Electronic information and its transfer is part of your everyday world in emails, texts, online shopping, data and information collecting, entertainment, etc. And, virtually all of you participate. It saves money, time and adds convenience.
Telephone and fax are slow and fraught with potential errors. The bottom line is—it’s about time. It affects patient satisfaction, the business, time management and efficiency.
Our focus is the patient so let’s start with them. Today, great products, excellent service and the perception of value received drive patient satisfaction. Excellent service can even make products seem better and their delivery more successful.
For example, a pair of glasses ready, a day or two before promised, can exceed a patient’s expectations. That can help make a patient more receptive to the instructions to learn how best to wear their first pair of progressives or a new and very different Rx post surgery. After all, by beating expectations, a patient’s confidence in their optician increases.
The opposite is true when glasses are late. The patient just left and you’re happy with the choice of frame and lens, especially for the first patient on a Monday morning. In fact, they agreed that the new personalized lens made a lot of sense, even though it was more expensive. You told the patient that the glasses would be about a week and you’d call when they came in.
The handwritten order was faxed in at the end of the day Monday, but first thing Tuesday morning, while the order was being keyed in at the lab, there was a question about the left axis; was it 160º or 100º. The lab was back east, the office in California so the lab put aside the call for 12:30 p.m. (9:30 a.m. PST) after the office would be open. The lab was busy that day and the call came in at 11. The office was also really busy—reception took a message that the lab needed a call back—they thought that it was Heather that had called—get where I’m going? By the end of the day, you were just catching up on messages and decided to call the lab first thing; you just had to leave to pick up your kids on time. On Wednesday morning you tried the lab back but there was no Heather, but Manny would take a look and call you back. Thirty minutes later Manny found your job and the error was corrected. The job would start. It’s not unusual, it happens but the clock started for the patient when they left the office. You’ve now lost two days; and if there was a back order or a breakage the job will be even later.
Here’s the issue, the patient has paid more than they expected, is trying something new and if they have any issue with fit or vision, a late pair of glasses may contribute to the patient assuming that it’s the glasses that are wrong.
So, an office’s efficiency, attention to detail and process adds to patient satisfaction. Offices will improve efficiency and accuracy with electronic ordering.
Efficiency and Accuracy
The components of an efficient electronic ordering engine are many. Look for clear and complete entry screens, the ability to order spectacle and contact lenses, frames by collection, error checking and “missing” information messages, the ability to order from multiple labs and vendors, integration with office practice management systems, one time Rx data entry, order tracking, history and archive availability, HIPAA compliance and the opportunity to grow into third party insurance transactions. With all of these available, you can reduce errors, add efficiency and speed the receipt of glasses for dispensing. That means faster turnaround and increased cash flow—terrific for any practice. If you contract additionally for insurance connectivity, it reduces time for approvals.
According to Cheryl Copeland, ABOC, CPO, optician and office manager at Table Mountain Vision Clinic,
“It saves time so we can concentrate on bringing in new patients or spending more time with patients we have in the office. More one-on-one with our patients improves the variety of product options and benefits we offer. That increases our average sell price and profits while patients get better products.” Cheryl uses VisionWeb and OfficeMate.
Entry Screens — Data must be clearly positioned and easy to enter. Pull down menus for labs and vendors should contain customized catalogs of product for completeness; virtually all orders should be able to be input using a one-page system, even from multiple vendors. In addition, an entry screen should be educational, teaching the new employee. A screen that can also affirm the Rx or frame components quickly tutors staff and improves the basic knowledge of the office. While a variety of lens shapes are described to help the lab initiate the jobs, the opportunity for a frame trace allows the most accurate start to the surfacing process. Once the frame is received, the final in-lab trace contains the accuracy for the best edging.
Order Accuracy — If order entry can access all the products a lab offers, there will be fewer questions as to what coating is allowed on what lens, what progressives work with what prescriptions, etc. Also, with all the parameters entered, the system must be able to tell you whether a lens will cut out with a particular frame and/or the availability of that Rx. Confirm these features when selecting a system.
Integration — Practice management systems contain the patient’s Rx record, eyewear information and can create forms. Therefore, to ensure there isn’t the need for double or even triple entry of the Rx, require the system that you choose be integrated with your practice management system. Russ Tolar, Operations Optical Master at Eyecare Centers, Greensboro, North Carolina, describes their process,
“we have eight offices running Electronic Medical Records (EMR) and the ordering system for spectacles populates the Rx portion of the order directly from the EMR into the patient’s eyewear record. It adds a trace of the frame, checks to be sure all data required is filled in and transmits a completed order from our own screen. In our case, the optician never sees the actual portal order entry screen, it’s been made transparent to save time and increase efficiency.”
Eyecare Centers also has a filter that reduces a lab’s available product list to be consistent with the products the company has decided to sell. While choice is important, we have many choices and there needs to be some way to add selectivity about the products an office offers. This is an efficient way to do that. Eyecare Centers integrates Compulink, VisionWeb and Eyecare Advantage for a seamless entry and order system.
