Article

Get Your Diagnostic Ducks in a Row

Use checklists for guidance on the maintenance and procurement of diagnostic equipment in 2020 and beyond

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So many of us are approached by various diagnostic device companies with a host of enticements to purchase new equipment “by the end of the year!” Some of the more popular are tax based (section 179), while others are built around software security concerns. Although many of these enticements have merit, they don’t necessarily constitute an effective long-term strategy for ensuring our diagnostic devices are up to snuff. However, employing a basic checklist for evaluating the present-day health/value of our current diagnostic devices and a checklist for acquiring new devices, based on our clinical focus now and in the future, does. The reason: These checklists provide objective guidance for the maintenance and procurement, respectively, of our diagnostic arsenals.

BASIC CHECKLIST

This is comprised of the following:

  • Device age. Keeping tabs on a device’s age is important when deploying a maintenance and purchasing strategy. For example, we want to be aware of replacement costs, so we can craft a budget and tax strategy.
  • Service contract. What is the expiration date and renewal expense? Service contracts can be useful if older equipment requires significant upgrades that would usually indicate the need to purchase a new device for a significantly greater sum.
  • Device service date. When was the last time the device was serviced, and how often is appropriate?
  • Last software update. When was this done, and who is the responsible party? This is important, as software updates and year-end incentives will often be combined by the device companies. It’s a way to ensure we obtain maximum value. Many times software is bundled. Many times, this step falls through the cracks, and doctors end up using a dated version of the software, limiting its diagnostic capabilities. Should you need help with this, reach out to local manufacturer representatives or consider hiring an IT professional.
  • Current operating system. Related to software updates, operating systems include Windows XP/7/10, iOS version and other proprietary platforms. The reason: Many excellent diagnostic devices are running on Windows 7 or even XP and will be for quite some time. However, updates, may take away protections. For example, Windows 7 will no longer be protected by Microsoft security updates as of Jan. 14. To continue using these devices, while ensuring data security, the Industrial Control Systems Computer Emergency Readiness Team, also known as ICS-CERT, (a government agency that seeks to reduce the risk of systemic cybersecurity and communications challenges) suggests minimizing network exposure for all medical devices and/or systems. To do so:
    • ensure networks are not Internet accessible;
    • locate all medical devices and remote devices behind firewalls and isolating them from the business network;
    • and use secure methods, such as Virtual Private Networks (VPNs) when remote access is required, (One additional note: recognize that VPNs may have vulnerabilities and should be updated regularly. A VPN is only as secure as the connected devices.)

Additionally, confirm the device is running both the factory-recommended operating system version and the latest version of the device software (see previous software update). O.D.s also should be sure they have set auto updates to their firmware, again, based on the device manufacturer’s recommendation.

As a related aside, I recommend considering an investment in a data management platform, as it can provide remote data backup; image management similar to Google photos or iCloud photos; and even multi-modal analysis, integrating data from different types of diagnostic devices. Today, more than ever, including a data management platform is a critical tool to ensure data integrity and stability for years to come.

This is not an exhaustive list, but it covers what is necessary to establish a strategy for ensuring our diagnostic devices are in working order for 2020 and, when done annually, years to come.

NEW DEVICE CHECKLIST

I recommend we define our clinical focus today, as well as the future focus we envision, so we can determine what diagnostic devices we need in 2020 and in the future. This checklist should fit the practice’s demographics, the optometrist’s skill set and practice profile, so the diagnostic device doesn’t end up being stuffed in a corner, unused.

Examples of checklists based on clinical focus:

Primary eye care

  • Auto-refractor
  • Digital phoropter
  • OCT
  • Topographer
  • Visual field analyzer
  • Retinal photography
  • Anterior segment OCT
  • Anterior segment photography
  • Endothelial cell count
  • Topography/tomography/tear analysis

Retina/glaucoma

  • Comprehensive OCT (including anterior segment - pachymetry, angle analysis)
  • Image management platform
  • Posterior segment (progression analysis, angiography)
  • Retinal camera
  • Visual field analyzer

Now, we should divide these items into “currently owned” and “targeted for purchase.” One way to determine what specific device(s) to target for purchase is to keep tabs on the diagnostic devices that are evolving, so we can determine whether they will assist in providing more effective detection and treatment. To accomplish this, I recommend attending industry trade shows, related lectures and reading eye care magazine articles (reading advertorials with an especially careful eye).

Examples of evolving devices:

  • OCT. When Time-Domain OCT first came out, it largely remained a tool for the specialized ophthalmology retina practice. With the emergence of Spectral-Domain (SD)-OCT, we began acquiring the technology, which has become a mainstay in the primary eye care practice. With the introduction of OCT angiography, we have seen the opportunity to more effectively manage patients by obtaining images of the unseeable.
  • Topography. No longer is a topographer used solely for the fitting of complex contact lenses. Some corneal topographers now include a keratometer and color cameras for anterior segment imaging. These features allow us to evaluate the meibomian glands, acquiring non-invasive TBUT time and tear meniscus height, including the lipid layer.

PREPARATION IS KEY

By using a basic checklist for assessing the current health/value of one’s diagnostic devices and a checklist for acquiring new devices, based on our clinical focus now and in the future, we get objective guidance for both the upkeep and purchase, respectively, of diagnostic devices. Here’s to a successful 2020! OM