Digital tools are coming to ophthalmology, and the challenges of their integration into daily practice took center stage in our Day Three highlight session at the 2024 Annual Meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2024)—Navigating Real World Obstacles to Digital Transformation.
This symposium focused on the evolving use, need and application of cybersecurity and other powerful digital tools like AI and the blockchain in the modern ophthalmic practice.
Moderated by Dr. John Hovanesian, the symposium explored these technologies through the lens of challenges in staffing, training, infrastructure and data management. Each talk was followed by audience Q&A and the discussion among panelists Drs. Robert Weinstock, Ryan Smith, Jennifer Loh, Robert Chang and more was lively.
In his opening remarks, Dr. Hovanesian described the purpose as an “informal but informative talk with experts, both from our committee and from industry, to share with us real-world stories and how they overcame problems that they faced.”
What ensued would prove a far-ranging presentation full of pearls of wisdom and insightful contributions from both audience and panel on the digital age in ophthalmology.
Weathering change together
Leading off was Dr. Grayson Armstrong of Massachusetts Eye and Ear (USA) with Human Tech Troubles: Why Robots and AI won’t Steal the Show in Healthcare. Dr. Armstrong’s presentation delineated a number of friction points to the adoption of IT in ophthalmic practice based on his own experience onboarding new technologies to improve workflow during the COVID-19 pandemic.
Dr. Armstrong established from the outset that his fandom of recent developments in AI is his belief in its ability to improve the industry for the better. “There’s amazing sensitivity and specificity for disease detection. And we have a lot of data that shows that these are safe and effective. So much so the FDA has now approved three devices for autonomous diagnosis of diabetic retinopathy.
“The studies also show [AI systems] to be really good for clinical patients facing disease detection. They improve efficiency, improve our workflows, decrease health care costs and disparities and overall maintain or improve healthcare quality. It’s not the technology, that’s the problem–the only thing holding us down are people. We have a people problem.”
Dr. Armstrong went on to enumerate and describe several such people problems: General resistance to change, increasing patient influx vs. physician efflux, staff skill and training gaps, staff burnout, lack of leadership and a ‘not my problem’ attitude of indifference towards digital change.
As solutions, he offered a number of practical tips. These include increased staff engagement, improved communication and feedback, frequent reminders and retraining, tracking of outcomes and pitching new tech to various stakeholders as a solution.
Using tech to train better teams
Co-Founder and Chief Medical Officer of Alchemy Vision Dr. Mitch Schultz (USA) was next with his presentation, Leveraging Technology: Principles of Training People. This talk touched on the close-to-home problem of endemic ophthalmic staffing shortages and the potential role for tech-based remedies.
To emphasize the present manpower shortage, Dr. Schultz offered some sobering statistics. Notably, the ophthalmology workforce has decreased 12% since the pandemic while patient demand has increased by 27% leading to a 20% annual turnover rate.
Addressing this shortfall has taught Dr. Schultz the importance of teamwork. “A great surgeon is a great surgeon but if you don’t have a great team, you can’t have a great practice,” he said.
Dr. Schultz believes the solution lies in a combination of traditional and digital approaches. First, he recommends structural improvements to the hiring and career-advancement process. Doctors should be transparent about salary and job expectations but should also lay out a detailed career path with specified, realistic milestones should new hires wish to remain with the practice. These can be shown and tracked digitally during regular reviews.
Dr. Schulz believes that technology also holds the answer for another clear staffing need— effective training resources. Citing the dearth of brick and mortar ophthalmology assistant training courses available out there, Dr. Schultz points out the success his firm, Alchemy Vision, has had producing engaging KOL-taught video courses.
The price of information insecurity
The next segment involved a serious pivot in tone from, as Dr. Hovanesian put it, “the inspiring art of training people to the terrifying skill of dealing with data breaches.” The presenter for this alarmingly ubiquitous topic of modern-day healthcare discussion groups was Dr. Sydney Tyson.
In one of the more visceral talks of the afternoon, the New Jersey-based cataract surgeon laid out the clear and present dangers of the current ransomware scourge in both statistical terms and through his own harrowing story.
