Better, stronger, faster

Texas Retina Associates leverages innovative technologies to improve efficiencies and maintain stellar patient care.

Ashkan M. Abbey, MD (center), discusses diagnostic test results with Medical Assistants Lori Dowell, COA (left) and Gabriela Mendoza, COA (right).

“We have the technology. We can make him better than he was. Better, stronger, faster.” This quote, which introduced the 1970’s TV classic, “The Six Million Dollar Man,” could easily apply to Texas Retina Associates, a 52-year-old practice with multiple locations in the Dallas area. With the addition of innovative technologies, including patient intake tablets, drug-assistance technology, and a “smart” refrigerator, the practice “has really increased operational efficiencies, while maintaining our high level of patient care,” says William T. Koch, COA, COE, CPC, administrative director of the practice.

Here, the staff members of Texas Retina Associates discuss how these advances in technology have made the practice “better, stronger, faster.”

Streamlining patient intake

The patient intake process was one area where the practice identified operational inefficiencies. In the past, for example, “the front desk staff would hand patients a clipboard of papers, which they had to fill out manually and hand back to a staff member,” Mr. Koch says. “From there, the staff had to manually enter all the patient information into our practice management and EHR systems. It was time-consuming.”

To streamline patient check-ins, the practice adopted a digital patient-intake tablet (Phreesia) that includes, among other features, patient paperwork (such as insurance information), a credit card reader, and an electronic platform patients may use to complete necessary pre-appointment paperwork.

Phreesia’s menu-driven workflow guides patients through a series of questions that most often requires the patient to answer by checking boxes, rather than writing out their answers. In addition, the tablet is “a lot easier to read than handwritten paperwork,” Mr. Koch says.

Ann Mungioli, COA, Texas Retina Associates’ patient services supervisor, adds that Phreesia has freed up staff to spend additional time on assisting patients. “Most of our patients are elderly, so they have vision or dexterity issues,” she says. “Because we no longer have to spend time typing their answers into the EHR system, we can sit with them, if needed, and help them enter their information into the tablet. Also, it’s worth noting that our elderly patients have actually been the most successful in adapting to Phreesia.”

Mr. Koch says that Phreesia’s payment platform, which includes a credit card reader, has “dramatically increased” time-of-service patient collections. The platform relieves the staff from discussing billing and payment matters with patients, an area where the practice has sometimes struggled.

Prior to the launch, Ms. Mungioli and her fellow staff members used “test patients” to learn the system. To increase the likelihood of success during the roll out, the practice shifted an additional staff member to check in. In addition, Ms. Mungioli worked exclusively at the front desk during the first few weeks the system went live so she could assist staff while they acclimated to the tablet.

The staff used Phreesia-provided scripts to introduce the system to patients. The scripts also assisted the staff with its operation. Ms. Mungioli attributes the success of the implementation, in part, to the fact that the practice “was not forcing” the system on patients.

“We help and encourage patients, but, if we have a patient who is just not comfortable using the system, we go back to doing manually what we need to do,” Ms. Mungioli says.

In sizing up the impact of the patient intake system, Mr. Koch says, “We’re spending less time on administration and more time on patient care. That’s the bottom line.”

Simplifying patient assistance programs

The practice found inefficiencies in other areas, including the submission process for pharmaceutical companies’ patient assistance programs and the paperwork involved with providing in-office treatments.

Medical Assistant Gabriela Mendoza, COA (left) helps a patient with Systeem Connect, an automated patient payment assistance program.

Medical Assistant Sarah Osborn, COA, enters her secure password for access to the Cubixx refrigerator/inventory management system.

“When using a paper consent form, for example, we had to look up the patient’s diagnosis, their medications, have patients sign related paperwork, and then scan the forms into the EHR at the end of clinic,” says Gabriela Mendoza, COA, OSC, a scribe at Texas Retina Associates.

To solve this problem, the owners of Texas Retina Associates created a patent-pending tablet-driven technology called Systeem Connect that virtualizes these processes. Here’s how it works: After the doctor prescribes a treatment, such as an anti-VEGF drug, a scribe or tech signs into the tablet, which is connected to the practice’s EHR, and locates the patient record. Once the record is found, the password-coded system identifies all the possible assistance programs available to the patient. The system also provides associated paperwork, including any consent, statement of medical necessity, and income declaration forms.

“Now, the patient signs their paperwork in one spot, we click ‘submit,’ and it’s saved to the EHR,” Ms. Mendoza says. “Our workload has significantly decreased because we don’t have to physically look for and gather the necessary forms, amass patient information, and scan the forms.”

