Ophthalmology Business Minute Tips: The Technology Adoption Life Cycle

The Technology Adoption Life Cycle


Ophthalmology has been viewed as one of the more technologically advanced medical and surgical specialties. But not all of us have the same technology-adoption habits. How do you convince colleagues that some technologies could increase efficiencies, lower costs and ultimately raise revenues for your practice?

The decision to purchase a new technology is multifactorial, but understanding where our partners/colleagues are coming from will help us fine-tune the decision-making process to reach a well-thought-out solution. By identifying where you fall under the technology adoption curve and where your partners/residents are along the curve, you can use those insights to find ways to work with your colleagues to make informed tech-related decisions for your practice/department.

The Technology Adoption Curve

When evaluating new technology options for your practice or department, first ask yourself, “Why do we want or need this new product?” To facilitate the decision-making process, compare the new technology with what you are currently doing.

Start by answering these questions:

  1. Will this new technology increase patient safety?
  2. Will this new technology improve patient outcomes?
  3. Will this new technology increase efficiency?
  4. Do the economics of adding this new technology make sense for me and my practice?

Next, consider your mindset and that of your colleagues. Are you or your partners happy with your current technology? Do you or they refuse to explore newer technologies? Are you or they reluctant to pursue the new technology for cost reasons or because of a dislike for “change”?

For example, ask yourself which of your colleagues purchased a new iPad when they were first released and what this says about them. Which ones waited to purchase the iPad 2 or another tablet? Who in your practice is resistant to converting to electronic health records (EHRs)? Why?

Believe it or not, these behaviors — choosing to purchase an iPad or an EHR system during the early launch of the product or waiting until later — likely forecast your colleagues’ future decision-making processes regarding new technologies in your practice.

If you are a member of an established practice involved in assessing potential hires, then consider asking these tech-related questions of them as well. This is especially important if you are counting on a younger new hire to help you understand the new technologies.

In his marketing book Crossing the Chasm, Geoffrey Moore describes how people decide when to purchase a new technology. He also groups tech purchasers into five distinct categories along what he calls “the technology adoption life cycle. In order to help you identify where people (including yourself) fall along the tech adoption curve, I will describe Moore’s five groups in more detail, then look at how they apply to ophthalmology practices.


Members of this group, often described as techies, are interested in trying new technologies, but never want to pay for them. Rather, they prefer to be paid to use these innovations.

This group is well known for pursuing new technology products aggressively. Their endorsement inspires other people to purchase the product. They also tend to be the gatekeepers for new technology. They usually want just the facts — without the marketing gloss. They also want easy access to technologists with whom they can discuss problems with the new product.

Which of your colleagues fall into this category? Do you yourself? For example, whom do you know who is using the femtosecond laser for cataract surgery in 2011? Remember, innovators will typically choose to use a new technology earlier because they are receiving it for free to conduct research and/or at a discounted rate.

Presently, it is cost prohibitive for some practices to incorporate femtosecond laser technology. When a user has to pay for the technology, the decision is much more complex.

  • Pros of being an innovator: You can help members of your practice or colleagues gain experience with the new technology. You become a leader in this area of technology and a leading voice in discussions.
  • Cons of being an innovator: If you push the new technology too soon, when others are not yet ready to engage, you may be viewed as a maverick or out of touch with your colleagues. Identifying your tendencies and those of your partners/colleagues will help everyone make a well-informed decision.

Early Adopters

Also known as visionaries, these users are ahead of the curve and willing to try new technologies. They have the insight to match an emerging technology with a strategic opportunity to achieve a fundamental breakthrough to accomplish a business goal. Put another way, early adopters are looking for a high return on their investment.

This group might, for example, strategize on how to increase efficiencies in patient flow for intravitreal injections of Avastin or Lucentis. They might also choose the femtosecond laser for cataract surgery as a way to create a competitive advantage. As it stands now, femtosecond cataract surgery makes efficient surgeons less efficient, but the touted increased revenue from adding this technology may offset this decrease in efficiency.

Moore says early adopters are the least price sensitive of the five segments. They are willing to pay nearly any amount just to get the new technology. This group is easy to sell to but hard to please. They are also an outgoing and ambitious group. This group understands that there are three constants in life: death, taxes and change. This group embraces change and tries to get ahead of it.

