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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 3. April 2006

Business Tip: Staff Meetings

Whether you are a sole operator with just one support staff or are a partner in multiple practices, regular staff meetings are essential for communication. Be sure to take part in the monthly survey!

Read on for more.


 
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IT Tip : Questions you need to answer before you start going paperless.


Richard Rees is back! When he took over my IT needs about 6 years ago we were a mess. I had not sought out the appropriate information before we had started

Read on to find out the answers.

 

 

 

Visit Lookup for all your IT needs

 



Therapeutic Review: Atypical Blepharitis
Dr Anthony Maloof (Anterior Segment & Oculoplastic surgeon) goes into detail about the masqueraders of blepharitis

More Detail.


Business Tip: Staff Meetings

Holding regular staff meetings we have found creates more effective communication with less misunderstanding between staff members. In the end, the proprietor wins, the staff win and very importantly your patients win. If you do not have a regular staff meeting actually scheduled, start immediately from this week.

Our staff meeting is between 4.00 - 5.00pm every Wednesday. In fact our office hours clearly show that we close our practice every Wednesday at 4.00pm.

On average three out of the four meetings every month involve a small report in most areas of the practice to bring all staff up to date. The fourth meeting will normally be devoted to staff training such as:

  • Contact Lens insertion and removal
  • Contact lens solutions and proper disinfection protocol
  • Puff tonometry
  • Visual Acuity testing
  • The list can go on and on...

In a previous newsletter I discussed how each staff member is responsible for certain areas of the practice. Each area leader gives their brief of what happened last week and what might be expected the following week.

These meetings are a great opportunity to fine tune procedures. A recent example was:

  • I had noticed that our frame sales had dropped off.
  • The number of spectacle jobs that were being put through was about the same as always
  • We brain stormed possible techniques for encouraging frame sales

The following conclusions occured:

  • No old frame would be used without getting patients to sign disclaimers for possible breakage
  • All old frames would be carefully looked at and faults like frame corrosion etc would be brought to the attention of the patient
  • The result was an immediate increase in our frame sales.

This little activity occured as a direct result of the staff meeting where all staff participated. It was inevitable that any action that was agreed on would work, because the staff were responsible for coming up with the solution to the problem. When they contribute to the process they own it and believe it. I can guarantee you that if I had come up with the idea and then just told everyone to implement it, the result would never have been as effective.

Getting staff involved in the every day decision making processes of the practice is an invaluable tool in helping your practice grow. Contributing and taking responsibilty for ones contribution will always inspire one to do their very best rather than just be a member of the payroll.

In summary:

  • Start weekly staff meetings immediately
  • Hold staff meetings during your normal office hours OR
  • Pay your staff an extra hour a week to come to the meeting
  • Encourage everyone to take notes of occurences during the week
  • Present the problems
  • Brainstorm the solutions
  • Prioritise three things to implement the following week
  • In no time at all you will notice efficiencies increase &
  • Most importantly stress levels for all will reduce
 

 

The 7 Critical Mistakes that

Most

Optometrists Make in Their Practices… And how to avoid them

By Jim Kokkinakis

www.kokkinakis.com.au

 

 

NEW FROM THIS MONTH.
OPTOMETRICAL POLL.

Contact lenses seem to be a frustrating topic for many practitioners. The poll below will anonymously collect our opinions. You can keep coming back to see how the responses are going. I guarantee your opinions will not be accessible to others. Only anonymous data will be collected.

 

 

 

 

 

 

 

 

 

 

 

 

 

 




Information Technology Tip by Richard Rees of Lookup

So far in this series, we’ve looked at the benefits of investing in technology, and secondly we discussed the basic ‘layout’ or topology of a small business network.

In this issue, we’ll dig a little deeper into some of the questions you should have answers for, prior to kicking the can and setting up your very own bleeding-edge IT infrastructure.

What is the network going to do?

In computer-talk, we would re-phrase this question to read “what services will be made available to users who have access to the network?”

Clearly, this question will be answered differently in each and every practice, but the ‘vanilla’ response would include things like:

  • Client and Practice Management Information. Typically this information would be accessed via Practice Management software such as Optomate or Sunix.
  • Diagnostic Images from Topographers and Camera hardware. Typically accessed via packages such as Medmont Studio or similar.
  • Access to shared printers (cheaper than buying 1 for each desk), files and other documents.

 

More advanced but equally as common would be access to services like:

  • Internet access for some/all users some or all of the time. Some practices prefer to restrict access to certain sites, lunchtime or after hours, or to certain staff.
  • Internal and external Email and other communications Software… removing the ubiquitous post-it note phone message.
  • Remote access to company resources from home enabling select staff to work from home or whilst on leave.
  • Shared scanner resources to access the efficiencies of a paperless office.

