THE FLUID PRACTICE … SPONSORED BY MARCO

EPIC Wave Sweeps Cataract Workups

For a busy multi-center practice, the EPIC improves patient flow and requires less time and labor

By Myra Cherchio, COMT & Brad Houser

When we started using the EPIC system (Marco), we tried to incorporate it into our existing conventional patient workup. We treated the EPIC as an additional step, and our technicians couldn't figure out how to push patients through, so it sat idle most of the time — no fault of the system.

Finally, 5 years ago, we asked the folks at Marco to help us use the EPIC to its full potential. They helped us plan a reinvention of our workup process. Basically, we took apart our workup and reassembled it around the EPIC system.

We now have 10 EPIC systems in use across five practice locations that make up St. Luke's Cataract & Laser Institute. Rather than incorporating the EPIC into our workup, we've fashioned our workup and biometry process around the system. The EPIC systems have not only streamlined the way we perform cataract workups, but also how patients move through the practice, how we allocate staff and how much time we spend in testing. The results have been very positive.

A Crucial Change

For our cataract practice, changing to an EPIC-based workup has enhanced patient flow and efficiency. The key to making it work was keeping components of the cataract evaluation together. Previously, we had traditional exam lanes so our technicians were spread all over the floor. Now they're clustered together with sub-waiting areas, minimizing patient movement and wait time.

Implementing a model based on the EPIC system required some physical changes in our practice locations, but those changes were definitely worth the effort. Some walls had to come down, but by reducing tech space, we gained space for additional physicians. We cut exam lane space by a third, putting three EPIC units in the space of two exam lanes.

But the change in patient flow was the real revelation. The EPIC model enabled us to get patients through more efficiently, which helped to cut patient wait time and physician time in the clinic. When we compare the cost of buying the equipment to the increased throughput and savings, the results are excellent.

A Smooth, Fast System

With the physical layout in place for optimal use of the EPIC system, we began using it for all of our cataract workups. Cataract patients who come to our practice are generally referred, so we know we need biometry performed on these folks before they walk in the door. We integrated the biometry process as part of the EPIC exam by using the keratometric data from the EPIC for our IOL calculations.

Because the EPIC combines multiple steps, it requires less time and less moving around for patients. The technicians' portion of the cataract evaluation, not including dilation, can be done in 40 to 45 minutes, including biometry and lens calculation. Previously, it was substantially longer.

Not only do patients spend less time waiting, but they also don't have to return for separate testing and lens calculations. They certainly prefer having all the testing done in one day. Patients who travel a long distance can even undergo evaluation and surgery on the same day.

What's more, because we gather all of this relevant information for cataract patients before they see the doctor, the doctor is ready to offer a complete surgical plan when he sees patients for their evaluation. That's a good use of physician time, allowing for a more informed, productive discussion with the patient.

Significantly Fewer FTEs

When we moved to this new process of merging biometry with the workup, we saved enough staff time to trim three full-time employees at our main office. There, two cataract surgeons perform 150 to 200 procedures per week, and the cataract service alone sees approximately 20,000 patient visits per year.

Although other doctors are on the floor, the EPIC staff's primary function is cataract evaluations. There are three EPIC systems operated by three technicians who handle three cataract evaluations per hour per machine. Two or three people complete the workup, and three technicians perform a combination of biometry, and then discuss surgical options.

Skilled EPIC Staff

Although the EPIC automates refraction, we still employ experienced technicians on the system, rather than using staff with limited skills. Technicians have tremendous subjective control over refractive outcomes, particularly in refining the autorefraction. That's where we see the value of experience. Surgeons are basing their IOL selection on the results, and skilled technicians make sure that those results are accurate. Our doctors are satisfied with the results they get, and they can make their selection with confidence. Of all the people in our office, the technician team has come to appreciate the EPIC the most. It has enabled many of our technicians to become specialists in their work. An individual's strengths gear him for different responsibilities, and the EPIC model lets people follow those strengths. Technology-oriented technicians perform exceptionally well when working with the EPIC. Technicians who enjoy talking and connecting with people complete the exam, discuss lifestyle and vision correction options, then prepare the patients to see the doctor. Everyone feels more empowered handling their portion of the exam, and they excel in the roles.

An Excellent Fit

In our large, high-volume practice, the EPIC has been an excellent fit. The cost of the equipment is more than recaptured in staff savings and a smoother, better workflow for staff and surgeons. It also reinforces a message that we want our patients to hear: We are committed to staying on the cutting edge of technology to deliver the best possible outcomes. ■

---

Myra Cherchio is the director of clinical operations at St. Luke's Cataract & Laser Institute, a multi-center practice in the Tampa Bay, Florida, area led by James P. Gills, MD. Brad Houser is the administrator at St. Luke's.