Early Majority

This group, also referred to as the pragmatists, sticks with the herd and will rarely be the first to try out a new technology. This market segment generally focuses on making a certain percentage improvement in their existing technology.

Members of this group are hard to win over initially, but are very loyal once they have been convinced. This segment cares about standardization and the support infrastructure for a new technology. They focus especially on the reliability of the product and the service associated with it. This group generally won’t buy a product until it has become established.

Late Majority

The fourth group, also referred to as the conservatives, typically raises a lot of questions, slowing the decision-making process. As its name implies, this group is late to adopt technology, and it is fairly large in number.

By listening to this group, to gather the pros and cons of purchasing new technologies for your practice or surgery center, you can gain more information and make a better-informed decision.


Also referred to as the skeptics, this last group will likely never obtain a new technology unless someone else in the practice makes the decision to purchase it. Laggards tend to be naysayers who try to block purchases. They continually point out the discrepancies between the sales claims and the delivered product, but eventually will come around to using the technology when it is imposed upon them and/or the only option.

For example, can you think of someone who refused to use PowerPoint on their laptop and insisted on using the slide projectors? Today, it is unheard of in our ophthalmic meetings for a physician to use a slide projector.

Moore’s Categories in Practice

Are there people in your practice who refuse to convert to EHRs? This does not make them bad partners, but it should make you ask yourself why they are not interested in using the new technology. For example, we have heard many arguments about new technologies being too expensive or, in the case of EHRs, the government’s way of invading our privacy.

Let’s say you are part of the late majority and your partners want to implement a new EHR system, The differences among you could create some tension. However, it is important to have all types of individuals on a team. Change is difficult for all of us, but the transition is easier when an experienced colleague can train you to use the new technology and explain its clear benefits. The important issue here is to remain open to new ways of doing your daily tasks that may be more time efficient and cost saving.

There are advantages to being a laggard too. This group can buy a product after it has stabilized, and leave it to the innovators and early adopters to work out the bugs in the beta version. Typically, by the time the laggards purchase the product, there will be more competition in the marketplace, lowering the cost of entry.

This group also has the advantage of choosing from several product lines in the later stages of development. For example, think of the cataract surgeons who implanted the first multifocal lenses. Individuals who choose to wait another five to 10 years for additional products to reach the market will have the luxury of choosing from many types of intraocular lenses.

Where Do YOU Fit In?

What type of surgeon are you? What type of doctor? What type of business partner? Are you the first to try out new techniques or technologies? Do you have the latest phaco machine, femtosecond laser or other cutting-edge equipment? Have you implemented EHRs in your practice? Do you take business courses to improve your practice?

It’s said that you can’t teach an old dog new tricks. So, how do you avoid becoming an old dog? Learn new tricks.

* * *

About the author: This article has been adapted from the original version, written by Robert F. Melendez, MD, MBA, which appeared in the fall 2011 AAOE News. Dr. Melendez is a partner at Eye Associates of New Mexico and assistant clinical professor at the University of New Mexico in Albuquerque. The editor-in-chief of the Academy’s Ophthalmic News and Education (ONE®) Network and 2012 YO Committee chairman, he is a former editor of YO Info and a graduate of the AAO Leadership Development Program.

Cataract Surgery Pearls for the Young Surgeon

Join us for High Yield Cataract Surgery Pearls for the Young Cataract Surgeon

Monday,  4:30PM – 5:30PM
Session: 516    Location: NORTH 22

Robert F. Melendez, MD, MBA

Uday Devgan, MD
Tom Oetting, MD, MS

  1. Sitting Position
  2. Wound Construction
  3. Capsulotomy tips
  4. Hydrodissection
  5. Techniques for disassembling the cataract

VI.IOL Technologies
VII. Advanced IOL technology tips from toric to multifocal IOLs

VIII. Communication tips both pre-operatively and post-operatively

IX. What’s new with cataract surgery?

Post questions here.


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Burnout term is burning out…replaced with Moral Injury or “F Factor?”

I have been reading a lot about burnout and moral injury. Why is this issue important? Depression is on the rise within medicine and the physician suicide rate is nearly 2x that of the general population and even higher when compared to the military.  This is absurd and appalling to me and we should not tolerate suicide in anyone. It is heart breaking to know that fellow colleagues are suffering along this potential continuum. We need to help everyone along this path. As a veteran myself, moral injury should not be used in this context of physician burnout, but it is a better phrase than burnout. I think most of us know what the problems are and disagreeing on what term to use is not as important as the solutions. Once we get beyond this et terms, we should use a new term, the “F Factor,” or Fulfillment Factor. As physicians, we sacrificed many years of our lives because we care about patients, driven to learn, and have a desire to be give back to others. We need to focus on a Physician’s “F Factor.”  Irrespective of the term we use, we need to simply define what we are speaking about-conflict by the physician to put the patient first with other competing priorities- self interest and company interest.