 

Why do we need to think about these things?

Each of these questions, and many more not covered here, will assist you in determining how best to resource your Practices’ unique IT requirements. By determining what services are to be accessed by your staff, we can ascertain the physical specifications of hardware sufficient to run your practice.

There is no point buying a $40K super computer to run a 2 person dispensing practice. Conversely, you’re dreaming if you think a $999 “entry level” server from your local Super Store is the right choice for an all-singing, all-dancing optom practice running all the bells and whistles.

Apart from the overall ‘grunt’ of the server, serious consideration need be given to storage capacity. Don’t go scoping out your hard-disk requirements based on current usage, if you intend upgrading your Fundus camera to a whiz-bang new 12 Mega Pixel jobby! We may need to allocate 20Mb of space per patient! And if you want to back those puppies up, we’ll need to consider backup strategies accordingly.

Are you going paperless? Again, how many documents do you currently have… how many can you justify converting to digital format? If you don’t access them now, will you access them simply because they’re online? If so, what resolution do we need, and how much space will each patient file take up?

If you’re going to allow staff to access the Internet, Email and are considering remote access to the practice, we need to assess a suitable grade of connection to the Internet. All of these services are cool, but won’t necessarily change your world if you’re running them on an unreliable, dial-up speed connection!

And if we do go broadband Internet access, what lengths should be taken to secure your network from external threats such as hackers, and viruses. What measures should be taken to curb Internet usage by staff during business hours.

Lastly, all of these great services are provided by appropriate software. It’s not uncommon at some sites for the Software cost to exceed the cost of physical hardware! So it’s important that we only get the packages we need to meet your real requirements. Again, this can only be determined by asking a heap of questions!

So what will it all cost?

Well, the point of this exercise is to give you the tools to start answering that question for yourself!

Deciding between what you need and what you want is the first step.

The second step is to contact us me at richard@lookup.com.au or at www.lookup.com.au

 

 

 

FOR YOUR KERATOCONIC PATIENTS

From February this year I have started a BLOG called Keratoconus. Many of you will know that I see many keratoconic patients and the misconceptions I encounter every day require discussion. Follow the link below, all comments are welcome. Your keratoconic patients are welcome to visit and comment also.

http://conicalcornea.blogspot.com

 

 

 

 

 

 

 

 

 

 

The graphic below shows how different components in your IT system require either performance or storage. So what is the bottom line? Surprise, surprise we keep needing more storage and more performance from our computer systems. If that is the case why not just buy the biggest & the fastest? The answer is you will waste a lot of money on things you do not need. A good consultant to do develop your IT is an invaluable investment.


Therapeutic Review: Atypical Blepharitis by Dr Anthony Maloof

Read this for Dr Anthony Maloof's biography

 

The previous segments reviewed blepharitis (inflammation of the eyelids). This is a very common condition, affecting a significant proportion of the population. Whilst the condition is very benign, the symptoms can be distressing and debilitating. However, there may be underlying disease processes which can present as blepharitis and are called “masquerade syndromes”. Some of these conditions can be life or sight threatening. This edition will cover the relevant conditions:

 

  • Systemic Lupus Erythematosis and Discoid Lupus Erythematosis
  • Sebaceous gland carcinoma
  • Molluscum contagiosum
  • Basal Cell Carcinoma
  • Parasitic Blepharitis
  • Recurrent herpetic blepharoconjunctivitis

 

SLE

SLE is a chronic multi system disease featuring the production of auto antibodies. It occurs frequently in women, with the peak age of onset in the 30’s. Possibly due to abnormalities with auto regulation, auto antibodies such as antinuclear antibodies, anti cell membrane antibodies, and immune complexes are formed. These cause local tissue damage. Double stranded DNA auto antibodies are highly specific for LE and correlate with disease activity. The most common cutaneous feature of SLE is an erythematous rash, which can appear on the nose and cheeks in a “butterfly” distribution, and on the neck and extremities. The eyelids may feature telangiectasia just above the eyelid margin. Episcleritis or scleritis is not an uncommon finding, and can be the presenting sign of the disease. The episcleritis responds well to topical steroids. Necrotizing scleritis is less common than in other systemic vasculitis disease. Anterior uveitis is usually present in association with scleritis. Although report with SLE, LKCS (Lacrimal Keratoconjunctivitis Sicca) is relatively rare and usually mild in SLE.

Other features include arthritis and polyarthralgia. The most common findings involve the retina with cotton wool spots, retinal haemorrhages and retinal edema, probably all related to retinal vasculitis. Diagnosis confirmed by detection of auto antibodies.

