Healthcare providers, including optometrists, have experienced the pinch in reimbursements for services over the years (some may say that is an understatement). We understand this trend and ODs continue to add additional specialty care to make up for lost revenue and tighter profit margins, such as dry eye treatment, specialty contact lenses, and myopia management. But understanding the overall healthcare strategy and the focus of third-party payers is paramount! Transferring from fee-for-service to outcome-based reimbursements, healthcare data sharing, implementation of more preventative care strategies and adopting health information technology has been the focus for the past 8+ years, and optometrists, and other healthcare providers have been slow to adapt and respond. CMS (Centers of Medicare & Medicaid) and HHS (Human Health Services) provided incentives for providers who were early adopters to diminish the costs of care, but it has not been as successful as hoped. The pace of escalating costs of care has been outpacing the implementation of outcome-based care. As for optometrists, some have implemented these changes, i.e. electronic health records and e-Rx, take real-time blood pressure & BMI, along with reporting to registries to better medical outcomes to decrease costs, along with expediting care.
September 2017 during a keynote event, Apple’s CEO, Tim Cook, announced “Health care is big for Apple’s future.”1 While healthcare providers (including optometrists), hospitals and pharmaceutical companies chase after reimbursements, Apple is capitalizing their best practice of “user experience,” with their control of both software and hardware. They are now translating it to patient experience to drive outcomes. With tremendous disposal of cash and loyalty from their consumers, Apple has extraordinary advantages. It was not long ago in 2013 when they filed a patent for a “Wellness Registry” (sound familiar?), and 2014 with the release of their Health App, ResearchKit and HealthKit on the iPhone, which later was expanded to Apple Watch.2 ResearchKit alone allows researchers to conduct large-scale studies using the iPhone. Along with its ability to scale current tools to streamline processes, Apple is gaining the attention of institutions and corporations.
However, when it comes to eye care, Google’s DeepMind artificial intelligence (AI) has been the most impressive. DeepMind was founded in 2011 and its goal was to “solve intelligence,” to then use that intelligence to “solve everything else.”3 This attracted many big tech players, including Facebook and Google, where Alphabet (Google’s parent company) acquired DeepMind in 2014 for $500 million.3 Since the acquisition, Google has used DeepMind’s AI for speech recognition, photo searching, Google Lens, and health care.
In 2016, DeepMind partnered with London-based Moorfields Eye Hospital, the oldest and largest teaching and research ophthalmic center in Europe, to develop artificial intelligence software to detect diabetic retinopathy and age-related macular degeneration.4 Since then, the deep learning AI is now capable of diagnosing over 50 eye diseases with an accuracy of about 94% of the time.5 Several algorithms were designed using 15,000 optical coherence tomography (OCT) scans of approximately 7,500 patients that were treated at Moorfields Eye Hospital.6 The system uses a 2-stage approach for adaptability for different OCT manufacturers and is used in triage ocular emergencies that are categorized as urgent, semi-urgent, routine and observation to prioritize patients for treatment. The AI does not just output a diagnosis, rather with differential diagnoses with a confidence factor to allow physicians an opportunity to analyze the results, as seen below.
This artificial intelligence does not have regulatory approval and is slated for clinical trials to test the accuracy. It is important to remember that AI technology is making diagnosis more quickly for improved treatment times; however, the implementation to change the standard of care will require the confidence of physicians, and also the trust of patients.
Bryan M. Rogoff, OD, MBA, CPHM has a unique background in areas of holistic eye care, business management and healthcare reform. He specializes in LEAN clinical management and operations, technology implementation, healthcare strategy, and strategic partnerships. Currently, he serves as a consultant for for the FDA, Immediate Past-President & Education Chairperson for the Maryland Optometric Association, Federal Keyperson and Meetings Committee Member for the American Optometric Association, reviewer for the Council on Optometric Practitioner Education and is the Founder of Eye-Exec Consulting, LLC. To contact Bryan, visit www.eye-exec.com or email firstname.lastname@example.org. He can also be found on LinkedIn, Facebook, Twitter and Instagram.