Automation of data needed for ophthalmologists to advance

Issue: May 25, 2010

ByRichard L. Lindstrom, MD

Richard L. Lindstrom

I have discussed before that the aging population is on a collision course with the increasing demand for eye care services, with an at-best stable and more likely slowly declining cohort of ophthalmologists in America. The same is true for most parts of the world.

There are many potential adaptations to this situation, and one is for ophthalmologists to re-engineer the way they see patients. If we go back 30 years to when I first entered practice, most ophthalmologists saw one patient at a time, calling them in from the waiting room, taking a history, and performing appropriate testing including refractometry, IOP measurement and the like. The examination included a careful slit lamp biomicroscopy and fundus examination, findings recorded manually in a written chart and then a discussion with the patient followed by treatment.

This approach, while desirable in many ways, was time intensive and limited patient throughput to two to four per hour, depending on the doctor. Working 4 days a week in the office, the hard-working ophthalmologist could hope to complete about 125 patient visits a week and 5,000 a year. Day five of the week was spent performing four to six surgical procedures.

Since that time, most ophthalmologists have adapted to the increased demand by adding care extenders such as ophthalmic assistants, technicians and technologists, allowing the surgeon to see at least six to eight patients per hour, and surgery has increased to eight to 12 cases or more per week for most surgeons. However, while portions of the work have been delegated, the examination has remained quite similar and still entails a good deal of manual testing, examinations at the slit lamp biomicroscope and with various methods of ophthalmoscopy, all recorded manually in a written medical record.

I believe that achievement of the next meaningful increase in efficiency will require a major shift toward automation of the data and image gathering required to make a diagnosis, formulate a treatment plan, record the appropriate findings electronically, and finally inform, counsel and educate the patient. Those ophthalmologists who embrace this next level of care will see patients quite differently than we do today, and they will see 12 or more patients per hour, tripling the clinic throughput that was typical when I first entered practice.

How might this office of the future look and operate?

Of course, a history will remain critical, but this will be gathered and displayed electronically when the patient enters the ophthalmologist’s consultation room. Instruments such as advanced wavefront aberrometers and anterior and posterior segment optical coherence tomography, combined with new point-of-service diagnostics that provide objective measurements such as tear film osmolarity, will allow the gathering of a data and image set that will be displayed for the surgeon in a fashion that will allow magnification, enhancement and comparisons with previous visits and with normal sets. The use of a slit lamp or ophthalmoscope will be a rare enough event that these pieces of equipment will not even be present in most consultation rooms. These same images, displayed to the patient and family, will illustrate the pertinent findings and will be followed with high-quality animated educational presentations that all occur in the same room.

While some will be threatened by this vision and not all will adopt the technology required, I believe such changes will allow the majority of us to meet the increasing demands for our services while retaining a caring and compassionate environment with high patient satisfaction.