Incorporating myopia control into a practice can seem like a daunting undertaking. Who will help with insertion and removal training? Who will make sure the patient is scheduled correctly?
It’s true that, in the beginning, it may require more time and effort to achieve the right myopia workflow in the office. However, the payoff in the long run is well worth it.
As an optometrist who integrated myopia into her private practice a couple of years ago, I can affirm that this was one of the best things I have done for the business. Not only has it grown our patient base, but it has distinguished our practice from the hundreds of other competing practices in the area.
Furthermore, patient loyalty is very high. Once committed to management, parents and patients will likely stay with you for, at least, 10 years (during pre-teens to adult years). Lastly, it's not covered through insurance, so you typically avoid the hassle of trying to figure out a fee schedule or billing.
What is a clinical workflow and why is it important?
A clinical workflow refers to the sequence of tasks and activities that a clinician or team carries out to provide patient care. The purpose of a clinical workflow is to enhance the patient experience, streamline processes, and reduce errors. A well-organized workflow enables optometry practices to utilize resources efficiently, coordinate patient care, and deliver high-quality services.1,2
This is especially important when you are incorporating a specialty into your practice since it can involve more complex testing and require advanced technician/staff training. Having organized and set protocols can reduce confusion among patients and staff and improve efficiency and profitability in the practice.
A study published in the Journal of Ambulatory Care Management outlined important aspects of clinical workflow, such as:2
- Identifying patients
- Engaging and educating team/staff members
- Providing proper testing/care,
- Monitor and making adjustments for future patient appointments
Strategies for a smooth myopia workflow
There are several proactive measures to actively and effectively engage staff in your myopia workflow. The following sections provide a more detailed review of these steps.
1. Create consent forms and training materials
Before introducing your staff to myopia control and its workflow, the first step is creating a detailed consent/contract form that outlines the details of the myopia control treatment, benefits/risks, yearly costs, and the average number of follow-ups needed per year depending on age and time in myopia control treatment.3
When I was an optometrist just starting out, I was able to contact a friend who was already practicing myopia control. She shared her consent forms and then I tailored them for my practice. Once these are established, you can then go over them with staff/managers to review and make sure everything is agreed upon.
Download a sample Orthokeratology and Myopia Control Therapy Informed Consent Form
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Orthokeratology and Myopia Control Therapy Informed Consent Form
Download this template myopia control informed consent form and tailor it to your practice as needed!
2. Set your front desk up for success
One of the main roles of the front desk, at least in my practice, is to schedule patients in their correct time slot and appointment type. Depending on the type of myopia control, the time and frequency of the follow-up may vary.
For example, I tend to spend a full 30 minutes with orthokeratology patients since they require more imaging and time with a doctor, while soft myopia control lenses or atropine require only 15-minute appointments. Furthermore, the front desk often needs to know when to book them (such as after wearing the orthokeratology lenses for a week) and what they need to bring to the appointment (lenses/glasses).
I always remind my staff, if someone calls to book an appointment and they are not sure of the exact reason or length of time of visit, they should verify with myself or the manager before booking a definitive slot. I will usually have my myopia control patients ask for the one point-person in the office who is more versed in myopia control to book the appointments.
Sample phone call: When patients book a myopia-control appointment
Patient/Parent: “Hello, my name is Steven Johnson and I would like to book a follow-up myopia control appointment for my son Byron Johnson.”
Our staff: “Okay. What current myopia control treatment are they currently in?”
Patient/Parent: “They are currently in orthokeratology lenses. We need to book our 1-week follow-up since we just received the lenses in the mail.”
Our staff: “Ok, perfect. That will be a 30-minute long, 1-week follow-up for orthokeratology treatment. Does Friday at 1:00pm work for you?
Parent/Patient: “Yes, perfect. Do we need to come in wearing lenses or bring them with us?”
Our staff: “Please bring the lenses with you but do not wear them in. If you have any questions about cleaning or wear time, please feel free to call us so we can have the doctor contact you!”
