The end of an era
Shortly after I began as your chair, our CEO for the past 21 years, Tim Padovese, announced that he would be retiring effective February of 2024. While not unexpected, the news is sad for OMIC but exciting for Tim and his fantastic wife, Karen, as this is well deserved. I wanted to highlight for our members Tim’s accomplishments as our CEO.
Read my entire message in the Digest.
An inflection point for OMIC and the nation
I have spent my entire career in the trenches advocating for our patients and profession. As ophthalmologists, we’ve been engaged in a valiant fight to defend the facts we all know to be true – ophthalmic surgical practice requires the training and education achieved during our years of medical school, residency, fellowship, and hands-on experience. Yet, we now feel pressures to delegate complex procedures, including surgery, to ancillary providers. This should concern us all.
Read more in the 2022 Digest Vol 32 N0 1.
The year of vision
This was supposed to be the year of vision; 2020 began with so much promise for our profession yet we had no idea what was hiding in plain sight. A virus, COVID-19, would force a dramatic, almost complete shut-down of our nation and our practices. Non-urgent care and elective surgeries were cancelled. Our teams were sent home. We were simply waiting it out and in survival mode.
I know many of you felt like I did. How do I keep my practice afloat and my staff employed with my clinic closed down? It was a sinking feeling to think we might not make it through this unprecedented event.
As a leader for both OMIC and the Academy, I am focused on our future, post COVID, and what we can do to mitigate threats to our livelihoods. I am clear-eyed about the challenges we face, but also optimistic that through crisis we will persevere, emerge stronger, accelerate change, and improve care.
The future of eye health is now and OMIC will continue to add resources that reflect our new realties and enhance safety protocols. Regarding medical training and education, our ophthalmic community implemented new methods of instruction, rethought our approach to assessment, and identified new ways to achieve competencies that are more in line with a modernized world. The Academy just completed a highly successful virtual meeting without skipping a beat. Let’s focus on these achievements and strive to improve our systems to meet the challenges of tomorrow.
I would like to take this opportunity to recognize Anne M Menke, RN, PhD, a key employee of OMIC for many years who will be enjoying her well-deserved retirement beginning in 2021.
You’ve seen Anne’s name appear in almost every OMIC Digest published over the past 17 years. You’ve also perhaps spoken with her on our confidential risk management hotline or at one of the many ophthalmic society meetings where OMIC has presented valuable information to help us protect our patients.
To say Anne has had a significant impact on our practice of ophthalmology would be an understatement. Her influence is evident in many of our most recognized resources for insureds. She perfected our “safety net” to prevent retinopathy of prematurity (ROP) and her dedication to patient safety undoubtedly helped save the sight of infants and adult patients in our care.
Steven Brown MD
I would also like to recognize the many years of service of Dr. Steven VL Brown, MD, FACS, who will complete the maximum number of years allowed for OMIC Board and Committee members. He has been an insured ophthalmologist since OMIC’s inception in 1987. We view these members as the founders of OMIC. Steve has been a board member since 2003 and past Chair of the Underwriting Committee. He recently served as the Chair of the Nominating Committee, and Vice Chairman of the Board.
Few ophthalmologists have given so much back to our profession as Dr. Brown. I speak for the entire OMIC Board in saying how much his presence will be missed at our great company.
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.
Message from the Chair
GEORGE A. WILLIAMS, MD, OMIC Board of Directors
Stuff happens.
At the most basic level, insurance is a rather simple business involving the assumption of risk. The risk may be a hurricane, car accident, fire, illness, or medical liability. Virtually anything can be insured. In order to assume risk, we must understand the probability that an adverse event will (not may) occur. That probability is then applied across a covered population. The cost of risk is determined by frequency (how often) and severity (how much in cost) of an adverse event. The cost is distributed across the population as individual premiums and deductibles.
Every service we provide our patients has risk and, regardless of how hard we try, there is no way to completely eliminate it. Simply put, stuff happens. Among the most feared risks for an ophthalmologist is endophthalmitis. Fortunately, the frequency of endophthalmitis is low. Unfortunately, the visual consequences of endophthalmitis are often dire and therefore the severity may be high. This issue of the Digest discusses the OMIC experience with endophthalmitis.
The low frequency of endophthalmitis sometimes leads to surgeons’ complacency or even denial. We all know the signs and symptoms of endophthalmitis, but we may think or hope that the post-procedure inflammation we see is sterile. Since endophthalmitis is a recognized complication, when it is recognized and treated in a timely manner, OMIC rarely loses a lawsuit regardless of outcome. Such cases are vigorously defended. Conversely, we almost always lose when the diagnosis or treatment is delayed.
Although we can’t eliminate the risk of endophthalmitis, we must do all we can to minimize the risk. Attention to sterile technique has always been critical, but as Anne Menke notes, so is patient engagement. An engaged, educated patient is our first line of defense.
The face of endophthalmitis is changing. Historically, the most common cause of endophthalmitis has been cataract surgery. With the explosion of intravitreal injections, that is certain to change. We know from the IRIS Registry that the incidence of endophthalmitis following both cataract surgery and intravitreal injection is approximately 1 in 2,000 procedures.
However, injections far exceed cataract surgery and continue to grow. Already the IRIS Registry has recorded over 10,000,000 injections. The power of such large numbers provides OMIC with a potent risk management tool. That is why OMIC has been a strong supporter of the IRIS Registry.
This support is another example of the unique synergy between OMIC and the American Academy of Ophthalmology. Of course, this is one of the many advantages OMIC has over other malpractice carriers; just what you would expect from a company of ophthalmologists for ophthalmologists. When stuff happens, OMIC will be there for you.
