By Stephanie Zultanky Pavlou
A customized CAD-CAM system can streamline each step of creating custom foot orthoses. Experts say proper preparation is the key to managing this technology’s workflow.
Philip Wells, BSc (Hons) Podiatry, technical support manager for Stepahead and Salts Techstep in Birmingham, UK, emphasized the way in which creating a more efficient workflow improves profitability for a practice.
“There are both direct cost reductions—shipping costs, casting materials, etc.—and indirect savings, such as improvements in personnel efficiency. Both of these reflect in improved profitability,” he said.
With technology like email and instant messaging, patients can stay informed regarding the status of their orthotic devices at any point throughout the process, Wells said. Moreover, the immediacy of such technology allows for alerting both practitioner and patient about potential issues or production interruptions.
Originally from Australia, Craig Tanner, BPod (Hons), podiatrist in the sports science department at Aspetar Orthopaedic and Sports Medicine Hospital in Qatar, worked exclusively with plaster before relocating to the Middle East. Tanner and his two colleagues currently control all orthotic manufacturing at Aspetar with a 3D laser scanner CAD-CAM system with computer numeric control (CNC) design and machining software.
Making the switch to this technology is quite simple, he said; it is fine-tuning the plan for the best use of the system within the practice that is difficult. As he and his colleagues continue to practice with this technology, they increase their proficiency and further decrease delays in workflow.
Adjusting to this type of workflow takes time because it is not a turnkey system, he said; instead, his team members are learning to tailor each step of the process to their needs. Although they are unable to work face-to-face with the CAD-CAM manufacturer because of location, the two teams troubleshoot over the Internet. Currently, the manufacturer is creating templates for Aspetar to streamline workflow.
Wells said he found lag time in the process whenever the program requires additional clarification or his team needs technical support or advice. Even in these cases, however, digital media-based communication has streamlined the conversation.
Although Tanner said he has yet to see any major disturbances in his CAD-CAM workflow, he and his colleagues have instigated a system to properly scan, file, and transport patient scans and designs to prevent technological hiccups.
“So far we haven’t found any problems at all. It’s just a case of keeping organized, having a system that everyone understands,” he said.
Ryan Robinson, BKin, CK, CPed (C), CPed Tech (C), director of operations at Walking Mobility Clinics, with clinics throughout Ontario, uses a CAD-CAM system featuring 3D laser scanner technology and CNC router technology for making both polypropylene and EVA (ethylene vinyl acetate)-based orthotics.
To hone a practice’s workflow, Robinson said, first practitioners and technicians must agree on a language that works for them so that they are able to create the proper devices for patients. The second step is learning how to use the software, including whether that means full 3D, CAD-CAM modeling of the foot, or simply templates.
“The technology is as good as you want to make it,” he said. “The technology is there to make an extremely exact product.”
Sometimes, however, practitioners don’t want that level of precision in their devices because it eliminates the opportunity to make subtle changes.
Workflow management, too, Wells stressed, is only as good as practitioners’ relationships with their customers.
“Just because something can be done quicker, it does not necessarily mean that it should,” he said. “Using workflow management to resolve your customers’ needs is essential. Listen to them and respond accordingly.”
To develop a new workflow integrating these tools—and to effectively manage that workflow—practitioners must review the amount of time and money spent in each area of the process, from time with patients to costs for outsourcing to a central fabrication laboratory.
“We want to make sure that just because it’s faster and more efficient, that it’s also as accurate as it can be,” Robinson said. “The technology isn’t coming—it’s here. We should learn to use it appropriately and work it into our practices to hopefully make us better practitioners in the end.”
Sponsored by an educational grant from Delcam