Our first priority is to our patients. Physicians are second and anything the physician needs to enhance the physician-patient relationship, then it needs to be honored and respected. Do you need a scribe, then get a scribe. Do you need a stapler at your desk or a scanner or a printer, then get one. Arguments about adding a printer would be too expensive is where the problems are made worse.  A printer at the physicians desk or in the exam room needs to happen if that is what will increase the physicians “F factor.”  Albeit this is a simple example, create a list of issues that impede patient flow and limit time with the patient. Prioritize what will enhance the patient experience and increase your “F Factor,” and start addressing each one. Partner with your administrator to implement these solutions. 

Next, move to the larger system within your practice. Do you have enough technicians, do you need a scribe? Are there too many do’s and don’ts from upper management that interfere with your clarity of thinking about the patient first. Are you driven more by economics than what the patient needs? Obviously, be mindful of the economics, but do not be driven by them! 

Finally, focus on advocating for your patients at the national level by meeting with your legislators. Reduce burdens on physicians. The system focuses on physicians clicking too many times within their EHRs while ignoring the person, the patient. This reminds me of when I worked in the grocery business in high school and college where I saw customer service decline and more burdens were placed on the customer. We moved from manual cash register to scanners. We moved from serving the customer to the customer serving themselves by having them unload their own cart. Now, there are self check out stands, although it can be easier, it still requires a learning curve. The airline industry is doing the same thing, making the customer check-in on their own to print the boarding pass to even placing the sticker tag on the bags. The customer in this case is the Physician. We are burdened with so many bureaucratic lists. We have had to become coders, billers, clicking to oblivion to improve so-called quality of care, and we know that meeting MIPS standards does not equate to higher quality. This is merely a “C average” mentality which is contradictory to our mindset as physicians. We have strived to be far above a “C average” mentality. Standards should be set by physicians when it comes to the physician-patient relationship. I want all administrators to ask physicians, what resources do you need to be successful? Give them those resources and determine whether the “F Factor” increases, efficiency improves, morale is boosted, and most importantly, the patient’s and staff’s happy factor increases.

I know we can make a difference! We need to make sure we as individuals are doing our very best and practice self-awareness and avoid being a victim, but rather step up and voice our concerns and demonstrate leadership. We need to improve our EHR systems too by creating voice to text and improving communication across so many different platforms. Voice your concerns with your partners, practice, and larger systems. Own it.

Change will occur if we speak up as leaders.

Rob Melendez, MD, MBA

A must see video and references below:

Video by ZDoggMD: (Offensive language)



What is Moral Injury

Welcome Advocacy Ambassadors! #MYF2018 Follow me @DrRobMelendez


Welcome to the AAO’s Mid Year Forum (MYF) 2018! I look forward to meeting a lot of you very soon. I was part of the inaugural Advocacy Ambassador class in 2004. Fifteen years  later, I am still actively involved with advocating for my patients and our profession.

The MYF is where ophthalmology leaders meet. On Wednesday evening, we will have dinner together describing Thursday’s Congressional Advocacy Day activities. You will partner up with your state’s ophthalmology leaders where we will visit your legislator’s office. Be prepared to (typically) meet with the health legislative assistant, who is very knowledgeable about health care issues. In some cases, you will get to meet your legislator and will be given an opportunity to take a photo (remember to remove your name tag). Call Senators, Mr. Senator Henrich (NM) or Madame Lujan-Grisham (NM) or Representative Smith. When entering their office, know who you are meeting with, this will be  given to you in advance. For example,  Good morning, we are here to see the Congresswoman or the Congressman or Stuart Martinez, we are from the American Academy of Ophthalmology. Carry very little in your pockets because you will have to walk through a metal detector upon entering every building. Bring business cards if you have them.

Our main issues this year for Congressional Advocacy Day (Thursday):

1. The Technology based Eye Care Services (TECS) program is a clinical care initiative funded though the Department of Veterans Affairs Office of Rural Health (ORH).

