No doubt you take every possible measure to avoid errors during cataract surgery. But does your error prevention strategy extend to the need to prevent errors before you enter the surgical suite?

Avoiding those mistakes is one of the goals of systems that connect diagnostic data to the OR. With these programs, cataract surgeons can avoid errors and improve efficiency by having data uploaded directly from biometers and other devices into a software platform.

In this article, we’ll take a closer look at the benefits these systems provide, including error reduction, time savings, improved outcomes analysis and help with staffing. We’ll also offer some tips for implementing them effectively. First, let’s take a look at how they work.

UPLOADED DATA

Cloud-based systems upload data directly from diagnostic devices into the software, eliminating manual transcription of information. For instance, at The Eye Associates, Sarasota and Bradenton, Fla., a Zeiss Veracity system connects to an IOLMaster 700 (Zeiss), topographer, Cassini and other devices, according to Cathleen McCabe, MD, medical director. Dr. McCabe also serves as chief medical officer at Eye Health America. The Zeiss Veracity system is part of the Zeiss cataract workflow solution.

Similarly, at Harvard Eye Associates in Laguna Hills and San Clemente, Calif., an Alcon Smart Solutions system — the SMARTCataract application — connects to an IOLMaster, according to John Hovanesian, MD. SMARTCataract is the first application under Alcon’s SMART Solutions platform.

Once the data is uploaded, Dr. McCabe can tell the Zeiss system to enter data into a formula she chooses, which results in a plan for the cataract surgery. Then, she can view a map of the eye and other information, such as where she plans to orient a toric lens or where the limbal relaxing incisions for astigmatism correction would be; the IOL power and type; and backup lenses. That summary can be used in the OR so all staff know the plan.

AVOIDING ERRORS

One of the biggest benefits of these platforms is the reduction of errors that might occur when staff members have to transcribe data from one device or system to another.

“There’s no question that the way most surgeons choose lens implants for surgery is very outdated,” says Dr. Hovanesian. “It’s a process that is susceptible to errors and inaccuracies. And it’s time consuming as well for us and our staff. So, I was motivated to use a system that can help us automate the data transfer processes that really are better performed by a machine than by a human.”

The Alcon system, explains Dr. Hovanesian, allows him to choose a lens using an interface where he can compare different lenses and see what the result will be; it’s a feature shared by Veracity. For instance, Dr. Hovanesian can try different toric combinations and factor in adjustments such as surgically induced astigmatism.

The Alcon system “allows you very quickly to go through information that is complex and do so without the worry about humans transferring information manually from one location to another, which is a source of potential error,” says Dr. Hovanesian.

Similarly, since biometry data is transferred directly from the Argos biometer (Alcon) to the SMARTCataract application, transcription errors are not just reduced — they are eliminated, says John Davidson, MD, refractive, cataract, lens replacement and MIGS, NVISION Miramar, Ventura County, Calif. You can, he notes, set and forget surgeon-specific defaults such as surgically induced astigmatism, refractive targets per lens model, AK nomograms and so on.

Dr. McCabe says her practice implemented the technology to help increase efficiency and collate data electronically to reduce the risk of transcription errors, review data and make customized treatment choices for patients. “Preoperative testing data can be automatically uploaded into the Veracity planning software and used to make a customized plan for the patient that isn’t going to have the added effort and possible errors of a person having to enter that data in for each of the patients for each piece of the testing equipment.” She can then run that data through some predetermined analysis to guide choices as she tries to meet the patient’s visual goals.

Yuri McKee, MD, partner surgeon, East Valley Ophthalmology, Mesa, Ariz., was also motivated by the wish to avoid the risk of errors from manual transfer when he brought the Zeiss system into his practice. “There have been absolutely zero mistakes since I started using it.”

TIME SAVINGS

Besides increased accuracy, these systems can help doctors save time. When Dr. McKee reviews surgical options with a cataract patient, he will bring up Veracity and ask the patient a series of questions then input the answers into the system. The patient, says Dr. McKee, watches him click on the screen, and the system brings up how to achieve the patient’s goal. The system “has given us this solution instantly, based on my preferences and the patient’s desired refractive outcome, and they get to see the math done, they get to see what’s going on behind the curtain.”

“I would probably spend several hours a week doing calculations before this,” notes Dr. McKee. “Now I do the calculation instantaneously in front of the patient. They can see immediately the different options for different outcomes and make a very informed choice right there in the exam lane.”

