Download A picture is worth 1000 words – and maybe 1000 sales

Feature
by Howard Larkin
A picture is worth 1,000 words –
and maybe 1,000 sales
Managing your Practice
J
ust about every LASIK and multifocal
intraocular lens candidate who sees Jorge
L Alió, MD, PhD, at Instituto
Oftalmológico de Alicante (VISSUM) in
Spain also sees an interactive video about her
or his eye condition, and the benefits and
risks of various treatment options.
The multimedia presentations that Dr Alió
uses are produced by Eyemaginations, of
Towson, Maryland, US
(www.eyemaginations.com).The
presentations include animations of
procedures, simulations of how the condition
might affect vision if left untreated,
information on aftercare, and simulations of
what the patient's vision might be like after
treatment, including minor complications like
halos and glare. Similar vision simulators and
products also are available from Eyeland
Design Network, a German firm
(www.eyeland-design.com).
“Without this it is very difficult to transmit
this information,” Dr Alió says.“But after this
presentation, patients really understand what
will happen and how it will affect them.”
Clinical benefits are the main reason Dr
Alió uses the videos, which are generally
presented by a nurse after he examines the
patient.“There is always a qualified healthcare
professional present to answer questions.” If
necessary, the patient is referred back to Dr
Alió for additional counselling.“But that
rarely happens because the presentations are
very good.”
The animations show patients how their
vision could deteriorate if they ignore their
condition, and demonstrate clearly how to
take care of their eyes, such as applying eye
drops or doing eyelid scrubs.As a result,
patients tend to adhere better to treatment
plans.And because the simulations show
patients what they might see in terms of
halos or other postoperative side-effects,
they tend to be more patient in waiting for
such side-effects to subside.
“If you don't tell them that this is a
possible complication in advance, they will be
angry or dissatisfied if it happens, but if you
show them, they will accept it,” Dr Alió says.
“This is one of the main causes of patient
dissatisfaction with multifocal IOLs.”
The interactive videos also improve the
practice's business performance, Dr Alió
notes. For one, the videos make him more
efficient. He estimates that handing off
patients to a nurse with animation software
saves him about 10 minutes per patient
compared with having to explain it himself
using hand-drawn illustrations.The patient
also ends up with a much clearer
understanding of the operation, he adds.
Enhanced understanding also makes the
practice more profitable. Once patients grasp
the benefits of extra-cost options such as
multifocal IOLs or femstosecond laser flap
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cutters, they are much more willing to pay
extra for them.“Before they watch, some
patients don't understand how the flap can
be made without a knife,” Dr Alió says.“After
they watch, they understand how the
IntraLase works and how the mechanical
microkeratome works.With this information
they are much more comfortable making a
decision.”
Raising conversion rates
Dr Alió can't say precisely how much
multimedia patient education has increased
his sales of premium products and services.
“But it is for sure evident,” he says. Indeed,
Dr Alió is so impressed with the benefits of
the product, which he currently uses only at
his Alicante location, that he plans to
introduce them into VISSUM's 52 surgery
centres throughout Spain.
Paolo Vinciguerra, MD, also finds
Eyemaginations animations a helpful tool to
promote premium IOLs at the Humanitas
Institute Rozzano in Milan, Italy. If anything,
the tool is too effective.“Sometimes the
expectation grows too much because the
animation is so nice.” (See sidebar on risk
management.)
That squares with Eyemaginations' claims
that its animation products, which include
presentations for all types of eye conditions,
eye care, and procedures in eight languages,
help increase sales of all kinds of products
and services, says Eyemaginations president
Jeff Peres.“It works across the board with
every procedure – high-end glasses, punctal
plugs for dry eyes, contact lenses.”
By showing patients what they can expect,
prospects for premium products are
converted into sales, multiplying the
effectiveness of expensive outreach efforts
such as patient information seminars that
many refractive surgeons offer.Though the
company hasn't commissioned any formal
studies of sales impact, many clients report
conversion rates doubling or tripling with the
software, Mr Peres says.That can mean
hundreds of thousands of extra Euros in
revenue per year.“Eyemaginations not only
helped our conversions to premium lenses
and custom/bladeless LASIK but also paid for
itself within one week.We love it!” said Rick
Haley, administrator for Loden Eye Centers
in Tennessee.
Eyemaginations software is offered in
several versions, including videos that can run
on loops or at computer kiosks in office
reception areas, interactive formats that
allow doctors to stop and draw on the
screen, and a new web version that allows
doctors to incorporate animated education
materials into their branded websites.About
7,000 practices worldwide use the software.
In July, Eyemaginations opened a European
unit based in Erlangen, Germany, to help
Vision simulation software aids informed consent, risk management
Before Paolo Vinciguerra, MD, of the Humanitas Institute Rozzano in Milan, Italy, began using
Eyemaginations software to counsel patients, he used hand-drawn figures to explain eye conditions and
procedures to patients. Trouble was he didn't always do it exactly the same. “After 10 times you get tired
and maybe you leave things out.” Not only was that poor patient education, it exposed him to
accusations and liability for failing to fully inform patients about the risks of surgery.