2. Department of Defense Peer-Reviewed Vision Research Program Support FY 2019 VRP Funding at $20 Million
3. National Institutes of Health/National Eye Institute Support Funding of $3
9.3 Billion for NIH and $800 million for NEI in FY 2019
AAO Urges Congress to Increase Research Funding for NIH to $39.3 Billion and NEI to
$800 Million in FY 2019
4. Simplify the Merit-based Incentive Payment System by Expanding Credit for Participation in Qualified Clinical Data Registries
5. Physicians Need Regulatory Relief from Burdensome Prior
Authorization Requirements
6. Ensure Timely Access to Compounded Drugs for Office Use
Cosponsor H.R. 2871, the Preserving Patient Access to Compounded Medications Act
Basic Terms:
H.R.  = House Resolution
S.B. = Senate Bill
On Friday, there will be a specific program just for ambassadors called the LEAP Forward program where the emphasis is on Leadership, Engagement, Advocacy, and Practice Management
When: 8:00 – 11:30 am, Breakfast at 7:00 am
Where:  Room: Mt. Vernon Square
This is an opportunity to meet fellow residents and leaders in ophthalmology. Make sure and take lots of photos. Get a pic with the YO Chair, Dr. Purnima Patel and the highly approachable YO Committee, they will be wearing purple beads. YO, by the way, stands for Young Ophthalmologist (residents, fellows, and ophthalmologist within the first 5 years of practice). Additionally, get a photo with our AAO President, Dr. Keith Carter too.
Feel free to ask any question you like and ask for a picture and use the hashtag: #MYF2018 in all of your social media posts.
Wednesday: Dinner
Daytime: Walk the halls of your Congressmen and Congresswomen.
Opening Session in the afternoon.
Dinner: Be sure to attend the Mid-Year Forum Reception and Banquet with our keynote speaker – physician and decorated NASA astronaut Dr. David Wolf.
After dinner: Surgical Scope Fund Reception at the Press Club-great place to meet other residents and leaders.
LEAP Forward Program 8-11:30 am
Lunch Meeting…

The Future of Artificial Intelligence in Ophthalmology

12:15 p.m. – 2 p.m.
Moderator: Rahul Khurana, MD – Editor in Chief, The ONE Network, American Academy of Ophthalmology

The next transformation in ophthalmology is the application of artificial intelligence in diagnosing and treating disease in clinical practice.  It is beginning to be used in retinal disease for detecting diabetic retinopathy and diabetic macular edema from fundus photographs, and its potential is to provide more efficient and objective analysis of images and prediction of disease progression.  The session will explore what artificial intelligence means for practicing ophthalmologists, its promise and limitations, and what the future holds.


Debrief Session 2:30 – 3:30 pm (Must Attend)
Council Meeting
OPHTHPAC Reception.  We will be at the Potomac View Terrace of the American Pharmacists Association building
Dinner: on your own.
Council Meeting (Join us!)
Download the “AAO Advocacy” app.
Follow me on Twitter for more tips on getting more involved with Ophthalmology and the Academy. Start with your state society. @DrRobMelendez
See you soon,
Robert F. Melendez, MD, MBA
-AAO Secretary for Online Education (ONE Network and EyeWiki)
-Comprehensive Ophthalmology, Eye Associates of New Mexico
-Clinical Assistant Professor, University of New Mexico Health Sciences Center, Department of Surgery/Division of Ophthalmology

Transformational Leadership starts with transforming yourself…Be more than a manager, be a Leader.

Check back and learn more about leadership.


Managers count value

Leaders create value by…


“I’ll handle A and you handle B.” A Leader.

Empower others to succeed on their own.


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Is Twitter Dying for the Ophthalmologist??

Is Twitter dying for the Ophthalmologist?

Rob Melendez, MD, MBA and Pavan Angadi, MD

We performed a study to investigate whether ophthalmologists are joining Twitter at an increasing rate and to determine whether they are more active on the site. We searched  for ophthalmologists using the following terms: “ophthalmologist”, “ophthalmology”, and “eye surgeon.”  We found that ophthalmologists started joining in 2007 when Twitter started and the number of new users was at their maximum in 2009 (56) and has been declining since then and  in 2017 only one ophthalmologist joined Twitter (See Figure 1). There were obviously more ophthalmologists on Twitter, but were difficult to identify because they failed to mention in their profiles that they were an ophthalmologist. This raises the issue of why some ophthalmologists are on Twitter. The ones who did not self identify themselves as ophthalmologists are likely on Twitter more for personal use and not professional reasons to educate others.

