The future, now present, ophthalmic surgical workflow - Brandon Ayres, MD

With COVID-19, the average ophthalmic surgery model was forced to change dramatically, but the pandemic was not the cause, merely a catalyst. This did not happen overnight: the traditional, doctor-centric and time-intensive exam model has already gradually shifted to a modern exam model that relies more on integrated technologies and less on the ophthalmological exam. However, with new social distancing protocols in place, a contemporary exam model has emerged as a distributed, flexible, and efficient system.

A 94-year-old female patient presented with signs of glaucoma progression which were substantially advanced from her prior exam six months ago. For several reasons, this patient would be put at risk by coming into the practice for multiple pre-surgical exams: she lived out of town, and between her risk of infection and preexisting conditions, it was in her best interest not to come in for multiple appointments.

So instead of setting multiple appointments for imaging and follow up, we made sure to collect extra images and videos during her primary appointment. That data was uploaded into VERACITY Surgical, and I called a glaucoma specialist to review the imaging. Instead of bringing the patient in for repetitive tests or simply to confirm that we would be scheduling her surgery, we collected the images in a single appointment, and scheduled consultations virtually. Very few surgeons are comfortable with performing surgery on someone they’ve never met; however, we were able to set up a video conference between the patient and the glaucoma specialist to review her exam and schedule her surgery.

Like us, our patients are busy, and they don’t want to come into the office if they don’t have to. This new model allows our patients to take their appointments at home, on their computer or mobile device. Right now, that’s hugely beneficial because it allows them to avoid potential exposure. However, we expect that when given the option, 9 out of 10 of our patients will continue to choose to take their appointments at home. The contemporary model allows patients the benefit of communicating with their doctors one-on-one but in a comfortable environment that saves them time and energy.

In implementing a hybrid workflow in our office, there were two things that we required from our team: first, a team member to step up as the leader and implementer, and second, for all technicians to feel comfortable with more independence in performing exams on patients. In most cases, that required less training in exam procedures, and more in using the integrations.

As the position of examiner is moving from doctor to technician, it’s crucial that the technology we use is as user-independent as possible. We’re teaching more photography and making sure that our technicians are comfortable with the technology, because we only have one patient visit to capture imaging.

The next step in this process will be ramping up our patient volume. As we’ve put this new workflow into place, we’ve increased our exam load from 10% to over 70%, without compromising on patient satisfaction or the safety of our patients or our staff. The remaining 30% of our patient volume is likely to be virtual or remote care, even once social distancing protocols are lifted.
This entire hybrid workflow is made possible by the cloud-based platform, which in the case of our practice is ZEISS VERACITY Surgical. By using a digital patient management hub, we’re able to use software as a conduit to get data from the patient to the doctor – and to allow doctors to share patient information when calling for a consult or building a care plan. I think there are quite a few cataract surgeons out there who could increase their surgical volume by using VERACITY Surgical to ensure their surgical workflow is seamless and efficient. Not only will it help increase surgical volume, but it will decrease administrative busy work inside of patient charts.

The pandemic was not the cause of this new model; merely an accelerant. We’ve had the technology that makes this possible for years, and doctors around the world had already begun developing innovative ways to combine and adapt the technology we use to practice with every day. It will be years before people are comfortable in crowds the way we used to be, and even when restrictions are lifted, neither patients nor doctors will want to abandon the accessibility and efficiency of telemedicine. By building sustainable hybrid workflows now, eyecare practices will be setting themselves up to succeed in the future of eyecare. We’re building strategies to meet the upcoming demands: no matter what they are, or when they come.