August 1, 2020
By James E. Grue, OD, and Ronald P. Snyder, OD, FAAO
More than any time in the past, there are changes to the way in which eye care is being delivered. The recent COVID-19 pandemic has ushered in a new recognition as to the value of telemedicine. The 21st Century Cures Act, which was signed into law in 2016, is going to make it easier for patients and other organizations to obtain total access to every piece of patient health information that you have recorded in your EHR during an eye exam. One of the uses of this data will be increased availability of clinical analytics to help patients decide where they want to receive their care. Online retailers will also be able to capitalize on increased access to the data that you have in your EHR. If you are planning to add or expand myopia management in your practice, you should consider how you can do it to minimize the effect alternatives to care such as telemedicine and remote exams can have on patients.
The use of telemedicine has rapidly expanded due to the COVID-19 pandemic. Telemedicine has also expanded to treat other medical conditions such as conjunctivitis, renewing glaucoma meds, managing dry eye, etc. Within eye care, we are identifying valuable applications for telemedicine. Social distancing recommendations are shifting patient acceptance of remote eye exams. This model of care delivery will likely remain a viable alternative for many patients for at least some portion of their eye care. Most certainly, as providers, we need to consider the impact that online retailers (as well as contact lenses and spectacle Rx’s) will have on your practice, such as increased access to your patient’s clinical data. These businesses will try to capitalize on your myopia management efforts. The 21st Century Cures Act puts in place financial penalties for both you and your EHR vendor for blocking access to patient information, so you need to create patient loyalty in different ways.
As the delivery of care shifts to alternate models, there is an increased interest in being able to accurately determine whether these alternative methods work as well as traditional care. Doing that has increased interest in outcome analytics. We are already seeing reports on how many patients with COVID-19 and other medical conditions have been managed either through telemedicine or through alternate care delivery. Within optometry, we are witnessing groups claiming to be saving payers significant amounts of money by actively working to shift patients to eye care practitioners instead of going to the emergency room. It is fine to suggest these changes result in better care at a lower cost. Still, it is a much more persuasive argument when we can actually measure the outcomes and be able to show both the clinical and financial benefits accurately. This is what is happening throughout medicine. Now that clinical data is no longer locked in paper charts or blocked from being released from an EHR, analytics are playing an increasingly important role in helping payers decide which providers to include on their panels. Analytics give providers the results they can actually use to improve care delivery and negotiate higher reimbursements.
Historically, health care, in general, has been resistant to incorporating the use of analytics in furthering outcome-based care delivery. Eye care has not included, to any great extent, outcome analytics into clinical care. In reality, outcome analytics may be one of your most essential tools for you to successfully compete in today’s expanded scope of care. Outcome analytics can differentiate your practice and make it more difficult for online retailers to attract your patients.
In June 2020, Review of Myopia Management published an excellent article by Thomas Aller, OD, FBCLA, entitled “Real World Myopia Management: When and How to Change Treatment.” This article makes it clear that there are limits to using randomized controlled trials (RCTs) to guide clinical care. As it becomes better known that there are limits to RCTs, and the importance of clinical outcomes increases, we can expect to see a significant increase in the use of clinical outcome registries. A clinical outcome registry is a service that automatically extracts data from any EHR and performs complex analytics that help providers better understand the effectiveness of the care that they are delivering.
Increasingly, the dependence on RCTs to guide care is being questioned. With paper charts, the only available guide other than scientific studies was “observation” and/or the impression that you gained through experience as a provider. Both of those have limits on your ability to guide care properly. Mining your EHR outcomes data fills in that gap and is the process that clinical registries address. To provide the most appropriate care to patients, we need more information than just RCTs or casual clinical observation.
Registries extract and analyze clinical outcome data from a practitioner’s EHR. Through the use of registries, every provider has the power of outcome analytics at their fingertips. When we apply analytics to myopia management, you can now know exactly what happens to every patient you manage from a statistical standpoint. You will be able to compare your results with those of other providers anonymously. When you have this type of data, there are many things that you can do that are not possible without it.
Is it even logical to think that all 14-year-old Caucasians at their first exam who start at -1.50D of myopia are going to progress at the same rate? Measuring how much each patient actually progresses will quickly reveal that you have several “populations” within that group. Some of those populations will do better than estimated, some will be close to the estimate, and some will do worse. When you measure actual clinical outcomes, you have a very accurate way of:
- understanding the variation within the population
- knowing what happens to patients who were excluded from RCTs
- knowing what happens to patients who you are managing with technologies, such as newer contact lens designs that were not available or part of RCTs
- having a clear guide to what to do next if a treatment plan isn’t performing as expected
The single most important thing that having access to this data does for your practice is to eliminate the appearance of failure. If the information that you use in your discussions with the parents of a myopic patient is limited to scientific study projections and estimates, you already know in advance that some patients within the population are not going to get those outcomes. When they don’t, it can look like a failure to the patient. When you have outcome analytics data that you can include in your presentation to patients showing the expected variation, you can prescribe a treatment plan that eliminates any appearance of failure because the possible variations were considered. The data that you show them will represent the results from your practice and your geographical area. This data has much more impact on patients than just a myopia calculator or scientific study projections to guide your management of myopia. With the use of outcomes data, you can deliver truly personalized care in a way that makes it easier to engage the patient in the decision-making process of what care is best for them. Whenever you do that, the patient is more likely to be compliant and to take responsibility to make sure the plan works. This personalized level of care is the big differentiator that hinders competition from online retailers and other alternate methods. When the patient needs additional treatment, your practice will be the only one that can demonstrate and compare that exact set of data so that they can see where they fit in the variation as they progress. You now have compelling data to support altering your management plan if the treatment approach you have initiated is not showing the expected results. By having the data, the patient does not feel like they are being “sold” but instead are included in making a well-thought-out decision.
As we emerge from this pandemic, it is an ideal time for you to consider embracing clinical registries to improve your patient outcomes.
Our next article will demonstrate examples of outcome analytics and explain how you can use this information to increase patient loyalty to your practice, get better outcome results by being able to engage in population management and to increase your ability to negotiate and participate in alternate payment models to increase your income.
James E. Grue, OD, is a Health Care Policy Consultant and Director of Analytics for HealthCare Registries, LLC. He can be reached at: JimGrue@HealthCareRegistries.com
Ronald P. Snyder, OD, FAAO, is the President & CEO of HealthCare Registries, LLC. He can be reached at: RonSnyder@HealthCareRegistries.com