Speed — An order received electronically by a lab is automatically translated into the Lab Management System (LMS). The LMS is the electronic system that stores job data, directs lab machinery operations, tracks the work and prints invoices, manages accounts payable and the lab’s own replenishment system. Automatic translation reduces double keying of jobs that might have been received by fax or phone. Jobs start faster in the lab; the trace allows a lab to better understand shape and ED for the right lens size and thicknesses. This is especially important for those ordering uncuts. Fax and phone orders suffer from handwriting errors, missed information and the time needed for input. That can add one to two days to a job.
Tracking — To meet patient expectations and maintain office efficiency, ensure that a keystroke, at any time, can check on a job in the lab. For example, when open, Vision-Web stays online and is available once logged on. This also works with the variety of integrated systems. Tom Hicks, owner of Oxford Opticians, Oxford, Ohio, might be checking on job status,
“but if a patient walks in the door, I can take care of them and then just sit back down and resume the query I was making. It doesn’t take a time out.”
Flexibility on screen, adds to flexibility in the office. In fact, some portals now provide inventory checking status online for frames.
Third Party — Insurance transactions are a major portion of any practice. Being able to link them seamlessly to your Rx record and transmit to the payer is a serious advantage. Connections to payers requires some additional cost and an agreement, it will save time and money. Most offices, when reviewing their reimbursements find missed payment opportunities because of missed codes, incorrect filing or staff that may have given up on a claim. Does third party connectivity make sense? Count the time spent filling out forms and transmitting to insurers. Also, consider the number of insurers you now work with or will need to. Therefore, an electronic system that allows direct claims processing is a must for a total plan over time.
Next, look for HIPAA compliant claim forms so that requirements are fulfilled automatically. This makes staff, especially new staff, act like experts from their first day. It also ensures office compliance.
For Medicare and Medicaid, no paper claims are accepted, so Internet connectivity is required. Integrating that with the ordering and practice management system simplifies an often-confusing process.
Lastly, if there is a security concern, there should be none. No dollars or payments are being transmitted and claims are HIPAA compliant i.e., transmission is password protected so patients’ information and identity are kept confidential.
Remember Tom from Oxford Opticians? When I talked with him he was using Vision-Web, feet up, watching a football game at home, while inputting his day’s orders. He says this allows him to leave the office on time since 24-hour availability of the Internet allows him access when it is more convenient for him. It also means that the order is printed immediately and available for the lab to tray up, pick lenses and get the job started. In many labs today, swing and even graveyard shifts provide service around the clock. A job once transmitted can virtually start immediately.
Also, since the screen can be open all day, information, orders, forms, claims or other services can be accessed as needed while the office and staff goes about their everyday tasks.
No Charge to the User – Support for the Industry
Clearly, such services that compile and transmit orders should be low or no cost. Otherwise, the sending of data would add to the office’s operating overhead for order input and transmission. Order input and transmission and the linking to vendors using services like VisionWeb, or links from MaximEyes and Compulink, OfficeMate and others are low or no cost. Some practices I spoke with, not ordering online, didn’t realize that some ordering programs were no cost. Investigate all and decide the best plan for you. It improves the bottom line while it adds practice efficiency.
Obviously, there is cost to maintaining the systems and infrastructure of an ordering system that links to labs, manufacturers and vendors. The receiving lab or vendor pays a small transmission fee. Where do some of the monies collected go?
For example, the American Optometric Association is an equity partner in Vision-Web. This provides an AOA member benefit, contributions to State Associations and the AOA directly. This supports AOA educational programs.
In another example, orders received from registered members of the Opticians Association of America, a royalty based on order volume is paid back to the OAA to be used to support the Association and its programs on behalf of opticians.
Opticianry and/or Optometry Offices?
Online ordering applies to opticianry and optometry practices as both offices benefit from increased efficiency.
Cheryl Copeland of Table Mountain Vision Clinic notes,
“Since the integration with OfficeMate, there has been significant time savings. Electronic billing has saved time in that I am able to bill a weeks worth of insurance in about five minutes. Before, data entry happened twice a day and would take up to an hour to bill a days worth of claims. We receive some of our checks within two weeks. Spectacle lens ordering is much better with the integration, with less data entry mistakes.”
“Technology is linking us in ways that we never imagined possible: Google, Twitter, Wikipedia, and others—all blend to create a web of interconnected minds,” The Lost Symbol, Dan Brown, Doubleday, 2009.
I thought this a true statement since this concept of electronic ordering, intuitive training and on-screen education; Practice Management (PM) integration and third party billing ensures the same kind of inter-connectivity that a modern office requires.
Every system implemented in any practice has some side effects. Electronic ordering is no different. They’re positive though. Dr. Tommy Crooks, a former president of the AOA and current CEO of the 19 location EyeCare Associates, offers the following insights. (Dr. Crooks also serves as the professional relations advisor for VisionWeb.