Now that he uses the software, Dr Vinciguerra is confident that each patient receives the same
information, and in a much more effective format. “When the patient receives information in words they
retain maybe 25 per cent to 30 per cent, but with pictures it is more like 70 per cent.” Also, Dr
Vinciguerra can document exactly what he told the patient.
Animated vision simulation software from Eyemagination, Patient Education Concepts (PEC) and Eyeland
Design Network all support informed consent, their producers say. Eyemaginations has certain packages
that allow doctors to record notes and drawings they make on the screen when using their simulations to
counsel patients, and sells a package specifically tailored to meet the needs of informed consent. PEC
includes a consent form that must be signed at the end of its IOL Counselor software. “If there are
problems afterwards, they can show the jury what they showed the patient,” says Eyemaginations
president Jeff Peres.
While many surgeons leave the animation presentation to nurses, surgical counsellors or other
technicians, Dr Vinciguerra prefers to do it himself. “It takes about five minutes and I can usually finish
the notes while it runs,” he says.
Afterwards, Dr Vinciguerra talks to the patient to assess their level of understanding. “I want to look into
their face and say ‘I explained it personally to you’. I want to make sure there is no excuse for
misunderstanding. They cannot say ‘your colleague told me something else.’”
Overall, Dr Vinciguerra believes the process saves him time. “There are patients who understand what
you tell them and there are difficult patients who will never understand no matter how much I explain.
With these patients the animation saves a tremendous amount of time.”
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ophthalmologists incorporate the software
into their patient counselling routine.“If you
have well-educated staff, you can bring
patients to the point where they might spend
an extra Euro because they understand why
it is better to have the multifocal lens or
wavefront guided LASIK,” says Robert Habel,
who heads European operations.
A pilot study last year of a similar product
from another firm demonstrated dramatic
conversion rate improvements for multifocal
IOLs. Practices that introduced the IOL
Counselor, developed by Patient Education
Concepts (PEC), Houston, US, in conjunction
with Eyeland Design Network,Vreden,
Germany, typically saw the percentage of
eligible cataract patients choosing premium
multifocal lenses rise from around five to
seven per cent, to 20 to 30 per cent, says
PEC president Robert D Watson.
“The software is designed for one purpose
alone – to increase the conversion rate for
patients considering the monofocal lens to a
premium lens,” Mr Watson says.“We built it
to take someone who has never played a
role in conversion or up-selling anything and
make them proficient at it.”
The IOL Counselor simulates the impact
of presbyopia and cataracts on vision, and
shows how various lenses will affect near,
intermediate and distance vision using several
scenarios including driving scenes day and
night, grocery shopping, and sporting events.
It also includes a module laying out charges
and financing options, and ends by asking the
patient either to choose the premium lens,
or acknowledge that they were presented
with the option and declined.With
sponsorship from AMO and Alcon, the
ASCRS sent 4,500 copies of the software to
its members earlier this year. As of late
September, about 2,500 copies had been
activated.The software is also available in
French, German, Spanish Portuguese, Russian,
Chinese and Japanese, with other languages
coming.
One practice that participated in the pilot
study, Pepose Vision Institute, St Louis, US,
saw its premium IOL rate rise to 80 per cent
in December, and averaged 70 per cent
through the first half of 2007.“That is about
65 percentage points above the national
average,” says Dawn Cavanaugh, chief
operations officer of the clinic.
The Pepose Vision Institute used a formal
quality improvement approach, including
process mapping and outcome measurement,
to find the most effective way to integrate
the software into its practice routine, Ms
Cavanaugh says.“After testing our model
several different ways we found we achieved
our best result presenting the IOL
Feature
Process mapping – Your guide to improved performance
We all want better outcomes for our patients and ourselves – better clinical results, better financial
results and more fulfilling personal results. All these outcomes are the result of processes – care
processes, administrative processes, human resource processes, financial processes. So improving
outcomes is really a matter of improving processes.
Before you can improve a process you must have a process. A good definition of a process is a series of
connected steps that result or are intended to result in a particular outcome. A process can be as simple
and straightforward as the proper steps to take an X-ray, or as complex and multi-channelled as the
steps required to develop and execute a population-based health improvement plan. If all the steps are
followed consistently, a process can be said to exist.
Process mapping is an essential first step to process, and therefore outcomes, improvement. Process
mapping is the method by which the steps in a process are identified and recorded so the process can be
understood, analysed and improved. It is simply a matter of writing down each step and how it relates to
the next step. Once the process is mapped and understood, you will begin to see gaps and opportunities
for improvement.
To map a process, first define it in terms of its starting point and ending point. For example, the process
of a patient receiving an X-ray might start with the doctor determining the test is needed and end with
the patient receiving the X-ray. Sit down with your staff and brainstorm all the steps. The simplified map
might look like this:
n
n
n
n
n
n
n
Doctor examines patient and determines need for X-ray;
Doctor tells patient they need an X-ray;
Doctor fills out X-ray request;
Doctor tells patient to wait for appointment in the post;
Patient receives X-ray appointment;
Patient travels to X-ray lab;
Patient receives X-ray.