We also investigated how active these ophthalmologist have been in 2016 and 2017. We found that the average number of tweets/month in 2016 was 60.6 and in 2017 it increased to 80.4 (38.6% increase). We also found that the total number of active users increased from 138 in 2016 to 169 in 2017 (22.5%). We also identified the total number of tweets from these  ophthalmologists in 2016 was 3739 and 5865 in 2017, which was an 56.9% increase. We found that although the number of new users on Twitter has declined since 2009, the existing users of Twitter has increased. Given the paucity of ophthalmologists on Twitter, suggests that it is a great opportunity for more ophthalmologists to become leaders on Twitter to educate others. We also identified which types of ophthalmologist are most active on Twitter (see Figure 2).



Figure 1. Number of Ophthalmologists on Twitter and what year they started.                                                Figure 2. Ophthalmologist Twitter Users by Subspecialty

What is wrong with Volume to Value based care? Focus on Hypervalue

What is wrong with Volume to Value based care? Focus on Hypervalue

Rob Melendez, MD, MBA  @DrRobMelendez

The phrase “volume to value” is a misnomer. It implies that we are not currently providing any value to our patients and that we are providers who are simply focused on RVUs and FFS. I am appalled by such a phrase. Our focus should be on the term that I will use “hypervalue.” Hypervalue is a term that raises the bar for patients at all levels of patient contact using lean management principles. We need to improve the healthcare system for one reason: to improve the health of our patients. As we have seen over the last 5 years, clicking on boxes to simply satisfy a payment requirement hasn’t increased value for the patient. These programs drive some people to play the game to simply get paid. Our standards should be so high for our patients that when the government mandates so-called value targets, it will pale in comparison to what the increased value or hypervalue that we are providing for our patients. For starters, Let me review two hypervalue concepts for our patients.  1) Improving communication with the providers and patients. 2) Using technology to reduce waste and to analyze how we are caring for our patients.

  1. Communication: We need electronic health records (EHR) that communicate with other providers and healthcare systems to streamline healthcare. Often times, duplicative testing is being performed and we are not aware of the other ordered test. We also need to continue to improve communication with our patients. The Mayo Clinic has an excellent app for their patients to access their exam notes, labs, appointments etc. This app is an example of hypervalue for our patients. I personally have seen this app in action.  Our practice currently uses a patient portal system to communicate with patients which brings value to the patient. We chose to implement EHR in 2005 before we had to because it provided a mechanism to access medical records across our 15 clinics around the state of New Mexico as well as the ability to analyze where we can improve processes and patient care points. Sadly, the cost is enormous for EHR. The costs of EHR can range from the cost of computer equipment, training, IT support and maintenance and beyond. The benefits of EHR are evident today, but when were first started, the costs outweighed the benefits. For example, the IRIS® Registry created by the American Academy of Ophthalmology is a prime example of the huge advantage of EHR. This will increase value to patients, hypervalue. Just think, you now have the ability to easily determine how many of your glaucoma patients had a visual field in the last year and how many of your patients with Diabetes had macular edema to cite 2 examples.
  1. Technology: Can you imagine a time where patients can input their medical histories online before seeing the doctor via home computer, tablet, or phone with an app? It’s available now, but cost prohibitive in some cases. We trialed a kiosk in the waiting room with little success. It required extra people to teach the patients how to use it. I believe this will come back with time. Think how you first felt when you had to use the kiosk at airports to check yourself in, it was frustrating at first and still is at times. I remember a time in high school when I was a clerk in a grocery store and personally unloaded the customer’s shopping cart and checked them out myself. Now a days, businesses are trying to use technology to improve efficiencies and convenience for certain type of customers with fewer items. Hypervalue would be providing the technology option plus a person to educate the user one to several times until they learn how to use it. The benefit of updating your information before the visit would be to decrease wait times in the clinic. What if there was a faster way to verify insurances before the visit? Perhaps there is, so please share any insights. As we move from so-called volume to value, let us remember that the patient is always first and trying to improve their experience while improving their health is paramount — Focus on hypervalue.

RVUs = Relative value units

FFS = Fee for Service

EHR = Electronic Health Records


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