“Many optometric offices are single doctor, staff of three to five, seeing 15 to 20 patients, and placing eight to 10 orders a day. That means there is little spare time for the doctor.” Adding tools that improve efficiency and help bring order to the daily routines of a practice ensures there is time for the unexpected. He adds, “Staff can do what they were hired to be responsible for.”
Expand Capability, Grow
Electronic ordering in its simplest form provides growth in two ways: office growth in products used and system growth in the office. As in most e-opportunities today, they have more capability than most people initially use. Just think about your cell phone.
For smaller offices it’s as if there are more people. Efficiency increases professional identity. For the patient, there are more options when the optician has more product choices available. Dr. Crooks notes,
“Eyewear delivery times are shortened by 0.5 to 1 day.”
Says Cheryl Copeland,
“We are able to process more items faster, and in turn do more. We can try more products that maybe one would not have tried before, because you were unsure of what products were available. That means more confidence to sell maybe a golf lens to more patients, to be able to look up and see the parameters of the Rx with frame size and PD to ensure the best product in the end.”
Enjoy Patients More
This from both Hicks and Copeland:
With more time and easier lab communication, the ability to spend the time to understand patient’s needs or “just chat” makes the office that more personal. Copeland suggests patients stop by to see what’s new, there’s now time to gain knowledge of true needs and get into product benefit conversations. For Table Mountain Vision Clinic this meant starting a safety Rx business in both clear and sun. Since Copeland and many of her customers hunt, that also means her office becomes a destination for prescription safety sunglasses in prescription.
If efficiency saves time that means less of the daily crush. While no office just sits around with their feet up (except for Tom Hicks at home) it means that an office manager has more time to take care of those other office needs like HR issues, training, education and planning.
It seems the hardest part of implementation experience was the initial setup. It takes some time. It’s similar to learning the latest software or the changing to the newest version of Microsoft Word; it takes some time but after a few weeks you can’t remember some keystrokes from the previous version. Both Copeland and Dr. Crooks, suggest their experience is that the time “lost” in learning the set-up is gained back within one week and that was the easiest part of getting the staff on board.
“They immediately felt they were able to spend more time with our patients,” says Copeland.
Screams of “Agony”
Once implemented, electronic ordering brings screams when the Internet is slow or down. It wasn’t too long ago that we were satisfied with dial-up access. To be efficient, speed is critical. Be prepared to hear the agony as Dr. Crooks described,
“…anytime one of my staff receives an error message or there’s difficulty accessing the Net, listen to the complaints. They rely on connectivity to do their jobs and do them well.”
I know some of you are still in denial, “It’s not for me, I really have enough time to call, I don’t see the savings, I want/need the personal attention…” I’ve heard a number of reasons. Millimeter rulers changed in favor of pupillometers and digital camera measuring systems aren’t too far off from increased adoption. Science and technology offer us new opportunities from freeform to memory metals for benefits that patients value. Electronic ordering is the platform behind us that makes us much more effective at what we do best: sell and dispense great eyewear.
This is meant for the doctor, practice/business owner—if you are not involved with the daily activity of ordering, tracking, insurance, etc., it’s easy to misunderstand the demand on staff time. This is a good project for staff implementation with goals set to demonstrate how effective electronic ordering can be. Remember, empower staff to make their own jobs easier; it will also promote practice growth and efficiency.
Supplier Accounts — Set-up and implementation requires adding vendors and lab suppliers to your account, inputting account numbers and identification. Once developed, they are immediately available for use.
Everyone I spoke with suggested the office add capability as understanding increases. In this way, there’s not too much to learn initially and it doesn’t interrupt daily office flow. Use the supplier companies for tutorials online or in person to develop a plan. As you develop lens ordering expertise add frame orders, contact lenses, PM integration, insurance billing and EMR.
Remote Tracing — Some offices use the remote tracing feature to receive edged lenses from the lab for patient’s own frames. This has been especially important in an economy where patients use their existing frame for a new prescription. As an added benefit, some offices use this capability for some of their rimless work where the office is also expert at three-piece or semi-rimless assembly. This can sometimes save up to a week in lab time. Plastic frames work well also, especially for minus Rxs. Discuss this with your lab; remember that attention to tracer calibration is required daily.
It’s About Time
Offices that participate in electronic ordering of lenses, frames and contacts, add efficiency, get easy access to information and infuse convenience. If you’re not participating now, it’s time to get started. You can improve patient satisfaction, the business, empower staff and improve time management.
Increase your participation in electronic claim filing and there are benefits for both patient and office. For the patient, they can maximize their plan. For the office, the costs to participate are far outweighed by the speed, efficiency and accuracy that e-filing delivers.
It’s about time, don’t you think?
by Mark Mattison-Shupnick, ABOM