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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
Is the computer separate?
When I buy an expensive instrument, I’m 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 I’ve learned about computers it’s that they don’t last very long. They
either break down or become outdated in a few years. Fortunately, computers are
fairly replaceable items. That’s 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 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. I’ve
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
I’ve 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
• 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
• 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
Don’t 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 you’re
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, you’ll be less likely to order it or use