Keeping an eye on standards

Press Article from The Irish Medical Times

Greg Baxter speaks to Dr Steve Schallhorn of Optical Express about driving clinical governance standards in the laser eye surgery industry.

Optical Express, the leading provider of laser eye surgery in Europe, may not face the complexity of services doctors face every day in acute hospitals or GP surgeries, yet its priorities as a healthcare business have, according to the chief medical director, put the company in a position to lead the industry globally in standards and volume within three to five years.

Dr Steve Schallhorn met with Irish Medical Times last week as the company announced a major expansion, in number, of its treatment and consultation clinics in Ireland.

Worldwide, the company has plans to open 20 to 35 new facilities over the next 18 months, bringing the total number from 60 to 95.

Dr Schallhorn is, in more than just the field of refractive Surgery, a pretty famous guy. Before the interview, I was told on several occasions by his PR handlers that I might like to write about the fact that he is a retired naval aviator who flew at the Naval Fighters Weapons School in Miramar – which everyone knows as Top Gun.

In fact, he was the advisor to the screenwriter for the movie. I had expected to encounter a man with a flat-top haircut and Ray-Ban aviator shades who would turn every conversation toward inverted dives with Migs and jet wash – the kind of man who tries to sell himself rather than the business. Dr Schallhorn, however, never mentioned his aviator past. More reserved and focused, less maverick, he says he is passionate about growing the business, driving clinical governance standards in the industry, and helping people.

There are two things that distinguish Optical Express from its competitors; the two priorities that drive its success as a business – a zeal for clinical governance and a commitment to an industry-best IT infrastructure. Dr Schallhorn is the head of the international medical advisory board – made of experts in the field – that provides oversight and clinical guidance for the clinical operations of Optical Express.

“It starts with the experts in the field. They take and review all aspects of clinical practice of refractive surgery. From that, it is promulgated to the surgeons and clinics.”

Guidance includes gaining consent from patients, the indications for surgery, who is eligible, how patient follow-up is conducted, how treatment should be managed and how surgeons should be trained and evaluated. “Certified surgeons provide the procedure. They are trained and have all the credentials, and are licensed (registered by the Medical Council) in Ireland.

“That’s just the start of it. Then there is specialised training. We also have large medical education meetings with the surgeons for continuing medical education. We take the qualifications of the surgeons and optometrists seriously, and we monitor their outcomes. I don’t know of any medical organisation that more carefully monitors the outcomes of surgeons than Optical Express.

“It’s in our best interest to provide the best, safest procedures possible – to make sure the best patients are operated on, and they’re followed appropriately.” Dr Schallhorn said Optical Express prizes its focus on audit.

“We do it with a much greater intent and rigor than our competitors. We have data on every patient who has come through. We have an electronic patient record system, so we track every patient outcome. Patients are offered follow-up for as long as they want. We follow all patients for six months to a year, but we offer long-term follow-up after that.”

According to Dr Schallhorn, investment in IT makes it all possible. He said the importance of IT to Optical Express was and ‘larger than for any organisation I know of. Hugely important’.

“In order to do the kinds of things we want to do with clinical governance, the IT system has to be second-to-none. It has a complete electronic medical record system. I have at my fingertips every patient’s outcome. I have hundreds of thousands of outcomes at my fingertips. We have a biometrics team. All they do is analyse the clinical outcome. We electronically track almost every aspect of the patient’s procedure. We even give patients questionnaires, post-op, and we track that. We have the highest percentage of compliance with post-operative surveys of any large corporate provider. So we can track what the patients think of us, their surgeon, their experience.”

Dr Schallhorn said the IT system, along with the volume of procedures that take place at Optical Express, will ensure that the company is driving standards of care in refractive surgery.

“My guess is in three to four years, we’ll be driving this industry and the largest provider of refractive surgery in the world,” he said.

Dr Schallhorn said it was a myth that refractive laser surgery was the single field in healthcare where the costs went down. He said price wars in the US contributed to a drop in prices, but staying on the cutting edge of technology required money, and he expected costs of the procedure, in general, to increase in line with other elective surgeries.

Two lasers are used in the procedure. Each costs about a million euro, and for every procedure, Optical Express pays the manufacturer a fee of hundreds of euro. An Optical Express theatre can see up to 20 patients in a day, at around a cost of and €600 an eye.

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