Delegating Technical Tasks To Your Technicians

By Walter D. West, O.D., F.A.A.O.

It may have taken some getting used to -- in fact, some practitioners thought it was heresy -- but today most of us are comfortable having our staff teach patients how to insert, remove and care for their contact lenses. And many of us are fortunate enough (or forward-thinking enough) to have skilled contact lens technicians who perform all our computerized corneal topography, including simulated fluorescein, and who also dispense contact lenses.

IS IT TIME TO DELEGATE REFRACTING?

Now, we can go a step further with new, computerized, programmable refracting systems that enable us to delegate this very labor-intensive procedure to appropriately trained staff.

This is an important opportunity for us as practitioners and patient managers to position ourselves as data-analyzers and decision-makers. It frees us to do what our patients find most valuable -- evaluate and give meaning to the data that has been gathered.

And with the demands that managed care has placed on our time, it's more important than ever for us to streamline procedures and decrease the amount of time that we spend with patients. Although we don't want to eliminate the quality time that we spend educating patients one-on-one, we do need to reduce the overall amount of time we spend on routine, easily delegated tasks.

TAKING ADVANTAGE OF NEW TECHNOLOGY

With any new technology (corneal topography is a recent example), a lot of practitioners have the mindset, "Why do I need a $20,000 instrument when I've been doing the same thing with an $800 keratometer?" And many practitioners believe the most important thing they do every day is refraction.

Automated technology has improved how we do our jobs. We've gone from trial lenses to the phoropter, from the manual to the automated lensometer, from a tangent screen to automated perimetry for visual fields. The computer-assisted refracting workstation is the ultimate time-saver for the clinician.

This is a savings that the contact lens practitioner can translate to profit. One of the things we miss out on with potential contact lens wearers is taking the time to talk to them about contact lenses. The result is that the patient may not get the best type of correction, and the practitioner is not rewarded with the additional profit that comes from prescribing contact lenses.

KEY FEATURES OF COMPUTER-ASSISTED REFRACTING

The computerized refracting system that I use (Epic-2100 by Marco Technologies) has an auto lensometer and a computerized programmable phoropter. Other manufacturers offer similar systems.

While refracting with the manual phoropter has always been a little more art than science, this new instrument makes it more easily taught and delegated.

The practitioner defines what tests he wants and the order in which they should be performed. The technician pushes the start button and goes through the sequence test by test. The technician is prompted on the LED screen as to what target is showing, what questions should be asked and the responses to expect. The instrument also produces a printed record for efficient documentation.

The manufacturers provide training when you purchase their instrumentation. For example, I sent my technicians to Marco's facility in Florida for a two-day seminar where a certified optometric technician taught them the new system. The cost of the seminar was included in the purchase price.

PATIENTS SHOULDN'T FEEL SHORTCHANGED

In a contact lens practice, one of the things you do is overrefract a contact lens patient at the progress visit. This is easily accomplished by the technician using this instrumentation. All that's required of the practitioner is to perform the binocular indirect ophthalmoscopy, the slit lamp anterior examination, and then from the data, prescribe contact lenses and/or spectacles or primary care in the form of pharmaceuticals or other appropriate therapies.

When procedures mesh together properly, patients don't dwell on who did what, but rather how much time was spent with them. Once we pull it all together so they can understand what it means, we create value in the data we've gathered. When you have the technology and your staff has the training, you have the confidence to delegate. CLS

Dr. West lectures nationally and internationally. He is in private practice in Brentwood, Tenn.