With this map in hand, you can begin to ask questions, such as: Does the process result in timely care?
Is it efficient for the patient and the doctor? How much does each step cost? What could be done to
make it easier, quicker, cheaper, or more efficient?
You and your staff may be surprised by how many steps many common processes take – and how
difficult they are for patients and staff to follow. Often, opportunities for improvement will be immediately
evident.
Adapted from the UK NHS Modernisation Agency, www.modern.nhs.uk
Counselor after the patient had met with the
surgeon. Patients were more apt to absorb
the information on the back end. Our
findings pointed out on the front end the
patient was more nervous and less focused,
than at the end of the visit after our clinic
had taken the time to educate the patient
and their families.”
The process of promoting multifocal lenses
starts with identifying potential candidates
and informing them throughout their
diagnostic work-up and examination that
multifocals may be a good option.After
patients are examined by the surgeon who
determines if the patient is in fact a
candidate, the patient along with their family
meet with a surgical counsellor, who goes
through surgical availability, consents and
Care Credit financing options. In this
environment, the IOL Counselor serves as a
closing tool, giving patients already familiar
with the multifocal concept the confidence to
proceed ahead with a once in a lifetime
opportunity, Ms Cavanaugh says.
In addition to its work on the IOL
Counselor, Germany's Eyeland Design
Network offers a wide range of animated
graphics and stock images, says Karl Brasse,
MD, a practising general ophthalmologist who
heads the firm along with designer Guido
Schulte.These include a vision simulator
package that has been distributed to 20,000
practices in Europe by Pfizer, and is available
on the web at www.visionsimulator.com; and a
host of animations of symptoms, treatments
and outcomes for conditions including
cataracts, glaucoma and macular
degeneration.
Dr Brasse emphasises the detail
incorporated into the firm's 3-D images,
Images that show patients what they are missing, such as these illustrating the impact of macular degeneration from
Eyeland Design Network in Germany, can help convince patients to curtail driving and other potentially hazardous activities
which he says exceeds what can be done
with photography because it is not limited by
depth of field issues.“We are design focused,”
Dr Brasse says.“The images can be used for
patient education or grand rounds at
Harvard.” The firm's work has won many
awards, including an Oscar at last year's
ASCRS Film Festival.
Beyond their educational, aesthetic and
emotional appeal, these products also can
help convince patients of the value of
technologies such as HRT and even
pharmaceuticals such as Macugen and
Lucentis, which may not be fully covered by
German state health plans, Dr Brasse says.
Understanding the conditions and available
diagnostic technologies and treatments not
only relieves patient anxiety, it encourages
patients to invest in extra-cost services to
protect their eye health.
Improving diagnosis and staff
understanding
Beyond improving patient understanding and
increasing sales, some surgeons find animated
vision simulation can help diagnose and
monitor vision problems.“I am basically a
refractive surgeon and with the myopes we
are very aware of retinal detachment,” says
Arthur Cummings, MD, of the Wellington Eye
Clinic, Dublin, Ireland.“If they get light flashes
or floaters they need to be checked out.” But
patients may not recognise these symptoms.
Being able to show a patient what they look
like helps, he adds.“The patient knows when
they need to seek care.”
Since installing Eyemaginations software on
one in-office computer and on his website
five years ago, Dr Cummings also has found it
a valuable training tool for staff.“Everyone
better understands what the patients are
experiencing and what they are talking about.
It helps people feel they are in a place of
higher quality and it helps the staff provide a
better quality of service.” He is in the
process of putting the software on
computers throughout his office, which
recently moved into a new location.
PEC also sells an internet version of the
IOL Counselor that allows individual
practices to promote presbyopia correcting
IOLs on their websites.“The more you
educate patients about presbyopia correcting
IOLs before they enter your practice, the
easier it is for them to decide to spend the
extra money for them,” says Mr Watson. It is
also available in eight different languages and
three different sizes so it will easily install
into most web formats.
Ms Cavanaugh says that animations give
her staff valuable insight.“The younger staff
said 'I never realised what they were talking
about when patients complained about
muted tone.' They were shocked to see what
it looked like on the IOL Counselor. It really
put it together for them.” The clinic held a
Saturday training session to introduce the
software, and formally trains all new
employees on it.
Dr Alió also believes that animation is an
essential tool for building a high-end practice.
“If you want to be at the top, this kind of
information is more and more necessary.”
Eyeland's Dr Brasse, who maintains an
active ophthalmic practice in addition to
producing animations, believes animations can
be a valuable, even life-saving, addition to any
practice. For example, vision simulations can
help visually impaired patients understand the
implications of reduced acuity, making it
easier to convince them to give up driving or
other hazardous activities when necessary.
“I used to use images of churches and
skylines to show how conditions can impair
vision,” Dr Brasse says.“Now we use images
of children on the road. In my experience
these images of kids are very effective in
getting the message across. If a picture is
worth 1,000 words, these animations are
worth 10,000.”
Or, as Dr Cummings puts it:“This is the
ultimate tool for explaining what is going on.”
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