optoblog.com

I recently received in the mail a free audio CD from The Williams Group which goes over important features for optometric practice software. Of course, their product, Enterprise Solutions by OD Professional, has all of these. Actually, I was fairly impressed, and their software doesn’t have the silly restriction that MaximEyes has of an 800×600 pixel display.
On the whole, though, I feel that the EMR features of all current optometry software fall short.
My goal is to have a paperless office. How can I do that if my visual field machine tests and corneal topography maps aren’t automatically imported into the record? There is no software vendor on the market with the capability to import a Humphrey visual field into the EMR. This is my biggest beef. Why is it so hard for the software companies to import the hardware data? Proprietary interests I suppose. DVD, JPEG and other formats where defined by different companies in the industry coming together in a work group to sort out the details. Software vendors and ophthalmic instrument companies need to make standards for exporting data or at least an image of the reports. I would prefer data import to allow database searching and reports.
Also, I would expect from my practice software true website integration (while maintaining HIPAA compliance). The main website feature I would like is a contact lens re-order system that doesn’t require my staff to manually look up patient file to see if the CL Rx has expired. I definitely don’t want patients to schedule themselves online, but it would be nice to have them fill out patient information and history forms online (of course using encryption to be HIPAA compliant) that would automatically import into the software so my receptionist doesn’t have to type anything, just verify the information is correct when the patients comes in.
Also, the optometric software/hardware working group should come up with standards for optometric EMR database rules to allow easy conversion from one software suite to another. It would also allow an office to use (if desired) one brand of software for scheduling, one brand for EMR, and another for billing and financials. The standards group could also facilitate the format for ordering via web to any lab and billing to any insurance or clearing house.
Since Ziess Humphrey is the main perpetrator of not allowing data/report exportation, I suggest they become the leader in the proposed work group to devise these standards. Of course, Topcon, Marco, Tomey, Nidek, Optos, OD Professional, maximEyes, VersaSuite, RLIsys, and others should get involved as well.

When the Acuvue Advance (Dk 89) and Ciba O2Optix (Dk 138) lenses came out, my first reaction was “Why?” The Advance and O2Optix are high Dk but not as high as Ciba Night & Day. They can be worn for occasional overnight wear and/or up to 6 nights extended wear, but Night & Day can be worn 30 days. I myself wear Ciba N&D and love them, so why would I want a “lesser” lens?
Now I have seen the light. The O2Optix and Advance lenses are 2-week disposables for patients in the real world. You know, the patients who are wearing their lenses 16-18 hours a day and occasionally sleeping in their lenses. I think most patients are like this, or at the very least, would be like this only they can’t stand the feeling they get when they over wear there regular hydrogel lenses, so they have no choice but to take them out.
This is where the newer not-as-high Dk lenses come into play. They allow the patient to “flex wear” their lenses for 2 weeks then throw them away and start again. Since they aren’t wearing them continuously, they don’t need as high of Dk as N&D, yet, they have enough oxygen passing through to allow what would normally be considered “over wear” with other regular hydrogel lenses. Nice.
I think the Acuvue2, Frequency 55 and the other regular hydrogels should be history. Most patients should just be directed over to this new 2-week replacement modality because that’s how most patients live their life. I can’t tell you how many patients I see that could have avoided corneal neovascularization if they could have had this type of lens. They’re not bad patients. They were just trying to live life without worrying about their contacts. They were trying to wear their contacts like their friends and family with contacts do, but their eyes won’t allow it without repercussions. Now, there’s a contact lens modality that fits their lifestyle and won’t bring neo and the wrath of their optometrist.
Please note, I wish I had a financial interest in the above companies, but I don’t and cannot since I work for the government. Also, my practice doesn’t include a contact lens service, so I have never actually fit any of the above lenses. I read the available information and specs on the products and submitted my opinion to this blog. For what other ECPs are saying, visit the Optometric Management forums which includes a thread on O2optix.

In Utah, the Daily Herald reports that Judge Bruce Jenkins decided Intermountain Health Care is not in violation of anti-trust laws. For those of you outside Utah, IHC is the major HMO in Utah. Almost everyone is a member of IHC. My understanding of the issue is that IHC allegedly favors ophthalmology over optometry.
I agree with the plaintiffs. IHC is patently biased against optometry. Do a search on the IHC web site for optometrist providers, and you will see there are only 32 optometrists paneled with IHC in the entire state of Utah while ophthalmology has 87 providers. This ratio is out of proportion to the number of Utah eye care practitioners (157 optometrists registered with American Optometric Association and 111 “EyeMDs” registered with American Academy of Ophthalmolgy.) Also, note that only 2 optometrists are in the SLC valley, none in Provo, none in Cache Valley, and none in Ogden. The rest are all located outside of the Wasatch front which is the main population area in the state. Tell me how that happens unless someone has a vendetta against optometry.
Supposedly, if the optometrists would have won, they were going to finagle a way so that only the 49 optometrists paying money for the suit get the benefits of getting on board with IHC (I heard this with my own ears from one of the plaintiffs). I don’t see how that would happen. The law is the law, and I would think everyone could reap the benefits if IHC were found guilty. I believe they were hoping that IHC would just settle instead of go to court and that a condition in the settlement would be that only the 49 plaintiffs would get paneled to IHC as optometry providers. So much for that game plan now that Judge Jenkins has ruled.
Even though the lawsuit has failed (but still can be appealed) IHC should allow any Utah optometrist to participate as a preferred provider. IHC should recognize that optometry is the primary eye care profession. You would also think that an HMO would recognize that optometrists on average bill much less that ophthalmologists. (Of course, I guess that doesn’t matter if you are a preferred provider which accepts the allowables.)