3. Scheduling axial length appointments
Since we do not have an axial length machine at our practice, we often have to refer patients to a local ophthalmology practice in order to obtain these images. It can be challenging, especially with new staff, to train them how to ask for the correct imaging with ophthalmology staff members.
In the beginning, I will usually sit with the front desk point person (one or two people trained to work with referral offices) and create a script that they can use when booking an appointment for axial length measurements.
Sample conversation: Booking an axial length measurement appointment at an ophthalmology practice
Our staff: “Hello, this is Ms. _____ from Clarity Eye (not real office name). I am calling because Dr. Goldberg would like to set up an axial length measurement appointment for patient ______.
Dr. Eisenberg’s staff: “Ok, I am not sure what that means. Are you trying to book a referral to Dr. Eisenberg at Precision Eye (not real office name)?”
Our staff: No, Dr. Goldberg has an agreement with Dr. Eisenberg that her patients can be referred to his office to obtain axial length measurements for her myopia control patients. It is often done with the IOLMaster he uses for cataract patients. If you are unsure about what appointment to book, can you please transfer me to the manager?
Dr. Eisenberg’s staff: "Okay, one second."
Our staff: “Hi, this is Ms._______. I am calling from Clarity Eye to book an axial length appointment for one of Dr. Goldberg’s myopia control patients. It is not a full exam but just a measurement Dr. Eisenberg has agreed to provide in order to help Dr. Goldberg monitor her myopia patients.”
Dr. Eisenberg’s staff: “Ah yes, I can help you set that up. Can you please provide the patient's name and DOB?”
4. Train technicians to go with the flow
Technicians play a crucial role in the myopia control workflow. It can be difficult to understand the nuances of all the various myopia control treatments, so often, it is beneficial to write out the flow for each type of treatment. It is important to have a technician who is familiar with your myopia control patients and can help train new technicians if needed.
For example, with orthokeratology, I often have the auto-refraction and topography performed without lenses before they are seen in my chair. This helps save a lot of time for the doctor and allows them to study important information before seeing the patient. With atropine and soft myopia control lenses, often less pretesting is needed, and patients can be brought directly back into the chair.
Technicians often also need to understand their post-exam roles, such as the type of follow-up needed, whether lenses are ordered, and if any further testing is required (such as axial length measurement).
Insertion and removal training is one of the tasks that a technician or front desk staff will likely be most involved with. It is important once again to have a point person who has experience in insertion, removal, and care of the lens and can help train other staff members if they are out of office. However, just in case of an issue or emergency, the doctor should be in office when a training session is taking place.
Lastly, this is probably one of the MOST important tips that will help make this new workflow a success, is get your staff INVOLVED. Consider meeting with your staff/technicians once a week while implementing a new workflow to allow them to suggest new ideas, and brainstorm what went well and not so well. They want to feel they are a part of the team, not just a lone soldier against the myopia army.4
5. Promote proficiency in the essential equipment
Most practices already have the basic equipment needed for myopia management, making it easier to incorporate without substantial cost! Of course, there is more advanced imaging equipment you may choose to invest in down the road, but oftentimes an auto-refractor and topography are all that is initially required. A slit lamp camera can be a nice addition to help troubleshoot when fitting orthokeratology lenses with consultation, but this task is usually performed by the doctor.
Likely the most difficult piece of equipment for technicians is the topographer. Nowadays, the topographer is very user-friendly, and images are analyzed by the doctor, not staff. Yes it’s true that the quality of photos can help when determining the success and fit of orthokeratology lenses.
It is important that the staff can distinguish between a good and poor-quality image, such as lid blockage or poor team film. In these cases, the head technician who is already experienced with this technology can help demonstrate or monitor newer technicians.
Meeting with a technician at the beginning and end of each day to go over why certain testing was performed and how together you and them can enhance workflow can be a game-changer for efficient workflows.5
6. Establish a protocol for ordering lenses and drops
In our practice, orthokeratology lenses are ordered through the doctors only since they tend to need more customization and direct contact with consultation. If only a replacement lens is needed, the staff are allowed to call the company and order a new lens, but all parameters must be the same, and the doctor should be notified beforehand, if possible.