For Dr. Hovanesian, the average planning time for a non-post-refractive case has decreased from 3 minutes to about 1 minute through use of the automated system. For a post-refractive case, the reduction in planning time has been even more dramatic with a decline from about 8 minutes to close to 1 minute, he estimates. And as they use the software for more patients, “it’s several hours a month that are saved by the doctor in planning the surgery,” says Dr. Hovanesian.

Dr. Davidson says his time savings have been dramatic. Office staff members no longer need to log on to various online calculators, charts no longer need to sit on his desk until he can get to the desk in that office, and OR staff members no longer need to enter patient data into his femtosecond laser.

OUTCOMES ANALYSIS

Besides helping in surgical planning and execution, software like Veracity and SMART Solutions, can help physicians in a critical but often overlooked area: outcomes analysis. “Performing outcomes analysis for a lot of doctors is a blind spot,” Dr. Hovanesian says. “It’s an area where we have failed to go back and look at what we could have done differently with our lens planning to achieve the more desirable result.”

Traditionally, the biggest barrier to performing outcomes analysis, according to Dr. Hovanesian, was the time it took staff to find a patient at 1 or 2 months post-op refraction and understand the result so there could be a “report card” on attempted vs achieved correction. But with these systems, data collection happens automatically, he notes, and allows surgeons to make real-time adjustments to achieve better accuracy.

“Since I began using a system like this,” says Dr. Hovanesian, “I’m doing fewer enhancements with excimer laser and fewer lens exchanges for patients who missed their refractive target, simply because we have a feedback loop that reliably evaluates our outcomes.”

Surgeons have a propensity to overestimate their outcomes, says Dr. McCabe. “That’s the tendency to say, ‘All my patients were great and everybody was happy.’ And if you’re not looking at your outcomes and really measuring them and then analyzing them statistically, you don’t really know.” These surgical systems can be a way of improving outcomes, she notes.

STAFF RELIEF

Other benefits accrue from these systems. For one, having such an automated system can be an aid when it comes to staffing.

“Anything that takes away full-time equivalents from staffing necessities is a wonderful benefit at a time when staffing is a huge challenge,” notes Dr. McCabe. “The efficiency and the need for less full-time staff paying attention to just simple data entry is critical right now when we’re really challenged with staffing.”

In addition, Dr. McKee reports that his system has “driven upgrades considerably in my practice, largely for toric lenses. I’ve always had a reasonably good upgrade rate. It is definitely higher than it was before implementation.”

Arguably, these systems also improve staff communication and documentation. Once a week, says Dr. McKee, he will buy his surgical staff lunch and together they will view Veracity on a big-screen TV and review each patient scheduled for surgery the coming week. That means the staff has already seen the patient’s plan when the patient comes into the OR. “It’s very helpful because now everyone’s on the same page,” says Dr. McKee.

The surgical technicians know what to pull for each case, he says, while the ordering technicians know what lenses to have in stock because they can see it in the system. Staff knows how to program the femtosecond laser for the toric lens. “Everything is right there for everyone to see,” says Dr. McKee.

The system will generate an automatic operative note that he can acknowledge and sign, says Dr. McKee. Any variations to the operative note, he says, can be done in one or two clicks.

HOW TO GET STARTED

In implementing these systems, first understand what they can do, recommends Dr. Hovanesian. Next, sit down with your staff to explain why using the system is a worthwhile change and get their buy-in. Third, even though you might be doing double work for a time, plan surgery using both the new system and your current method, so you can see the efficiency gained.

You’ll likely find that you are not using very different lenses with the new way compared with your current method, which will give you confidence that the new system is accurate, notes Dr. Hovanesian. But it will quickly show you the areas where you could have made errors using your current method.

“Spend the time when you first implement the system to look at all the ways of customizing it to make it work in a way that’s intuitive for you and for your team,” says Dr. McCabe.

She recommends that anyone unsure if they need such a system should ask themselves if their outcomes meet their expectations. “If you feel there’s room for improvement, the best way to do that would be a system like this,” Dr. McCabe says.

A system such as Veracity or SMART Solutions “maximizes efficiency, it maximizes safety, it maximizes patient and staff education, and it streamlines everything,” says Dr. McKee. OM