U. Waterloo, which has an optometry school, has an official blog for students. One of them is a pre-optometry student. The lame thing is that only a select group of students are allowed to blog on the official site. Lame really is an appropriate word here because they’re neglecting the leg of the animal which tells us the not so warm and fuzzy aspects of the school.
But let’s restart this discussion. Wouldn’t it be great if an undergrad could research which optometry school to choose by reading blogs of the current students?
Wouldn’t it be great if the current fourth year students could blog about the cool stuff they see and do during their rotations? “Oh flip! One more item of busy work to do,” I would have said three years ago. But knowing what I know now, I would have blogged and read others’ blogs to enhance my experience. I had one rotation where the first week, I saw an inferior, mac off retinal detachment, a macular hole, and something else cool that I can’t remember because I didn’t blog it. You can learn all you want from a textbook, but until you go through the process yourself, you don’t internalize it. What if the students could go through the process vicariously several times by reading their classmate’s blogs!
Also, the optometry student bloggers could give their opinion on how well their optometry school facilitates their becoming an optometric physician. But here in lies the danger for optometry schools to sponsor an official blog space. Universities have to worry about brand and image. Having a student blogger being overly or unfairly critical of the school could be a problem for the brand. On the other hand, aren’t campuses a bastion of free speech– the epitome of civil liberties in action? Maybe, but nothing says the school needs to provide via blog space the outlet for critical tirades. But hey, if an institution is that worried, they should read the 95 points of the cluetrain manifesto.
But, back on the other hand, optometry schools with nothing to hide should sanction blogs for their students, provide gentle guidance as to their terms of use, and let the students run with it. The students should remember the case of the Google employee who was fired over his blog posts. In fairness, many schools like Pacific University offer webspace to their students and one could easily use blogger.com to manage the content, but it would be more cool to see a designated blog space where most interns are information sharing.

www.optometrynews.it appears to be a blog set up by some Italian outfit for the sole purpose to get people to visit their site and display adds. It looks like a link blog that is probably set up automatically to search the internet for mention of “optometry” or “optometrist” and then display a short summary and provide a link to the original article.
Don’t be fooled by these automated robots. Here at optoblog.com, there is a real person behind the information.
However, I do have to say a link page for the optometric industry, research, and patient information would be a great idea, and I’m trying to get one done. Give me a couple weeks.

Ever wonder what patients tell other people about you and their eye appointment? Here’s an example of what one patient says. I just did a technorati.com search for “optometry” and it searches the blogosphere for all entries that mention us. You could also easily get feedback if your website included a blog and bulletin board.

AOA News website was recently launched. I finally took the time to login to see what it’s like. It has a blog format, but the disappointing thing is that they haven’t syndicated it with RSS or Atom. They also don’t allow you to see the full article unless you log in with your member number and password.
I really think they’re missing the boat on this. AOA News has the captive audience and the industry relationships to make a “bleeding edge” blog. If they could implement an RSS feed, I could have up to the minute optometric info, without having to surf a website. Robert Scoble, a prolific blogger, delivered a keynote address on the concept of web logs. Before, RSS he would have to visit each individual site to read the updates. With multiple sources of news, one cannot use a web browser to click through every site offering newsworthy content. It just takes too long.
RSS feed aggregators (like newsgator.com or bloglines.com) do the work for you by downloading the syndicated content at leisure and highlight the new posts. Scoble and other bloggers have over 1000 feeds that they keep track of.
Of course, in the optometric world, there are fewer sources of industry news than in the tech world. Still, optometry needs to think to the future which technology. We as a profession have historically been slow to adopt new technology. For the good of the profession, we must become more trend forward.
A visit to any optometric conference exhibit hall shows us that the future of our profession is integrated with technology. The time has come for our profession to start on the band wagon of information sharing through blogging and syndication (RSS/Atom). We need more optometrist blogs and more industry blogs. All optometric product companies should keep us current with feeds and blogs. If a blog doesn’t have an RSS feed, it’s just another website-not a true blog. AOA News should be the example to optometry by offering syndication for at least the non-login content. (Even the Official AAOphthal blog has an RSS feed.)

