Data has become one of the sharpest tools to inform the clinical and commercial aspects of optometry businesses in 2023. Insight sits down with data scientist PAMELA TSE at Australia’s largest optometry provider to understand how she brings numbers to life.
Assumption, intuition and anecdote used to be the way optometry businesses informed their strategies. But when it comes to multi-million-dollar technology rollouts, reporting on Medicare utilisation to prevent vision loss and making a meaningful dent in undetected eye disease rates, there is only one tool that guarantees results – data.
Since arriving on the Australian optometry scene in 2008, Specsavers has been advancing the local eyecare agenda on several fronts, using swathes of data that are interpreted to drive macro and micro clinical decisions, commercial initiatives, its trademark marketing campaigns, and much more.
In fact, it’s thought the company holds the largest optometry dataset in Australia, and one of the biggest and most robust globally. It tracks every single point of 4.5 million patient journeys per year, accounting for around 42% of all optometry appointments in Australia.
At the company’s ANZ support office in Port Melbourne, Ms Pamela Tse has the important role of filtering through the data collected from thousands of appointments held daily across Specsavers’ 385 stores across Australia. As the in-house optometry data consultant for almost four years, she is tasked with turning these into actionable insights that gives full visibility around how many clinical components of the business are performing.
After initially wanting to pursue a career in physiotherapy before eventually studying economics, accounting and statistics at university, the role is ideally suited to her.
“I’ve always had an ability to see patterns in numbers. I wouldn’t say I’m special, but I’m different in that way; in fact, I can still remember my grandma’s phone number today,” she says.
“To help people perform their job better and help manifest the good health outcomes we’re seeing every day at Specsavers is a privilege for me. The care and nurture I had back when I wanted to be a physio has now translated into reading numbers and telling optometrists you are doing exactly what you need to do, you are treating your patients exactly how we want you to. It’s also been phenomenal to see with programs like KeepSight how system change can create behavioural change and deliver better patient outcomes.”
Tse works closely alongside Dr Joe Paul, head of professional services for Specsavers ANZ. He says in a previous era the industry was content to assume it was doing a good job.
“And for the most part we were, but to practise optometry in 2023 it’s incredibly important to be informed by the data,” he says. “It lets us answer the big questions and make real tangible changes that are driven by an understanding of what the current situation is, and what it needs to be. It informs all decisions we make; there’s nothing we do in the optometry team that isn’t measured, tracked and based on a quantifiable problem.”
Paul says one of the most powerful examples of a data-informed strategy is the OCT roll out to all Specsavers stores in Australia and New Zealand. The world-first initiative to use a Topcon Maestro Fully Automated OCT/Fundus Camera in the standard eye exam was a $40 million-plus investment.
“I believe this was one of the best examples of a data-driven intervention not only in optometry, but healthcare, in the past 10 years,” Paul says.
“There was a problem that 50% of glaucoma was undiagnosed in the community. As an industry, we weren’t tracking how many of our patients were being referred. We started to track this and found that the referral rate was less than the population prevalence of glaucoma, so clearly there was an issue.”
Specsavers put OCT into a handful of practices, looked at 150,000 patient journeys and suddenly saw that by implementing OCT systematically alongside the RANZCO referral pathways for glaucoma and the accompanying training and support for optometrists, it was referring glaucoma twice as often, much closer to the population prevalence.
“This is a great example of using data to find a problem, measure the problem, put an intervention in place, and measure the outcome – and even though it was a small group of patients at the time, it very clearly worked,” Paul says.
“That then informed the much larger strategy of store partners investing in an OCT machine at every practice to be used free-of-charge on every patient. The data supported this because we showed a measurable outcome for patients and a major improvement in detection of glaucoma across the country.”
Specsavers has now seen 175,000 unique glaucoma patients during the past five years, and with ongoing monitoring can confidently say it is detecting glaucoma at the estimated national prevalence rate.
Real time industry insights
To make data a central component to an operation at scale, a lot of work needs to occur in the backend to ensure it can be optimised for use.
At Specsavers, this has involved a lot of work to standardise the data being collected. The company has set up automated systems that pre-populate data straight from the measurement device and into the optometrist’s clinical records/Socrates practice management system, eliminating wasted time and the potential of transcription errors with manual data input.
The data then flows onwards to the data engineering team, being de-identified and ready for use by Tse, the IT team and other departments for reporting purposes and to obtain high level insights.
Tse says across all industries there are questions about the reliability of data and whether it’s ready for use.
