Many ophthalmologists have wondered, “If I had to start my practice brand new today, what would I want?”
While this question is generally rhetorical, for me it was very real as I decided to leave the world of academia to begin a new private practice. Having worked at a top institution for many years, I had a chance to experience not all, but very many, of the “latest and greatest” devices that had become available. However, with limited resources I had to allocate my funds wisely. So where to begin?
EMR/PM – Electronic Medical Records (EMR) is a reality all practices have to face, and the difference between a good EMR and a bad EMR may mean the difference between seeing 10 patients a day and 50. Completely disregarding the requirement to have EMR in the practice, the meaningful use money is better the sooner a physician acquires it. Furthermore, while technology will always improve, I did not want to have to worry about converting paper charts down the road. I believe fully that cloud-based software is the way to go because there is better data protection from viruses, computer crashes and other tech issues, patient information can easily be acquired anywhere—whether opening a satellite office or taking a patient call from home—and software updates can occur without any delays or added expenses.
I chose Modernizing Medicine’s EMA Ophthalmology for my EMR system and CareCloud for my practice management software. EMA is an iPad-based EMR system that allows me to talk to my patients while inputting data that is not only quick, but will create the entire Superbill for me. This bill is then sent directly into Care Cloud which files the bill with the appropriate insurance and tracks that it has been paid. Neither of these systems requires any space in my office, other than an internet connection and WiFi setup.
Lanes – Though I was tempted to purchase used lanes, new lanes can be quite affordable and offer newer technology. I chose the packages from Reichert Technologies after a demonstration at AAO because they, looked nice, were comfortable, had slit lamps that offered excellent optics and the ClearChart2 Digital Acuity System was a high tech yet simple and easy-to-use visual acuity system.
Ancillary Testing – As ophthalmologists we require many pieces of diagnostic equipment, and some are more important than others. While I’m not a retinal specialist, I still want to ensure a patient’s macular status is healthy, therefore I went with a new Carl Zeiss Meditec Stratus OCT. It allows me to screen patients for any pathology, and should I find any, I promptly refer them to a retinal specialist who will employ some spectral domain technology.
While I purchased a Humphrey Visual Field Analyzer 750, I purchased a used model because I did not see the latest bells and whistles as being worth the added cost for my office. My practice specializes in cataract and refractive surgery, with a focus on toric and presbyopia correcting technologies. To that end, I looked for the best in optical biometry and corneal topography. For optical biometry I purchased a Haag-Streit LENSTAR LS 900 Optical Biometer. In addition to its excellent reliability, it provides such exceptional K values that manual Ks are not required. It also gives me some information regarding angle kappa so I can best decide on the appropriate lens for a given patient. For topography I selected the latest Humphrey Atlas Corneal Topography System. Considered a workhorse by many ophthalmologists, it provides an excellent amount of data that can really demonstrate slight pathologies of the cornea. I am 100% comfortable with this device to base my toric axis placement for astigmatic patients.
Ultimately, starting a practice from scratch can be a daunting and exciting experience at the same time. Before setting out to purchase equipment, you should determine what type of practice you want to have and then what equipment you will need to make that a reality. Above all, try to reserve some funds, as equipment in ophthalmology tends to improve at a rapid pace, and you may find yourself requiring new equipment sooner than you’d originally thought.