It is often said that balance is the key to success, and Southern Eye Center (SEC) in Hattiesburg, Mississippi, exemplifies that credo with a practice built on equal parts ‘”high touch” and “high tech.”
“It’s all about giving the patient the best possible experience,” says cataract surgeon Kiper C. Nelson, MD, one of six physicians in the 35-year-old practice. “The patient’s comfort is at the forefront of everything we do, and with the latest technology and techniques, we do our best for them.”
SEC’s rural, southern Mississippi location is at the heart of its patient-centered philosophy. Patients typically travel quite a distance to SEC from remote areas throughout the state. This inspired the practice’s “one visit is it” policy that enables cataract patients to have preoperative testing and surgery in a single visit. Clinic Development Manager, Chris Crawford, COA, explains that, often times, these patients are elderly and some are infirm. They might not have the resources to make several trips back and forth to the facility for a consultation, workup, surgery, and after care. The opportunity for them to have their preoperative care and surgery and be out by, as Crawford says, lunch time, is quite valuable to them.
SEC has comanagement relationships with approximately 30 optometrists, as well as referral relationships with an equal number, so these cataract patients are seen 1 day postoperatively by a conveniently located optometrist who checks to make sure that IOP is under control, among other things (See sidebar, ODs Play a Critical Role in SEC’s Practice Model). When the patient returns to SEC for a 1-week checkup, if all is well, he or she has the option to have the second cataract surgery performed. “The second time, they are typically out within an hour and a half,” says Crawford.
Although patients appreciate the convenience of same-day surgery, Dr. Nelson says there’s more to it than that. “It’s a practice builder for us. This policy really sets us apart from other practices in the region,” he says. SEC’s patient-focused philosophy is about more than just getting patients quickly in and out, explains Crawford. It’s about pampering the patient through the entire process. “We strive to provide a Ritz Carlton experience to our patients from the minute they walk through the door; their comfort is a priority,” he explains. Throughout the intake and testing process, patients are offered beverages and cookies to keep them happy and occupied, and when it’s their turn to be seen, a staff member approaches them directly to accompany them to the appropriate room. “No one ever calls out a patient name and waits for the patient to present themselves. Our employees look at the patient’s photo in the EHR, and this shows them who to approach in the waiting area,” explains Crawford. “It’s little opportunities for personal care like this that go a long way with patients. The goal is to make them feel like they’ve had a red carpet rolled out for them.”
Dr. Nelson describes this red carpet treatment as “high-touch” care. “We really focus on what patients are experiencing and try to avoid having them feel like they are in a cold, clinical atmosphere. When I do a cataract procedure, I have my anesthetist or one of my nurses hold the patient’s hand the whole time, and I think it really makes a difference,” he said. In addition to the literal handholding that patients experience at SEC, if Dr. Nelson performs their surgery, patients can also count on a private serenade. “In an effort to keep them relaxed and distracted, I will sing to my patients while I am performing cataract surgery. I give them a choice of either country or gospel because those are the only two types of songs I can sing. It might sound hokey, but it really works. When I start singing and they are distracted by that, they stop squeezing against the lid speculum. They just relax, and it’s like they forget that I’m working on their eye,” he explained. He adds, “Anything you can do to take the patient’s mind off of the fact that you are manipulating their body is going to help make the procedure go a lot smoother.”
Another noteworthy aspect of SEC’s practice model is its commitment to employee cross-training. For the first 6 months to 1 year that an employee is on staff, he or she works for one physician. Once that employee has mastered that clinic, he or she moves on to another area of the practice to become familiar with each subspecialty. “I’ve been with SEC for 14 years, and I have worked in every clinic and with every physician,” says Crawford. “The purpose and the benefit is that the technicians become familiar with more than one subspecialty and can fill in for each other seamlessly during vacations and other times of transition,” he explains.
On the high-tech side, SEC was the first practice in Mississippi to offer blade-free LASIK; it has adopted the latest imaging and diagnostic equipment such as spectral-domain OCT, wavefront imaging and laser biometry; and the practice is almost 100% paper-free (with the exception of anesthesia), having adopted the ManagementPlus EHR system (ManagementPlus, Inc). SEC has an independent IT specialist on the case working to integrate and customize the system throughout all of the practice’s subspecialties. Ross Arroyo, an EHR consultant and software specialist, said, “Any practice can run the ManagementPlus software right out of the box, but SEC wanted to customize it to conform to its practice. Fortunately, they chose an EHR program that is flexible enough do that, but they had to hire a professional to modify the [software] forms.”
One of the most noteworthy EHR modifications that Arroyo facilitated for SEC was the integration of patient iPads for patient history entry and updating. “We went into this thinking we would get 60% adoption, considering that 40% of the practice’s patients are elderly and perhaps they would not be able to acclimate, but after I made multiple updates including enlarging the font as well as the keyboard keys, we ended up with 99% adoption,” he says.
