Optometric Management Tip # 90 - Wednesday, October 08, 2003
Computers in the Exam Room
There are some nice clinical advantages to having digital fundus photographs on every patient who has a comprehensive
exam -- but the WOW factor ain't bad either! Retinal imaging is just one of several excellent applications for a
networked computer system with terminals in each exam room. Since the cost of computer hardware is now more
reasonable than ever before - the benefits of the high tech office are now within reach of the average practice.
Why put computers in the exam rooms?
The internal marketing benefit is reason enough. Your patients judge the quality of your work by your exam, and it
if seems like it is the same exam that was performed in the 1970s, you aren't giving them a compelling reason to talk
about you -- or refer their friends to you.
What do you do with a PC in the exam room?
If the computers are networked throughout your office, a test done in one location can be stored on the central
computer server, and the image (or data) is instantly retrieved in another location. A great example is retinal
photography performed as one of your pre-tests by a technician. This technique is especially effective if it is
performed on nearly all exams, not just the small percentage that has a medical diagnosis. At the beginning of
my examination, I pull up these beautiful, large retinal images on a flat panel monitor in my exam room and I examine
them in front of the patient, and I explain what I'm looking at.
There are many applications, but here are a few more to consider:
You may already have a retinal camera, which can be modified to make it digital, and then add the imaging software and the additional computers in the exam rooms.
There are also good buys available on complete systems. In my case, I converted a non-mydriatic Polaroid retinal
camera to digital, and the money I saved on Polaroid film paid for the cost of the conversion! Digital photos require
no film, and hard copies can be printed, or the image can be e-mailed. A bonus is that the flash intensity is much
reduced with digital cameras, so both eyes can be taken without delay.
- Digital retinal photography.
- Corneal topography. We routinely perform this test at every comprehensive exam for contact lens wearers and
people interested in contact lenses, as well as all refractive surgery patients. I review the maps with the patient
just like I do retinal photos.
- Other test results can be viewed if the instrument's software can be networked, such as visual fields or retinal
- Patient education video clips - played automatically if patients are waiting, or clips and pictures about specific eye conditions can be accessed by the doctor or technician.
- High speed Internet access (available through the office network) - this has many uses, including accessing websites about eye care or drug interaction websites.
- Your office management software can be utilized in the exam room - to check ordering history, insurance, family members, or balance due.
- Patient report software can have values entered and sent to a printer at the front desk.
- Electronic medical record software requires a PC in the exam room, of course - or you'll be ready to make the switch in the future.
- Digital visual acuity charts. This will require a second monitor from the one on your desk - possibly behind the patient's head in a mirror setup. You may be able to
share one PC, but many acuity systems can operate with very old computers that you were going to discard anyway.
How do you do install the computers?
If you have to ask this question, I would hire a computer consultant to do it for you. Many optometrists are
tech-savvy enough to set up a simple computer network (why does it seem to be the younger ones?) - but if you're
not one of them, don't feel badly about hiring the expertise. The important thing is to not be left out of the
How do you charge for it?
Some practices simply increase the exam fee, and then include special tests like routine retinal photography at no
charge. The advantage to this is that every patient will receive the test and your investment in technology will be
used to the maximum. Another successful method is to offer the additional special test as an option, for a fairly
nominal fee. Making the fee nominal causes most patients to opt for the test - often as high as 75%. Many practices
explain the high tech procedure in a handout that is given to the patient at check-in, and the patient to indicates
"yes or no" and signs the form. When handled this way, the procedure becomes a non-covered service that is not
covered by vision insurance plans.
We charge an additional contact lens evaluation fee to all contact lens wearers, and corneal topography is part of
Making your exam procedures high-tech can be expensive, but it's good for your image, and you'll realize a good return on the investment.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management