Our service unit decided at the beginning of this year to break a long-held tradition. Non American Indian spouses and children of commissioned officers have usually been granted direct care at IHS clinics from service unit CEOs. In the past, what this meant was an office visit was performed and not billed to any insurance companies. Now, while non-Indian CC dependants are still granted care within IHS facilities, the new policy is to bill insurance, and the amount not paid by insurance is passed onto the patient. That is fine for the officer because his/her insurance covers 100%. The family will usually be on Tricare prime remote, which has a low deductible but only covers 80% for out of network providers, and IHS is out-of-network. According to an e-mail I was forwarded, IHS doesn’t ” . . . plan to become a provider within their networ[k] (it will have a negative impact on BMP billing, which is higher volume).”
So, someone crunched some numbers and determined that if IHS became a preferred provider for Tricare (accepting a lower fee as payment in full for both officers and dependants), they wouldn’t make as much money compared to staying out-of-network and getting the 100% fee charged for just billing the officers.
So, because Tricare reimburses so well for out-of-network visits for officers, their dependants get the shaft. Making the decision to bill all visits for non-ben CC dependants was done in the name of revenue enhancement; however, I don’t believe they will see a difference in revenue. The number one reason is that all things being equal (paying 20% co-pay to either IHS or a private doctor), I will go to the place with the best customer service and most convenient location. Often a commissioned officer will live in a town which is 20-30 miles away from the service unit, so the best location is in town. If the town happens to have doctors who accept Tricare allowables as payment in full, it’s a no-brainer.
Another reason why IHS won’t make any more money with this new policy is that because it ticks me off, I will avoid utilizing the IHS clinic, so their precious CC officer 100% out-of-network fee will not be earned.
Another negative impact will be loss of officer productivity. Anytime I or my kids are sick, I will spend more time out of clinic to go off-site for doctor visits.
Another issue, being a professional, I have the opportunity to give exams to my family. There is no way I’m going to pay IHS 20% per dependant for an exam that I perform. Now, if I were to choose to examine my dependants “under the table” that would make me subject to disciplinary action.
IHS can still get revenue enhancement and satisfy me if they would become in-network providers for Tricare, accepting Tricare allowables as payment in full. That way, everybody wins. They get money from exams on my family. I can still examine my family, and I don’t miss as much work because I can stay onsite to take my kids to the doctor.
An aside, my service unit claims that they aren’t able to bill Tricare for dependants because it is another government agency, so they are going to pass on 100% to the patient. This is absolutely false because I contacted a Tricare customer service representative and a claims processor and both stated that Tricare disburses payments to IHS facilities. (Of course if one is Native American, the Tricare claim would be denied, and if a claim is approved they would only pay 80% since IHS facilities are out-of-network). Our area office is currently investigating the Tricare billing issue.
I should point out that not all IHS service units are billing cc dependants, but it seems to be a growing trend. It is a very disappointing trend, and a slap in the face to me. I am the son of a PHS cc officer, and I grew up getting all my care at IHS clinics. I had joined PHS/IHS expecting the same arrangement for my family, but now that perk has disappeared from my service unit. I hope it doesn’t disappear from yours.

The NIH has made plans to require all NIH-funded research to be published on their website according to Reuters. This is great news! The controversy comes from the journals who require large subscription prices in order to peer review the articles before publishing. The original plan gave a grace period of 6 months after publication before beginning free access, but the NIH finally compromised at one year.
I think this is a victory for tax payers and researchers. The journals I subscribe to are mandatory for my membership in an association (AAOpt and AOptA), so they won’t be hurt. Optometry students writing a thesis should be wary of only searching the NIH site, though, because not nearly all research is funded through NIH.
The database of papers will be available at www.pubmedcentral.gov.
Please tell me there will be an RSS feed of abstracts for topics I’m interested in!

This week a received an unsolicited March 2005 issue of Sky & Telescope magazine. I never asked for it, and it has “David Langford, Optometrist- O D” on the label. I can only assume they got my name from the AAOpt mailing list. Ever since registering for San Diego 2002, I have received approximately 2 metric tons of junk mail from ophthalmic-related vendors and manufacturers. (Does anyone know how to opt-out of AAO partner mailings?)
Anyway, the astronomy magazine got me thinking about hobbies that optometrists may be more likely to take up. For example, my father, an optometrist, has an interest in astronomy and was an astronomy merit badge counselor for Boy Scouts. He also enjoys photography. These are two very optics-centered hobbies. On the other hand, I don’t take a keen interest in astronomy and am lukewarm with photography. Computers are my hobby. So, there may be no correlation between occupation and hobbies, but at the very least, I can look at my issue of Sky & Telescope and appreciate the content because I have some understanding of what they’re doing.
The greatest thing about receiving a free issue of Sky & Telescope is that I can put it in an exam room since I am in desperate need of newer magazines! (But seriously, I’m glad none of the AAOpt partners know my fax number.)