Mr. Koch adds that the process has gone from 20 to 30 minutes per patient with paper to two to three minutes per patient with Systeem Connect.

As is the case with the automated patient intake system, Ms. Mendoza says that Systeem Connect has allowed her and her fellow staff members to spend more one-on-one time with patients.

“We can now sit with patients and more fully explain the treatment plan, why it’s important, what patient assistance programs are available and how they work, and personally ask and fill in all the necessary information to submit patient assistance program applications for the patient right on the tablet,” she says. “I think that’s a valued service, because a large part of our patient demographic is older than age 65 and appreciates having someone helping them with this process. Also, I think patients are more likely to continue their treatments if they’re well informed about their condition, which is what the tablet allows us to do.”

Ms. Mungioli says Systeem Connect has also increased accuracy, thanks to its ability to automatically populate patient information from the practice’s EHR.

A “smart” solution for drug inventories

Much of Texas Retina Associates’ patient population requires anti-VEGF drugs, among other therapies used in-office, that must be refrigerated. In the past, these drugs were stored in a standard mini-fridge and managed via Excel files and manual accounting. This system resulted in the staff spending an inordinate amount of time receiving, dispensing, and monitoring this inventory.

“It was just disastrous,” Mr. Koch admits.

The practice found a solution in a refrigerator/inventory management system (CubixxMD, Besse Medical). Besse Medical and its partners pre-tag each drug, which is serialized and lot tracked, and deliver it to the practice for storage in the CubixxMD RFID Cabinet. From there, the system automatically reads each drug’s RFID tag and tracks and scans drugs as they are added to and taken from the refrigerator.

To access the CubixxMD RFID Cabinet, staff members must enter their own unique code on the device’s LCD screen and then select the patient’s name from the system’s practice schedule. (CubixxMD integrates with EHR and practice management software.)

In addition to keeping track of inventory, the “smart” refrigerator also provides alerts on temperature changes and expired inventory and detailed usage reports. Finally, users can access the CubixxMD data online.

In addition to the operational efficiency the CubixxMD has afforded the practice, Ms. Mendoza says that it has prevented patients from coming in too soon for their treatments. “Some patients’ health insurance has a 28-day global period before they can undergo another injection, for example. CubixxMD has enabled us to eliminate and discuss some of the ‘too-soon’ appointments, because, once you select the patient’s name, the device will ask you which eye and then check the global period.”


Texas Retina Associates credits its “bottom-up” management style with the successful implementation of new technologies in the practice.

“We listen to our staff; we always go to our staff. Even our CEO won’t make a decision sometimes without consulting with mid-level managers, supervisors and ancillary staff when appropriate,” explains Mr. Koch.

The steps involved in this management style include:

  • Forming a committee. Texas Retina Associates’ leaders create a committee comprised of front desk representatives, the senior clinical director, administrators, and others for their input at the outset. “Every single piece of the practice is represented at these meetings,” Mr. Koch says.
  • Meeting often. The practice committee starts out meeting daily for a few months, then weekly, monthly, and eventually, roughly every three months to stay on top of the technology implementation process. “There is a lot of communication when the technology first comes on, including staff education and training, having conversations with our individual teams to figure out how the technology will work in that area, and more,” explains Ms. Mendoza.
  • A measured launch. Texas Retina Associates starts a technology in one practice location then slowly rolls it out to the other practice locations, says Ms. Mungioli. “We have our employees come from the other locations to practice at our main office, and we make sure everyone knows what’s going on before we roll it out elsewhere.”

Staff training for CubixxMD takes roughly five minutes, and integrating it is a matter of finding a spot and plugging it in, says Mr. Koch. “More of the CubixxMD training was at the administrative level regarding all the device’s reporting capabilities, and we had multiple meetings with the company and their trainers to teach us how to run the different reports and understand what those reports mean.”

Tearing down silos

One bonus of the technologies is that they have “torn down silos among the different areas of the practice,” Mr. Koch says. “Staff is communicating better with the billing office because they’re starting to speak the same language; the eligibility and authorization people are communicating better with the clinical staff, because the clinical staff are required to understand the authorization process.”

At the front desk, Receptionist Kerra Scrimshire demonstrates the Phreesia patient intake system to the patient.

In addition to improving staff communication, it’s another benefit that drives efficiency, improves patient care and in short, builds a practice that is “better, stronger, faster.” OP