DLE

Discoid Lupus erythematosis refers to a characteristic skin lesion, which is sharply demarcated, raised, erythematous and scaly. It may exhibit follicular plugging and telangiectasia. The lesion may be seen in isolation or in association with SLE. Central scarring produces depigmentation and permanent loss of appendages. This lesion can affect any part of the body, and commonly affect exposed areas such as the face and scalp. The lesions may affect the eyelid skin, and can extend over the eyelid margin to the conjunctival surface, with secondary scarring. About 5% of patients with DLE will progress to SLE, although about 20% patients with SLE will have DLE lesions. Diagnosis is made via biopsy.

Sebaceous Gland Carcinoma

These are rare oil gland carcinomas, with a predilection for the eyelids. They have a tendency to metastasise, unlike other periocular tumours. Upper eyelid tends to be more involved than the lower, however there is often diffuse spread to the lower eyelid. The Tumour is WELL RECOGNISED to be a masquerade tumour, presenting as chronic blepharitis or recurrent chalazion. Any recurrent chalazion should alert the possibility of sebaceous gland carcinoma. This tumour has an aggressive behaviour, and combined with significant morbidity and mortality, requires urgent diagnosis, which is made via biopsy and staining with Oil red O stain. The margins of this tumour are diffuse, and it may feature a pagetoid type spread, leaving areas of tumour free zone between clumps of tumour cells.

Basal Cell Carcinoma

This is the commonest of the periocular tumour (accounting for >90% of all periocular tumours), and presents commonly in the lower eyelid as well as the medial canthus. The tumour may present in BOTH young and older patients, although it’s greatest incidence is in patients >45 years of age. The clinical appearance of a BCC is wide and varied. It is described as presenting as nodular, noduloulcerative, ulcerative, cystic, morpheaform, pigmented, linear as well as micronodular. The most common lesions are nodular, and relatively easy to diagnose. However, recurrent BCC or morpheaform BCC present in a much more indolent fashion, and a high index of suspicion is required. Loss of eyelid lashes (madarosis) is the key feature of morpheaform BCC involving the eyelid margin. If the tumour involves the skin of the eyelid, ectropion may occur. Chronic focal blepharitis resistant to treatment may also be a presenting sign of BCC. Diagnosis is made by biopsy, and Mohs surgery is the gold standard for tumour removal.

Molluscum Contagiousum

Molluscum is a pox virus that commonly infects the eyelid margins. It occurs commonly in adolescents and young adults, and is spread by close contact. It is a pearly white nodule, raised, round, non inflamed lesion with craterous centre. Conjunctival lesions can also occur and small white pimples containing caseous material on an erythematous base. Chronic follicular conjunctivitis can occur. The centre of these lesions is curetted out and histology confirms the diagnosis.

Parasitic Blepharitis

Phthirus pubis (pubic lice) have a predilection for lashes as well as pubic hairs because for the appropriate spacing of the cilia. Infection of the eyelid termed “palpebral phthiriasis” is a severe blepharoconjunctivits causing itching, irritation, redness of the lid margins as well as conjunctiva. Careful examination of the lid margins is required to establish the diagnosis. Eggs from the lice termed “nits” are small ovoid bodies stuck to the lashes. Treatment is by mechanical removal or physostigmine ointment.

Herpetic Blepharoconjunctivitis

Blepharitis is a less common form of recurrent herpetic disease, which usually manifests as keratitis. It may appear as isolated vesicles or groups of vesicles, with multifocal inflammation and ulceration. The key to the diagnosis is the variability of the presentation, occurring over 1 week or so. Secondary madarosis may also be present, confusing the diagnosis with possible BCC. The development of ulceration is called ulcerative blepharitis. Diagnosis is made by detection of antigen or polymerase chain reaction (PCR) testing. PCR tests specifically for genetic markers.

Anthony would welcome your enquiries at:

Email: drmaloof@cornea-eyeplastics.com.au

Phone: 1300 303 669

Rooms (Sydney city):

Suite 13, Level 9, William Bland Building, 229-231 Macquarie St Sydney 2000

Rooms (Westmead):

Suite 7, The Ashley Centre, 1a Ashley Lane, Westmead 2145

Atypical Blepharitis deserves to be in a whole days seminar. Register your interest for Ocular Therapeutics 2006 , which will devote a session to the diagnosis and management of this ocular disease. Efficient implementation of ocular therapeutics is another great way to differentiate your practice and thus make you more profitable.

 

 

 

 

 

 

DLE lesions

Sebaceous Gland Carcinoma

Basal Cell Carcinoma

Molluscum Contagiosum

Nits

Lice


 

 

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