The New Normal: Adding Technology to Your Practice

When change is routine in your practice, you can seamlessly add new surgical technologies.

By Blake Williamson, MD, MPH

Our practice, Williamson Eye, has been around for 70 years because generations of my family have surrounded themselves with a world-class team with one shared goal: a relentless pursuit of excellence in all the things we do to restore or transform our patients’ vision. We have learned that this effort requires going beyond simply having great surgeons and being nice to people. Creating a hotel-like customer experience and using the world’s best technologies have been crucial elements of our success.

To that end, we are driven to adopt new surgical technologies that can help our patients. We know that, to succeed, we have to continually adopt new things and let change be the norm. We want our surgeons to be always on the cutting edge, able to offer the latest advances to our patients without causing confusion among our teammates or gridlock in the clinic flow.

Our approach has been to nurture an environment in which everyone understands that change is a good thing, essential to growing the practice. We know that staff buy-in is an important key to success; when change is routine, that buy-in is more freely given with each new device, software, procedure, or other modification. Still, it requires a strong commitment to upfront training for our staff and a robust sense of teamwork.

ENTHUSIASM AND SMOOTH WORKFLOW

Training begins long before we actually use a new surgical technology. Our goals are to build enthusiasm among the staff members, expand their knowledge, and ready them to hit the ground running with minimal workflow disruption. We take different approaches with different parts of the staff, as outlined below.

All Staff

As the saying goes, “If you don’t excite, it won’t ignite.” We are meticulous about getting our entire staff excited about new technologies and preparing them to confidently answer patients’ questions about the technology. We invite the manufacturer or vendor to come in and educate our staff members about the new product, including how it works, how it helps patients, and when it is used versus other options.

Schedulers

We prepare front desk staff and surgical schedulers to schedule the right amount of time for preoperative testing and surgery with the new product. When we start using a new device, we schedule those cases at the end of the day, giving us a bit more time without affecting the schedule for routine cases. Once we feel comfortable, we can give schedulers an accurate procedure time.

Billing

When we adopt a new technology, the manufacturer’s representative who visits our practice explains how the treatment is reimbursed. If the treatment is not covered, but the surgeons think it should be, we work with our billing department, preparing to send letters and make our case to payers.

Nurses and Surgical Technicians

Technicians are told about the workup routine for the new treatment, and surgical technicians and nurses who will prepare and assist in the OR learn the details of the procedure. I encourage as many staff members as possible to watch the training so that they can feel invested in the new technology and be part of the team. If there is one thing I have learned in my early career, it is that you are nothing without your teammates. Respect them, involve them, and listen to them.

A New MIGS Technology and a Complex Case

Here is an example of how my practice has incorporated a new technology. This case illustrates how a combination of eye care providers, industry representitives, and practice employees can work in concert to ensure successful integration of a new technology. Hopefully you can identify some pearls that will assist you in introducing new technologies to your practice.

—Blake Williamson, MD, MPH

THE TECHNOLOGY

When the surgeons in our practice started using the Xen Gel Stent (Allergan), the company’s representatives discussed microinvasive glaucoma surgery (MIGS) devices with our staff and outlined how the Xen implant fits into the glaucoma treatment armamentarium. They explained that Xen works differently from other MIGS devices because it drains to the subconjunctival space. It can also be used alone, not associated with cataract surgery.

They further explained that technicians can approach diagnostic testing and workup the same as they would for other MIGS devices. The billing department learned the correct code for Xen. Although we do not have total coverage from all payers for Xen yet, more payers are coming online each week, and we have started to see good reimbursement. Nurses learned to handle and load the device.

We asked schedulers to set our first surgeries using the Xen implant late in the day. The procedure is intuitive for surgeons who have performed other MIGS procedures, so the learning curve was not steep.

All of this preparation paid off, and so far patients who received the implant are doing well.

CASE REPORT

A 75-year-old man with previous cataract surgery came to the practice for glaucoma surgery. Two selective laser trabeculoplasty procedures had been unsuccessful; his intraocular pressure (IOP) measurements were in the low 30s mm Hg on maximum topical therapy (three eye drops). Testing showed visual field loss, and his cornea showed epitheliopathy from the chronic use of glaucoma drops.

A few years ago, we would have performed trabeculectomy or tube shunt surgery for this patient, but I recommended the Xen implant. I explained to the patient that Xen implantation is a safe procedure that is less invasive than penetrating surgery and has a relatively easy recovery.1 It could also help reduce his medication burden, which would in turn make him more comfortable. He agreed to the procedure and took home a brochure.

My staff was able to answer the patient’s questions throughout the process, and they conveyed their enthusiasm for the technology. We operated at the end of the day, the team working smoothly together. At follow-up visits, the patient’s IOP dropped from the low 30s mm Hg with three drops to 7 mm Hg with no drops. His cornea has cleared up. He is now much happier and more comfortable, and he raves about how much we changed his lifestyle.

I shared the outcomes for this patient and others with my teammates so that they understand how this new technology can help our patients. This final step helps us all to maintain our enthusiasm for change as new technologies continue to emerge.

1. 510(k) Summary. Allergan XEN Glaucoma Treatment System. US Food and Drug Administration. Nov. 21, 2016. https://www.accessdata.fda.gov/cdrh_docs/pdf16/K161457.pdf. Accessed August 3, 2017.

THE FINAL STEPS

Having selected the new surgical technology, my colleagues and I are already familiar with it. At this point, we think through how we will discuss the new option with patients and what materials we will use. We typically have a brochure, and, sometimes, for patients with high information needs, we can provide video.

Finally, with all teammates ready to play their roles in introducing the new surgical technology, the surgeons can perform the first procedures. We begin with a late-day schedule and allow ourselves to get comfortable. Right from the start, as we see patients for follow-up exams, we share the outcomes with staff so that they can see how their teamwork and enthusiasm for change pays off for our patients. An example of how we introduce a new technology is outlined in the accompanying sidebar.

I intentionally make postoperative day 1 a fun and emotional time for our team and our patients. High-fives, hugs, Facebook posts, and tears of joy are the norm.

What we do may seem routine to us at times, but it certainly is not routine for our patients. It is experiential, restorative, and transformative. Many times, we are not simply fixing people back to the way they were earlier; we are making them better than they have ever been. That deserves celebration.

Blake Williamson, MD, MPH
• cataract, refractive, and glaucoma surgeon, Williamson Eye, Baton Rouge, La.
• financial disclosure: consultant, Allergan
blakewilliamson@weceye.com