When patients walk into SEC, they are handed an iPad with a stylus attached so that they can input their own information. Arroyo built in as many pull-down menus as possible so that patients don’t have to type in many responses. “It turns out that it takes less than 1 minute for a staff person to say, ‘Have you ever used an iPad? No? Don’t worry. It’s really easy. I’ll show you.’ Then, the staff shows the patient how to scroll up and down and click on things, and then they hand the device to the patient. At first, patients look a little frightened, but then they sit down and go for it. We considered having someone posted in the lobby to be available to help, but there really hasn’t been a need for that,” explains Arroyo.
When Arroyo was brought in to help integrate the EHR, he spent time observing the flow of the practice so that he could customize the system and avoid redundancy. “I developed a giant flow diagram of exactly how everybody did their jobs, and then I began to customize the software,” he explains. “That’s how I came up with the idea of building the patient iPad app. Patients get frustrated by having to fill out forms every year. Now, they just update a few things directly on the iPad, and it is synchronized to the host system,” he explains. “We also recently adapted an iPad solution that lets patients sign their consent forms on the tablet. It’s very efficient.”
The efficiency afforded by this customized technology is yet one more way to maintain patients’ comfort. “We do everything in our power to make our flow more efficient so that our patients wait less,” says Crawford. “This is how we are able to offer a patient a new visit experience and ensure that they will be out the door in 2.5 hours with cataract surgery.”
The practice is divided into three distinct “pods” for cataract, cornea, and retina. They operate like three separate practices but are all housed under the same roof and electronically integrated into the same EHR. “Each pod has its own schedulers, nurses’ station, testing area, and exam lanes,” explains Crawford. “The benefit is that it gives patients the ability to come into a large, busy practice and get personal service.”
Ross Arroyo tweaked the EHR system to add an additional layer of efficiency to the practice’s pod design. The ManagementPlus system has a flow monitor in it that enables the staff to electronically move and locate the patients as they progress through their appointment,” he explains. “Before, a user would have to close a [software] window and open up another one to see where a patient was. I adjusted our EHR to have a mini map of the building, and now the user can just push a button and that will move the patient from where they are to the next station,” he explains. “The other reason for doing that was so that I could capture data from that movement. Now we can analyze our patient flow and see where the bottlenecks are,” he adds. The next step, he says, is to add radio-frequency identification chips to the process. “When we incorporate this into the system, the patient will carry a little device with them, and it will monitor their whereabouts and check them in automatically as they go from testing to surgery to postop care.”
Patients and staff alike appreciate the efficiencies afforded by these high-tech solutions, which is why Arroyo stresses the importance of having reliable backup in the event of a power failure. In an effort to avoid finding out too late what the SEC backup shortcomings might be, he performed several live “disaster” simulations to see just how effective the system backups would be if a real event occurred. He simulated a complete power failure, a complete network failure, and a hard drive corruption and failure. He says the results were reassuring and revealing. “For the most part, things went well. We have battery backups on everything so all of our systems were still functioning, but we did discover some weaknesses. In a few months, we did it again, and the results were markedly improved. The plan going forward is to re-enact these tests quarterly,” says Arroyo. “If you have a backup plan, that’s great, but you really need to exercise that plan. If you don’t exercise it, you’re going to discover its weakness when you’re in a real emergency.”
The entire point of having high-tech equipment and EHR is to improve the practice accessibility and outcomes. “I don’t buy the latest technology just to be able to say we have it. It has to make sense from a practice management standpoint and from a clinical perspective,” says Dr. Nelson, “and our patients get it. It’s remarkable how savvy they are. They know when they are getting state-of-art treatment and they know that when they come to SEC, that’s what they can expect.”
ODs Play a Critical Role in SEC’s Practice Model
A crucial link to SEC’s “one visit is it” model is its healthy optometric referral network. “Optometrists are an important part of how our practice functions because postoperative care is crucial to our ‘one visit is it’ philosophy,” said Clinic Development Manager Chris Crawford, COA. Crawford is the liaison between SEC and its affiliated ODs—both those who have an official comanagement relationship with SEC and those who provide patient referrals. “We do not have an optometrists on staff, which sets us apart from other comparable practices, and we do not, have not, and never will write prescriptions for glasses or contact lenses. That shores up our relationships with our optometrists. I can with 100% confidence go to any optometrist and promise that if he or she sends a patient to SEC for surgery, that patient will be coming back to them for all of their routine eye care,” says Crawford.
SEC’s OD network covers about a 70-mile radius. “Once a week, I travel to regions throughout the state to visit with these optometrists, chat with them, and makes sure they have enough cataract packets,” says Crawford. The packets contain a DVD about SEC and all relevant printed materials about cataract surgery including brochures, consent forms, and directions to the practice. “The packet includes everything to help a patient make an educated decision about their lens choices before they come to SEC,” he says.
Twice a year, SEC holds educational seminars for optometrists—those who comanage with and refer to SEC, as well as any others who are simply interested in attending. “These programs give us a chance to reach out to optometrists and make them aware of new technologies that we may be getting involved in or new procedures that we may be offering,” explains Crawford. “They also give our surgeons the chance to shake a few hands and have some face time with these doctors—some of whom play such an important role in our patients’ care.”