“Over time we have identified opportunities to improve the quality of our data; we are in a privileged position of having a team that has put processes in place so that we can collect data in a more uniform way. We find it is a lot more reliable and user friendly, which helps immensely with interpretation and eventually making informed decisions for the business,” she says.
Paul says one of the major benefits of the Specsavers dataset is its ability to provide insights in real time. This is because the metrics are automatically refreshed every week, painting an up-to-date picture of the national optometry landscape. If referral rates, for example, are below expected, it may be a sign that a certain system or process is breaking down.
It also means optometrists at the coalface get almost immediate feedback and support on their clinical performance. Several years ago, Specsavers introduced clinical benchmark reports that are provided regularly to each store.
“This represents the closing of the loop in our data strategy,” Paul says. “It’s all well and good to have this data, but it offers the most value for optometrists on the ground who can get visibility of the fantastic job they’re doing, while using that to continuously improve. That’s why every week we send a pack of reports to all stores detailing their clinical benchmark performance. For example, how many patients are being referred for glaucoma, and are they doing that at national prevalence rates? It’s in the hands of the people who need it the most, regularly.”
Another powerful example of the value of the Specsavers dataset was in 2020-21 during the height of the COVID-19 pandemic. At the time, routine optometric care was off-limits for weeks, if not months, in some states.
In her role, Tse had become accustomed to counting down to milestones at the time such as the 100,000th glaucoma patient or the 500,000th KeepSight registration – often drilling into the data to celebrate the optometrist who helped achieve this.
But her work took on a more serious tone during the lockdowns. It was a fascinating period to track as a data scientist, but equally alarming when it became clear how many people with potentially blinding eye disease were missing essential follow up appointments.
“It was not a project that we embarked on on-purpose, but we had to because of the massive dataset that we have and the number of patients we see every day,” she says.
“Seeing that significant number of appointments drop off, and then come back with a big uplift in volume of urgent referrals was something we’d never seen before. It was concerning, but having these statistics was incredibly helpful for us to tell the industry exactly what was needed on the ground.”
Paul agrees, adding that the Specsavers dataset was crucial when it came to the industry banding together, including Optometry Australia and its various state branches, to advocate to keep primary eyecare services operational to some degree.
Some headline stats from the initial shutdown showed 600,000 fewer optometry Medicare patient services from March-April 2020 compared with the same months in 2019. In the first week of the March 2020 lockdown, Specsavers saw a 91% patient drop compared with the same week-long period a year earlier. And over a two-month period, 25,208 Specsavers patients that likely had eye conditions requiring specialist attention did not attend their appointments.
“It’s another really good example of having a real-time view of what’s happening across different states and territories and our ability to highlight problems and talk with the industry,” Paul says.
“When governments were considering new lockdowns, using our data we were able to show what happened to eye health in previous lockdowns. That meant we were able to more effectively lobby governments to at least consider the impact that those restrictions would have on avoidable blindness detection.”
How data will shape optometry’s future
Tse doesn’t only analyse internal Specsavers data. She provides insights on Medicare utilisation and census figures. Many of her findings are also made public both in trade media publications such as Insight, as well as on Specsavers’ own HealthHub data website (www.healthhub-anz.com) and in conferences and events, in a bid to influence the national eye health agenda, and prompt other optometry providers to evaluate their care models.
Paul says this approach is starting to positively impact the industry – and there is increasing appetite for a national optometry dataset, something that Optometry Australia is currently working on, and is supported by Specsavers.
“With the number of patients Specsavers sees each year, we can confidently extrapolate from that to understand the wider industry, but it’d be great if we didn’t have to. When issues like Medicare reviews come up like they did a few years ago, it’s much more powerful if we can, as a whole industry, demonstrate why funding shouldn’t be cut, or where extra funding is needed,” he says.
“Once we can get to that level, it becomes much easier for us to talk to governments, stakeholders and other funders about the challenges we face.”
Paul says it’s clear the important role that Tse plays within Specsavers ANZ. Other networks are following suit, with more data scientists joining the industry.
“Pamela is very unique among people that work in our industry. Optometrists are very good at caring for patients and doing things on an individual level, but seeing the bigger picture, pulling together large datasets, and picking out trends most wouldn’t notice, I think you’d be hard-pressed to find someone as good as her. That’s why she has been behind highlighting many of the fascinating stories that we’ve been talking about over the past few years,” Paul says.
“We’re fortunate to sit in this position to look at millions and millions of patient journeys every year. It’s never something I thought I’d end up doing in my career but I’m incredibly glad I am here because having that visibility of the big issues in our industry – and the fantastic work of every optometrist in our stores to help uncover the potential solutions and address these challenges – is a privilege.”
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