YOU ARE PREPARING TO BUY A NEW PRODUCT OR technology product intended to in-crease your profit margin and improve your patient care. You probably wish you had read an article on the top mistakes physicians make when integrating new technology into their practice. We have witnessed some common oversights that can threaten the successful integration of new technology into a medical practice. This article, and its second installment next month, will help you be better prepared in your next purchase, and to be successful in your present and future communications with the company from which you buy this equipment. Successful integration most often starts with a mutual understanding of the initial contract and clear agreement on the installation of the equipment.

First Steps
Let's begin with the initial contract. Miscommunications and improper expectations are key contributors to failed technology integration. Have you asked the important questions—and have they been appropriately articulated in an outline to your satisfaction?

1. Does the contract clearly define all the processes for installation and training you expect/anticipate?
• Is there a timetable from purchase to installation?
• Will the practice be required to make changes in the office schedule during the business day to allow for installation to avoid disrupting patient flow?
• If training is required has it been clearly stated, with dates and times?
• Is there a minimum or maximum number requirement for how many people can attend a training session and how many sessions need to be scheduled to complete the training process?
• Is the cost of the training included in the total purchase price or are there additional costs, for example, for additional company personnel time for initial and follow-up training?

2. Are there additional costs associated with the use of the equipment?
• Are there additional supplies that need to be purchased separately in order to utilize this technology?
• Is there a list of recommended vendors—included in the contract—whom you can contact to purchase the additional equipment?
• Is the service agreement included in this purchase or is it an additional cost?
• Are there specific requirements necessary for the environment of the technology to work at optimal levels?
• If you choose not to follow these recommended processes, will your service contract be null and void?
• Will there be any upgrades and software necessary? If so, what will the cost be for these additions?
• Are there any electrical/construction additions or modifications associated with purchase and installation of the equipment?

3. Does the contract refer to any minimum requirements necessary to operate the equipment?
• Is this technology user friendly?
• Will it require the hiring of additional staff to utilize this technology?

4. Does the contract outline the payment schedule? When is the first payment due?

5. Does the contract clearly outline what is required of you and your staff: Prior to the arrival? During the installation? For the training?

6. Does the contract provide you with key contact information? Who will be your point of contact for installation? For training? For technical support?

Installation Process
Just when you thought the tough part was over, you have yet another challenge ahead—the delivery and installation of your new technology. Every manufacturer has its own individual installation process and procedure protocols. Usually, after the contract is signed, a manufacturer representative conducts a site survey. Customarily, the customer receives a list of installation requirements.

Typically, the physician should designate a key contact person to oversee the installation process. This individual should be able to coordinate the project, so it would be helpful if he or she has some prior project management experience. Additionally your liaison should have problem-solving skills, insight into the process and use of the new technology, and be given the responsibility and authority to make any decisions that arise without having to call you every time something unexpected occurs.

Installation Requirements
• Room size. Enabling ease of installation and patient comfort during use. This may require structural changes and working with contractors.
• Lighting. Some systems require controlled lighting.
• Knowledge of state and local building codes.
• Electrical standards. Specific input and output voltage ranges may require an uninterrupted power supply (UPS).
• Room temperature and humidity. Some require separate air conditioning and air filtration units to stabilize a surgery suite setting that can have an impact on surgical outcomes.

At this point, it is important to stay in touch with your sales representative, and the manufactures" technical service department. Coordinating the initial site visit when the physician and/or administrator will both be available is also important. This allows you and the manufacturer's representative the opportunity to clarify any questions that may arise at the beginning of the installation process, ensuring a smoother transition. Miscommunications and unanswered questions are the number-one reason for unnecessary frustration and delayed installations.

Next you may be asking yourself, "Why should I follow the manufacturer's guidelines?" The answer is simple: Medical device manufacturers have extensive experience in the installation and use of their products. They do it every day. Some have internal quality departments that track product usage issues and initiate corrective actions to enhance the product. They have taken the time to test their devices, making adjustments to their product and system processes, to ensure patient safety and better medical outcomes. Take advantage of their free knowledge. In all likelihood, you are paying for their expertise in one way or another.

When to Upgrade or Replace Existing Technology
As with any technology, advances in eye care occur rapidly. Ophthalmology continues to evolve and improve as does our professional responsibility to keep up with those technological advancements. Such advancements may include an additional software upgrade, physical attachment, or total replacement with an entire new system. During sales contract negotiations, it is important to discuss technology upgrades with the manufacturer's sales representatives; upgrades may or not be included in your final price.

The most common questions to ask yourself when deciding to upgrade or replace your technology are:

• How much will the upgrade or replacement cost?
• How long do I plan on using this device? Some physicians may be transitioning to expand or downsize their practices due to changes in their particular market or business model.
• Will the upgrade or replacement cost balance with or exceed the upgrade benefits (better patient outcomes, speed and efficiency, device reliability, and/or increased profit margin)?
• What will be the new requirements for the upgrade or replacement?

Upgrades may be as minor as software changes, requiring self-study training for physician and staff. Device replacement most likely requires the full installation and training process, as mentioned above. With any addition or any change in your practice, minor disruption in the normal daily routine is to be expected. However, good pre-planning and active involvement in the process will help head off an inauspicious experience. Next month part two of this article will cover what to anticipate after your new technology is in place—staff training, implementing new procedures, budgeting and contingency planning.

Ms. Lapointe is a marketing and practice development specialist with IntraLase Corporation. Contact her at Ms. Watson is a clinical applications specialist with Alcon Laboratories. Contact her at