The future ain’t what it used to be.

Daniel Briceland MD
OMIC Chair

It is with great humility that I begin my tenure as the Chair of the Board of a truly extraordinary company – OMIC. Following such legends as Rich Abbott, Tamara Fountain, and immediate past Chair George Williams is a tall task, but one I embrace. Dr. Williams served on Board committees for 14 years and before becoming our Chair he led the Finance Committee. He oversaw the growth of our company to a record high of 5000 insured ophthalmologists and his leadership left OMIC in the best financial condition in our history.

Looking forward, I am reminded of Yogi Berra’s prediction that “the future ain’t what it used to be.” Ophthalmology and all of medicine are facing tremendous disruptive changes, which are coming at a fast and furious pace. Every ophthalmologist encounters unsettling challenges on a daily basis, whether from new federal or state mandates, scope of practice issues, private equity agendas, or drug supply and pricing issues. Fortunately our partner, the American Academy of Ophthalmology (AAO), has unequalled federal and state advocacy staff and physician leadership to advocate for our patients. Dr. Williams transitioned from leading OMIC to current AAO president earlier this year.

OMIC’s mission is twofold. First, we want to provide high quality insurance. In other words, we want you to sleep well at night. OMIC’s board and committee members are practicing ophthalmologists who face the same disruptive changes all of you do. To make life easier, the Board asked staff to streamline our application process and change our bylaws so we may continue to insure practices that are owned by private equity firms.

The second part of our mission is to promote quality ophthalmic care and patient safety. This Digest focuses on ocular toxicity of commonly prescribed drugs often listed in our senior patients’ medical records. These include hydroxychloroquine, ethambutol, glucocorticoids, osteoporosis medications (bisphosphonates), erectile dysfunction agents (tamsulosin), topiramate, anticholinergics, and anti-hypertensive agents.

This issue is personal for me. I followed a patient in her mid-seventies who presented with complaints of decreased vision from 20/25 to 20/50 while on ethambutol for three months for treatment of atypical mycobacterium infection. Her exam was unremarkable with subtle VF changes and few color vision abnormalities. Stopping ethambutol therapy and observing the patient’s vision drop to 20/200 over two agonizing months is an ophthalmologist’s worst nightmare. Fortunately, her vision gradually returned to normal within 3 to 4 months. It was alarming to learn that the patient had been prescribed the correct dosage based on her weight yet still developed optic neuropathy.

This patient was lucky: ethambutol toxicity is preventable with careful monitoring of dosage and examination, and immediately discontinuing it prevented irreversible damage. Other drugs present greater challenges. In this issue we provide insights on how to best protect our patients.

Finally, Yogi said it best about our future and as I step up to the plate as your Chair I will be ready for whatever is thrown my way. You can be assured that OMIC’s team has its eye on the ball, our head in the game, and we will always have your back.

The day my systems went down

During a recent busy clinic day my entire EMR system suddenly crashed, leaving our staff scrambling to cope with the loss of access to our records. A brief flash, screens flickered, then an ominous dialogue box warned about potential data loss. The chaos that followed, with patients backing up as we managed through various treatment and documentation issues, was a reminder to me that technology presents an entirely new risk to my practice and my patients.

In the days that followed I would learn of similar disruptive events from colleagues, and even within massive hospital networks, where software glitches brought entire systems down and arguably threatened patient safety. In many instances, back-up procedures proved woefully inadequate.

Because technology is central to our practice of ophthalmology, it is only a matter of time until an unanticipated event happens to each of us. This could be at the most inopportune moment, perhaps in the midst of a busy clinic as happened to me, or even worse during a surgical procedure, potentially causing serious injury to a patient.

While we all understand the opportunities medical technology provides to our ever-expanding treatment options for patients, we also must recognize that technology may present frustrations to staff and risks to patients.

When my EMR system went down, it brought back memories of my paper charts and how I was able to adequately evaluate and manage my patients’ complex problems without relying on software that could be compromised or unavailable during the course of treatment.

As bad as the system failure seemed at the time, it forced my staff and me to adapt and prioritize what was best for each of my patients until the records returned.

Ultimately, we saw the temporary loss of our EMR system as a learning experience that would make us more efficient in managing unanticipated events going forward. We implemented new protocols so that the next time it happens we will be better prepared to transition to back-up procedures and manual processes. We no longer fear that a software glitch or power surge might result in a complete shutdown of our patient care.

In this Digest we examine equipment and medical device (EMD) malfunctions and misuse. Some of the issues and concerns arising from EMD events are similar to my EMR experience and some present new and unique challenges. The important takeaways for handling almost any unanticipated event is to (1) implement protocols and procedures ahead of time whenever possible so that staff is prepared when they happen, and (2) follow the advice from OMIC’s risk management experts in order to mitigate the risks of lawsuits after events occur.

As we adopt new technologies we will rely on our team of technicians, nurses, and managers to ensure equipment is calibrated and maintained properly. We must train our staff to handle systems failures calmly and appropriately so that patients have confidence that their best interest and safety are our first priorities.

Xen

This is a sample form for XEN. Click on the name of the form or the download button to access it.

This form was revised on 2/21/20 to state that Xen includes gelatin derived from pigs. Some patients may have religious reasons to decline such an implant. We recommend you disclose this information to the patient.

We would like to thank Dr. Ansari and his team at Ophthalmic Consultants of Boston for developing and sharing his practice’s glaucoma forms with us. We made some content and formatting changes.

Tube surgery

This is a sample form for Tube Surgery. Click on the name of the form or the download button to access it.

We would like to thank Dr. Ansari and his team at Ophthalmic Consultants of Boston for developing and sharing his practice’s glaucoma forms with us. We made some content and formatting changes.

Trabeculectomy

This is a sample form for Trabeculectomy. Click on the name of the form or the download button to access it.

We would like to thank Dr. Ansari and his team at Ophthalmic Consultants of Boston for developing and sharing his practice’s glaucoma forms with us. We made some content and formatting changes.