If extra lenses and/ or refills are needed, soft myopia lenses and atropine orders can be placed through well-trained staff. Once again, the doctor should be notified ahead of time if possible.
In addition, staff are trained to collect lenses and soak them in a cleaning/conditioning solution above arrival and to call the patients. They are also trained to inform the patient about booking a follow-up (usually 1 week, depending on the doctor’s plan).
7. Provide tools to track billing
Myopia control treatments are most often not covered through insurance. This can save the billing department valuable time spent fighting with insurance companies.
However, it is still important to review the consent form with all those involved in accounts received and have them understand when and how much payment is expected (usually yearly) and exactly what is covered (replacement lenses, soft contact lens exchanges).
Because of the numerous follow-ups often required with myopia control treatments, it can be easy to forget when payment is due; this can be clarified by providing a spreadsheet for each patient to keep track of their payment schedule.
8. Cross-train to ensure complete coverage
Cross-training has been one of the most important practices implemented at the office that creates efficient workflows. Gone are the days when front staff stayed up front, and technicians only dealt with patient work-up.
In these modern times and with people changing in and out of jobs more than ever, it is important to have multiple staff members trained in all aspects of the practice. For example, our optical can perform insertion and removal training, order lenses and glasses, help book appointments, and even sometimes step in the technician role if needed.
Although it is important to have one main staff member who is considered the myopia control “expert,” it is equally as important to have other staff who know how to handle situations if that point person is sick or leaves the office. This can prevent major disruptions in workflow and reduce frustrations among patients.
9. Take advantage of the resource of reps
Educating and training staff on the “how” and “whys” of myopia control can be time-consuming, especially if you, as the doctor, are also busy seeing patients. This is where reps can be of extreme value!
Oftentimes reps of pharmaceutical and contact lens companies can be a great resource to help educate and train staff on their products. They are usually happy to come in and provide a lunch training session to help the staff understand the product better, show them how to deal with patients, and be a lifeline when they have any questions.3
Reps also can be a great resource for doctors as well. Although staff should never be the main point of contact when educating patients about types of myopia control treatments and their treatment process (that should be the doctor’s responsibility), they still can be helpful in providing educational materials, lens training, etc.
In addition, reps can provide handouts and start kits to patients to promote proper lens care, which is a major contributor to long-term success.
10. Anticipate barriers to treatment
Remember, these lenses/drops are medical devices that require commitment and compliance. The child and parent need to be educated BEFORE starting the treatment plan about what is expected of them to achieve successful results. Failure to comply should be relayed to the doctor and may result in a discontinuation of treatment.
It is vital for staff to be able to identify barriers to treatment, such as:
- Patients who are unmotivated to wear lenses
- Parents do not book timely appointments
- Patients who lack the maturity to care for lenses properly
- Inability to pay for service
11. Regroup
After implementing all these changes into a practice it is important to take a moment and re-evaluate what parts of the workflow are going well and which ones could be improved upon.
Try to identify gaps in the workflow and regroup with your staff to brainstorm together ways in which workflow could be improved. This will also make your staff feel involved in the process and more likely to be excited about the changes.6
Conclusion
To make it easier, below are five key points to remember when trying to implement any new protocol:
- EDUCATE the staff.
- BE PATIENT; it can take some time and effort to implement a new protocol.
- ASSIGN A POINT PERSON; this main staff member should understand the treatment plan on a more elevated, detailed level and be equipped to train other staff members.
- CROSS TRAIN as much as you can so that if the main point person is unavailable, someone else can step in.
- UTILIZE RESOURCES; whether it is a colleague’s consent form or a pharmaceutical representative’s expertise and educational materials.
Introducing a new treatment protocol will always have its ups and downs. However, with the right mindset and use of resources—from other colleagues, reps or myopia mentors— it can often be implemented in a way that is efficient and provides top care for your patients.
