Optometric Management Tip # 225   -   Wednesday, May 10, 2006
Shopping for Clinical Instruments

Acquiring new diagnostic instruments is a very smart investment for your practice. I recommend that all practice owners reinvest every year in some form of new equipment or software technology. New equipment makes you more efficient, provides new information, opens new revenue streams, creates a positive impression on patients, and offers some tax breaks. I like to keep a priority list for future acquisitions and rank them in order of importance to the practice.

Here are few subtle tips to consider as you venture out into the instrument market.

Is the computer separate?

When I buy an expensive instrument, Im generally planning to have it for a long time. I still have a phoroptor that I bought in 1976 and it works perfectly and looks great! Many instruments today are based on a computer and if there is one thing Ive learned about computers its that they dont last very long. They either break down or become outdated in a few years. Fortunately, computers are fairly replaceable items. Thats why I prefer clinical instruments that allow me to use my own PC, or if the initial PC is supplied, it is separate and replaceable.

Replaceable also means that the source software is supplied to the owner on disc, so that the program can be reinstalled on a new computer when needed. Ive had some instruments that have the PC buried within the device, and it is presented as a neat turnkey package. This looks great at first, but if the computer, printer, back-up system or other items fail, you may be in for big aggravation.

Ive also noticed that those integral computers are often based on technology with an older operating system, insufficient processor speed or inadequate memory. That may be due to an effort to keep costs down, or due to a time delay from design to date of purchase. But if the hardware were unbundled, the problem could be easily resolved.

I have separate computers connected to my auto-perimeter, nerve fiber analyzer, corneal topographer, retinal camera and visual acuity chart monitors.

Is it networkable?

You will greatly improve office efficiency and the patient wow factor if the test data is stored on the office computer network and can be viewed from multiple workstations. I find it a big advantage to be able to view retinal photos, corneal maps, nerve fiber test results and visual field printouts on the monitor in any exam room. Ask about this before you purchase an instrument and consider hiring a local computer consultant to assist you with installation if needed. Here are a few points to consider:

Is the instrument software capable of storing files on a computer network server, rather than only on the local hard drive connected to the instrument?
Is viewing software supplied that allows the test results to be accessed from any workstation on the network?
Is there an additional cost per workstation that you view the data on?
How does the company prevent additional workstation installations? Is there a sentinel key attached to the hardware? What if it fails?
Are files stored in a common format, like JPG, or are they proprietary and hard to work with in other programs? Can you email an image?
Can the data files interface with electronic medical record software as part of your practice management system? This is increasingly possible even with non-imaging devices, like auto-refractors and auto-lensmeters.
Remember that storing data on the server may present an easy way to back-up the data every night, because it is all in one place and you should already be backing up that data.

Who will be operating the instrument?

This is a critical factor that I consider when I buy a new instrument. Quite often, I intend for the instrument to be used by a technician, so I place a high value on ease of operation. Consider that several different technicians will perform the procedure, with various levels of skill, and since we all have some degree of staff turnover, there is frequent retraining. It seems many optometrists approach a new procedure without even thinking that the test should be delegated. That is a mistake in my opinion that will make you less efficient for years to come.

Tests like corneal topography, pachymetry, nerve fiber analysis, threshold visual fields and retinal photography should be delegated to competent staff members. If the doctor takes on these new responsibilities, the office loses efficiency and starts a trend that is ill-advised. Depending on the instrument, I find table-based instruments are often easier to operate than hand-held versions. Obviously a pachymeter probe is a hand-held device, but a corneal topographer or auto-refractor does not have to be. Chin rests and head rests usually make a device easier to use.

Consider the patient

Dont underestimate the importance of how the patient feels when taking the test. Of course, some diagnostic procedures are a little unpleasant, and there is nothing that can be done about that. There may be a bright light, or the need for eye drops, or the need to hold the eye open wide, and so on. But if youre comparing two instruments and most things are equal, go for the one that is easier on the patient. Be sure to have the test performed on you and evaluate it as if you were elderly and not healthy. Tests that are performed faster are always better, not just for office efficiency, but to reduce patient fatigue. If patients truly hate a test procedure, youll be less likely to order it or use it routinely.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management