer more may consider equipping their practice with the Blephasteam or intense pulsed light/low-level light therapy technology.

Be realistic about your ambitions when it comes to investing in equipment with the aim of expanding your scope of practice. For example, purchasing all the technology to offer myopia management may not be a sensible idea if your practice is located in a remote rural town with an average age of 70.

4. Consider what your business can afford.

This sounds like a no-brainer, but working out whether you can or can't afford a piece of equipment may be a bit more complex. If you're part of a group practice, you may be required to have a specific device for consistency across practices. The financing of these pieces of equipment can also vary from company to company.

If the decision is entirely in your hands, you may wish to speak to your accountant or a business mentor if you're unsure about the affordability of a particular piece of technology you have your eye on. One factor to consider is whether this new device will generate more revenue for your practice. For example, it is not uncommon for practices to charge a separate fee for OCT or fundus photography. Similarly, dry eye treatments that go beyond instilling lubricants can often incur an additional charge, such as IPL therapy. If you know you see many patients who would benefit from these dry eye management strategies, investing in the Eye-Light to treat Meibomian gland dysfunction could be well worth it.

However, the fee-for-service concept isn't the only factor to take into account. Consider an auto vertometer, such as the Huvitz HLM-7000 Digital Lensmeter. Although no one charges a fee to measure the prescription in an existing pair of glasses, investing in this technology will save you a significant amount of time from manually hand-verting!

5. Can other practice staff be trained on this technology?

While some optometrists prefer to do all diagnostic testing themselves, other practices have found improved efficiency by upskilling their other staff members. Common tests that optical dispensers can be trained to do include auto-refraction, non-contact tonometry, and visual field testing. If you’re looking for ways to increase the efficiency of your workflow, you may consider devices that are user-friendly enough to allow your appropriately trained staff to operate. Some manufacturers will even provide training for the use of their products. This can give you more time with the patient in your chair while dispensers conduct what some call "pre-testing" on the next patient.

As a side note, it can be helpful to ensure your front-of-house staff have a basic understanding of the technology you’re offering in the practice. They are likely to receive questions from patients about some of these tests, particularly if there’s an out-of-pocket fee involved.

6. Consider the compatibility of the new device with your existing practice setup.

Many practitioners – especially the newer generations – expect full integration and communication between their various technologies. It can be frustrating to manually download and upload data from one platform to another after every patient. Instead, discuss with the supplier whether those fundus images or OCT scans can be automatically transferred into your practice software as soon as you capture them, whether you’re using Sunix or Optomate. Similarly, consider a digital phoropter such as the Huvitz Digital Refractor HDR-9000, which can be networked straight to your practice computer to easily record the final prescription.

It is also worthwhile ensuring your information networks are suitable secured and have the capacity to manage all your devices. Do you need to upgrade your Wi-Fi or organise cable connections and additional data points? Even checking that you have enough wall sockets in the room to power all your devices can be a good idea.

7. Buy something because it’s a must-have, not because it’s a nice-to-have or looks impressive.

Though this sounds straightforward, emotion or unrealistic ambitions can sometimes be an enemy of sensible decision-making. It may be nice to have biometry capabilities for myopia management. Still, if you have no use for it in your practice considering your patient base, it's not worth purchasing at this point.

Some pieces of diagnostic equipment are non-negotiables, such as a slit lamp, tonometer, and visual acuity chart. As mentioned above, an OCT device is now also often considered an integral part of routine optometry practice. For some, a digital VA chart with randomised symbols is also a must-have. This can also offer additional features such as contrast sensitivity testing, colour vision testing, or symbols for illiterate and non-verbal patients.

8. Don’t be afraid to ask for advice or recommendations.

Many have walked the road before you, and you won't be the first to have debated which of the many available slit lamps you should buy for your room. If you’re part of a buying group, your choices for new diagnostic equipment may be slightly more limited than an independent, private practice. However, the options for almost every type of technology can be vast and sometimes overwhelming.

Always do your due diligence in research. As mentioned above, even considering something as practical as "will it fit through my doorway?" can become a dealbreaker for a certain model. After you’ve whittled down your options based on factors such as price and physical size, your next point of call could be the sales representative. Get him or her to talk you through the main selling points of the device you’re looking at. Any good sales rep will also be well aware of the differences between their products and those of their main competitors.

Asking your fellow optometrists or practice owners can also provide some enlightening information. For instance, a certain device may be prone to freezing or disconnecting. Nothing can replace real-world, in-practice, personal experience with these technologies.

Summary

Though there may be quite a several factors to consider when attempting to establish an efficient diagnostic ecosystem, it is possible. While some of these tips seem simple and common sense, they can be a little harder to apply when faced with the overwhelming choice of technology out there. For slightly less tech-savvy practitioners, there is help and advice available in the form of sales representatives and colleagues in the industry. But ultimately, your decisions should be based on the scope of practice you wish to be able to offer to your valued patients.