“I’m part of a large organization called Prism, which is a private equity group. It’s 30 divisions, it’s 60 different offices, 180 doctors, and you would think that their IT department was pretty robust. But the problem is that there’s always threat actors out there. There’s always somebody looking for a payday,” Dr Tyson said.
One critical point in his talk was the special attention ophthalmology practices receive from cybercriminals. “Our companies are health care companies and our data is twenty times more valuable to a criminal than any other data out there. Why? Because it’s non-fungible. It’s not like a credit card number where you can shut it down…and we’re legally liable for the security of that data,” he said
Offering a blow-by-blow description of an attack on his EPM and EHR systems, Dr. Tyson painted a grim picture of how his practice was left hemorrhaging revenue and fielding ghost visits.
To underscore the vulnerability firms like his face on a daily basis, Dr. Tyson explained that the breach had not resulted from someone in his office opening spurious email attachments, but from the exogenous weakness of the third-party IT firm they dealt with.
Best practices and realities
So what’s a firm to do when facing such a costly breach? Building on the theme of responsible cybersecurity, Wes Strickling, CEO of codexIT (Ohio, United States) took the stage to present his discussion, Managing IT in a Growing Practice. Mr. Strickling’s talk was a nuts and bolts discussion of how eye care practices need to handle IT challenges in order to scale up successfully.
Mr. Strickling first laid out the technical requirements of any practice–software, hardware and IT services–discussed the vulnerability of each to malicious actors and best practices for mitigation.
Like Dr. Tyson, Mr. Strickling did not mince words about the threats faced by practices of all sizes due to exogenous vulnerabilities. Queried by one audience member about how often ransomware attack victims pay—despite FBI guidelines against paying off the perpetrators— Mr. Strickling’s response was immediate and unequivocal: 100%.
“There’s best practice and then there’s reality. When you’re a small medical firm, the fact is you need to be up and running,” he said after this shocking revelation
Mr. Strickling offered some simple guidelines that practice owners can follow. Clear, written IT security protocols and a hybrid approach to in-house vs. outsourced IT security is the best way to balance control with efficiency, he noted.
Data ownership and security
Dr. Eric Rosenberg, DO, MSE, was the afternoon’s final speaker. His talk, Data Ownership: Interoperability and Integration was a forward-thinking (and upbeat, for a change of pace) look into the future of the blockchain in data security and ownership.
Dr. Rosenberg’s starting point was that patients and surgeons in the United States and beyond are facing a mounting data problem. Patient records are currently stored by large institutions in various states with differing rules and regulations. Furthermore, these records are not only vulnerable to data breaches, but patients also have little say over how their records are unwittingly and frequently exploited.
Dr. Rosenberg’s solution essentially entails beating the hackers at their own game by using the very same technology to safeguard medical records that currently powers the cryptocurrencies in which ransomware pirates are paid.
“When it comes down to cryptocurrencies, because of this, right, we see this as something bad or dark or something that obviates the responsibility that they’re holding something from you hostage. But the truth is, we can leverage this technology to protect ourselves and it’s time we do so. Blockchain technology itself creates a method for decentralization, allowing that information or transactional records to be stored in distributed databases.”
In a similar vein, Dr. Rosenberg proposes using blockchain tokens to safeguard credentialing.
“There’s something called sole-based tokens, where, let’s say, you know, I went to fellowship in New York City and Cornell can give me a soul-based token saying, ‘congratulations, you completed fellowship’, and then it’ll go into my digital wallet.”
From there, Dr. Rosenberg expounded the idea of patient’s owning their data in an encrypted digital healthcare wallet. “So we can all have a digital wallet, with EHR, genomic data, wellness data. Your wearables that you have on your arms, and wrists, and carry around the cell phone, we can store all that data, and the patient can be the owner of that–you, me or anybody else, we can pull in the data that relates to ourselves.
“And it’s all in one place. It’s organized and fully accessible to the owner. The owner can also receive personalized insights based on that data, depending on how they let people access it,” he said.
Overall, while there are certainly obstacles in the digital transformation of one’s clinical practice, it is also important to recognize that solutions abound–solutions that are constantly evolving and expanding.
Editor’s Note: The 2024 Annual Meeting of the American Society of Cataract and Refractive Surgery (ASCRS 2024) is being held from 5 to 8 April in Boston, Massachusetts. Reporting for this story took place during the event.
