Software Designed for Ophthalmology

Background

As those who are in private medical practice are all well aware and experience, insured private practice is under increasing pressure from the medical insurance industry due to their drive of managed healthcare and the resultant decrease in payments for services.  This phenomenon has escalated to such a level that the quality of service to patients, as well as the long-term sustainability of private practice is under threat.

Innovation has always been a hallmark of Ophthalmology. In response to the threat of managed care, the ophthalmic community in South Africa was the first specialist group during the late 1990’s to create a management structure, the Ophthalmology Management Group (or in short “OMG”), to take care of the private practice affairs of ophthalmology. This proved to be highly effective in steering through stormy seas, and this example was soon followed by other specialist, as well as general practitioner, groups.

Soon, however, in response to the above, the medical insurance industry changed the game by applying a variety of metrics upon practitioners, as well as the hospital industry, which again shifted the balance in the market in favour of the insurers. These metrics are mainly based upon claims data from service providers.

Another approach which influenced the market was the concept of so-called value-based health care. invented by Michael Porter from Harvard University in the US. He stated that within the healthcare environment, “Value” is determined by “Outcomes” versus “Cost”. This formula was eagerly adopted by the managed care environment with the aim to decrease the “Cost” parameter, and thus increase “Value”, without considering “Outcomes”. The formula only holds true if “Outcomes” remain the same, which is not the case when “Cost” is reduced beyond a level that can be sustainable for the delivery of quality service. The medical insurers do not have access to outcomes data, as this lies within the domain of the service provider. Their assumption is that “Outcomes” remain unchanged.

History of data acquisition project/s

In response to the problem outlined above, the OMG realised that the systematic accumulation of data has become critical to engage in meaningful discussions with the funding industry. This led to the initiation of a data project during mid 2017 with two electronic switching houses, MediSwitch and HealthBridge. Upon consent by the participating private ophthalmologists, approximately 75% of practice claims were captured in the Data Acquisition Project (or the “DAP”) in a big data database for the next three years, with the assistance of these two switches. This project, however, was discontinued in March 2020 as it did not prove to be financially viable for these switches. Valuable insights were obtained from this data, even though the data acquired had a number of shortfalls, which levelled the playing field to some extent for the OMG engagements with the funding industry.

The need for a complete data set

Already during 2016, Dr Frik Potgieter, who is intricately involved in the business of the OMG, made a recommendation to the Board of the OMG to develop a comprehensive ophthalmic dataset. The cost to develop such a customized tool, however, was prohibitive to OMG at the time, with the result that the DAP came about as an alternative.

In spite of the DAP functional at the time, Dr Potgieter decided to take the risk upon himself in his private capacity to develop a software tool that will meet the objectives of a comprehensive, large scale data project. This ambitious project was aimed at capturing raw billing data at the point of entry in the various practice settings in an anonymous manner, along with gaining insights into the cost of running a private ophthalmic practice. A project which was anticipated to be completed in a maximum of two years, turned out to take more than 5 years to reach the level of maturity to allow for the secure and safe operations of a medical practice.

Why AutoPrax?

AutoPrax was thus designed and developed as a novel project to achieve these goals. It is a full financial system at heart, with the unique distinction that it also addresses the data requirements to provide an advantage to the profession during discussions with the funding industry. With the explicit consent of the practitioner, it has the ability to accumulate structured data in an anonymous fashion within a big data database in the background during the normal day-to-day functioning of a practice. This includes both billing data, as well as practice costing information.

The software has the built-in functionality to reconstruct a treatment event, even though this event may occur at different locations as well as at several points of service.

It further has a number of proprietary intellectual property features, which assist in creating a full picture of what happens in private practice.

The system has the ability to seamlessly interface with the envisaged “Big Data” project of Ophthalmology. Information captured is stored within a highly secure environment, and can be accessed only by individuals with the appropriate rights to the data.

Although the software is designed and developed specifically for ophthalmology, it is also suited to other areas of medical services.

Apart from the benefits arising from capturing data at the point of entry, the software was designed in such a way that it optimizes the workflow of a practice, as well as automates a number of functions in the practice – thus the registered trademark, AutoPrax™.

Built into the software, is the practical experience of more than 25 years of private practice, accounting principles by a full-time chartered accountant, the conformation to legal requirements by a lawyer with a skill set in software development, three industrial engineers and three full-time software engineers with a collective experience of more than 30 years of software development.

We, as a development team, has worked hard over the past 5 years to create a product which we believe will once again change the rules of the game in favour of the patient and practitioner.