50^th ANNIVERSARY

THE FUTURE OF EYE CARE DELIVERY

A PROJECTION OF HOW THE INDUSTRY WILL CHANGE THROUGHOUT THE NEXT 50 YEARS

SCOT MORRIS, O.D., F.A.A.O., CONIFER, COLO.

I AM a little bit of a futurist at heart, so recounting the advances our profession has achieved throughout the last 50 years makes me ponder the next 50. With all the current changes in technology and health care reform, I predict that who we are as a profession and how we practice in the future will look very different from our past.

But before I begin, let me say this: I do not have a crystal ball. The following postulations are largely my educated opinions only. You can discount what I say or maybe even marginalize it; but there is no denying that these changes may very well be coming. And how we, as a profession and as individuals, navigate them will determine our survivability and, ultimately, our success and happiness.

BUSINESS REPORTING

I believe that increased competitive pressure to run a smart and more efficient business model will drive the development of real-time, comparative data of not just your business, but all other similar business models.

As a result, I see a single, unified national health care database in the near future, where all information will be stored in one place and accessed universally. Additionally, I believe the business analytics of how your business actually runs, how efficient it is and what value-based medicine you can produce will become the mainstay of American health care systems. Further, I predict future technology will allow us to access and process a tremendous amount of consumer data — even more so than today — including consumers’ purchases, shopping trends and lifestyle habits (more on that later). This data will be crucial to all aspects of business, including hiring, purchasing, pricing and general operations.

WORKFORCE CHANGES

Increased competitive pressures to have greater operational throughput will likely require increased staff utilization and delegation. Currently, an increasing percentage of our workforce is job sharing or working less than a traditional 40-hour workweek, and I think that will continue to evolve. In fact, given this current trend, I think there will be a need for many more providers to fill the same “hours” that our current workforce is occupying. This could lead to greater deployment of virtual or online staff in the near future.

INVENTORY MANAGEMENT

I believe that one of the most exciting and necessary changes will be how we oversee inventory management. Though the last decade saw increased proficiency via bar codes and QR codes, I see the utilization of embedded RFID and nanotechnology as the future for a more active and efficient inventory management. I base this prediction on the fact that companies like Wal-Mart and Costco have already mandated these changes in an effort to decrease their inventory management costs.

For independent practitioners, this technology will allow for more efficient, automatic ordering of clinic supplies, as well as all optical and contact lens inventories, while at the same time reducing workforce needs and costs. In the next decade, we will likely be able to perform a comprehensive inventory of our offices with the simple click of a button.

OFFICE ATMOSPHERE

I predict that front desks will be replaced by self-check-in stations. We see this already at airports and hotels. In fact, I took my son to see an orthopedic surgeon recently and there was no front desk, only a kiosk for patient check-in. Moreover, I see our practices becoming more spa-like as our industry realizes the importance of being consumer-centric.

IMAGINE THAT: In the future, as 3D printers become more affordable, faster and more widely available in the marketplace, consumers will likely be able to design and print any number of items if they choose, including customized eyeglass frames — from the comfort and convenience of their own home.

CONSUMER EXPERIENCE

As medical record keeping evolves to a more centralized system, I believe that consumers and providers alike will expect and demand access to their personal records, as well as to general health information. Electronic scheduling, messaging, transactions and health records are only a start. As healthcare reform continues, I predict consumers will demand interactive communication with qualified providers.

We have already seen that consumers are willing to give up some level of privacy in order to have access to what they want. Anyone who’s signed up for a members-only shopping website using their Facebook account — thus, giving the shopping site permission to any personal information shared on Facebook — can attest. It is likely that in the next few decades we will see a more customized experience.

3D PRINTING

As 3D printers become more affordable, I believe consumers, if they choose, will be able to design (likely via a fee-based app) and “print” customized frames and then have lenses made to fit those frames. To compete, manufacturers and providers will need to stay a step ahead of consumers and offer unique, value-based services not available through home 3D printer systems (think faster, less expensive and more convenient). Slightly farther off, we may no longer manufacture ophthalmic lenses as we do today, but instead have a universal, programmable transparent carbon film that is inset into a frame. I predict these lenses will be able to be programmed to any aberration status, not just primary refractive error, and that they will even be able to change chromatics based on the ambient lighting conditions. (These materials already exist and are used in aerospace and the military.)

WEARABLE TECHNOLOGY

Eyewear has led the wearable tech revolution, and I don’t see that changing. I predict that heads-up display technology will be through a phone or watch — and likely will replace both — like Google Glass set out to do. And with this technology will likely come an array of issues with perceptive vision, accommodative demands, vergence abilities and visual performance for O.D.s to treat.

PERSONAL INFORMATICS AND TELEHEALTH

I believe that nanotechnology embedded and integrated in our products will lead to a world where identity rendering or profiling creates personal informatics that we can’t even conceptualize yet. Imagine walking down the street and receiving heads-up display promotions on your “i-Interact” device about the special on golf clubs in the store across the street. Product marketing will be revolutionized.

Within the next decade, it is likely within that injectable nanotechnology will be utilized to monitor a person’s blood chemistry and hormones, look for pathogens and manage many aspects of a person’s health in real time. We see bits of this today in sports apparel, with watches that monitor heart rate and a chip in your shoes that can analyze your workout.

Remote diagnostics will become commonplace and necessary for the healthcare community to provide care. These remote diagnostics will likely integrate into more of a telehealth environment where true face-to-face interactions with health care providers will become less commonplace, especially for wellness care.

BIG DATA, OUTCOMES AND STANDARDS OF CARE

Paralleling personal informatics and telehealth, I see advances in big data that will truly revolutionize how health care providers provide care. I predict big data will process clinical outcomes and the standard of care for many, if not all, medical conditions. IBM’s Watson is only the beginning. For example, by looking at sample sizes in the millions in real-world environments — instead of well-controlled studies in the low hundreds — big data will be able to analyze trends and risk factors we simply don’t have the capability of determining at this point in the history of medicine. This demographic information will also be independent of bias and study design and study selection.

In conjunction with big data outcomes, the movement of value-based medicine will likely shift how we assess and treat many of the current systemic pathological conditions of today. We are likely to find that today’s best practices are inadequate and, in many instances, wrong.

MERGERS AND MANAGED CARE

I predict that throughout the next decade we will continue to see more vertical integration both in terms of industry and the products that we have access to. Managed vision care and third party managed medical care will be challenged to innovate in order to survive the upcoming changes in medical care. In addition, we will undoubtedly see more industry mergers. It is likely that this vertical integration will entail fewer entities controlling a much larger share of the eye care pie. Could the vision care industry be folded into larger organizations? Recent mergers and acquisitions are just the beginning.

FUTURE UNKNOWN

The rules of how to prepare for the future are simple: Watch, read and listen. Keep abreast of the changes in the health care world and related health care technology; embrace technology; develop a dynamic plan to adapt and adopt; integrate and implement; and above all, do your best. Our future will be full of challenges, but so long as we are proactive, there will always be opportunity. OM

SCOT MORRIS, O.D., F.A.A.0., is chief optometric editor for OM, director of Eye Consultants of Colorado and managing partner of Morris Educating and Consulting Associates. Email smorris@eccvvision.com, or visit tinyurl.com/OMcomment to comment.