By Jim Grue, OD,
Ronald P. Snyder, OD, FAAO,
and Michael J. Lipson, OD, FAAO, FSLS
March 1, 2023
If you follow best practices and evidence-based medicine studies, you might assume you are generating the best possible clinical outcomes for your patients. You may also assume your exams detect the existence of significant conditions or findings. Those assumptions, however, are faulty in eyecare.
Fortunately, there is a resource, clinical outcome registries, that can help you put your focus where it should be–on ensuring the best possible treatment outcomes.
You May Not Deliver the Care You Think You Deliver
Healthcare Registries, LLC, has been doing in-depth analytics of eyecare practices to create analytics that have far reaching implications on how clinical outcomes can be improved. Most notably, there is a striking difference in how providers view the care that they deliver. Those providers who follow best practices, and do not utilize a registry, can only assume they will detect anything that is present. In general, these providers have no idea what they can do to improve the quality of care they deliver. Providers who utilize a clinical outcomes registry have easy access to a lengthy list of activities that will improve the quality of the care they deliver.
You May Not Communicate as Well as You Think You Do
Another striking trend emerging is that eyecare providers who do not utilize a registry tend to show poor communication with the rest of the patient’s care team. This is especially true for those who continue to fax their diabetic exam reports to the patient’s primary care physician. Nationally, almost every large health system is encouraging providers to stop faxing because the receiving provider frequently never see the reports. Other than sending diabetic exam reports, these providers rarely send any other communications to the primary care physician.
On the other hand, eyecare providers who utilize a clinical outcomes registry clearly see their role as a valuable contributor to the patient’s care team and frequently communicate with the patient’s care team. These ECPs tend to create closer relationships with the rest of medicine, so the other medical providers understand what information they can expect to receive after an eye exam.
Case Study: How Well Are You Serving Patients with Hypertensive Retinopathy?
Let’s look at how the analytics on hypertensive retinopathy support the above. Most providers believe that if hypertensive retinopathy is present, they will see it. Registry data does not support that belief. In reality, the data supports the claim that “You see what you are attentive to.”
When practitioners do not routinely record hypertension in the problem list, analytics show that hypertensive retinopathy is diagnosed less than 1 percent of the time. On the other hand, ECPs who record hypertension in the problem list, document and diagnose hypertensive retinopathy 5-6 percent of the time. Based on registry users, there is over a tenfold higher rate of diagnosis of hypertensive retinopathy in practices that record hypertension in the problem list compared to those that don’t.
The difference between the practitioners who do and don’t record hypertension in the problem list is clear. It is unproductive, difficult and time consuming to document a detailed health history to create a complete problem list. As a result, practitioners who rely on the patient for their health history rarely list hypertension in the problem list. The history taken by a staff person may record hypertension somewhere in the record, but that doesn’t get included in the problem list.
Registry data shows that those practitioners who receive patient health information prior to the exam directly from the patient’s primary care physician have hypertension in their problem list. This is most commonly accomplished using a service such as Kno2, Carequality, CommonWell or by sharing information with a health information exchange (HIE).
To learn more: 844.393.3282. (toll free) or ContactUs@HealthCareRegistries.com
Data suggest even when hypertension is recorded in the history, it is not effective in prompting the provider to look for changes in the retinal vasculature. This may be because providers don’t always have and review the complete history prior to seeing the patient. On the other hand, almost all providers review the patient problem list at the beginning of every exam. It appears that once a provider reviews and focuses on the problem list, they become more “attentive” to the fact the patient has hypertension, which results in hypertensive retinopathy being diagnosed much more frequently.
Unfortunately, there are some providers who observe and document the presence of hypertensive retinopathy, but do not enter the diagnosis into the problem list. When hypertensive retinopathy is present, but not entered into the problem list, the provider rarely communicates that finding to the patient’s care team or to the primary care physician. When asked why these providers don’t communicate with the rest of the care team, providers express that they feel the physician doesn’t care about getting that information.
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With more frequent and more detailed communication, eyecare providers who utilize a registry tend to develop closer referral relationships with the physicians in their community. The registry has never had a provider who reported that the physician did not want to know about the presence of hypertensive retinopathy.
When asked whether or not they want to know, the physician’s typical response is something like: “When I am trying to encourage a patient to get better control of their blood pressure, it is very powerful to be able to say to them, ‘Your eye exam shows that your hypertension is affecting the blood vessels in your eyes. That means the same thing is happening in other organs in your body.’” The communications we send to the patient’s primary care physician empower that physician to be more effective in encouraging better control on the part of the patient.
Elevate Care for Diabetic Patients
The analytics associated with the management of early diabetes is also offering valuable new information. Those ECPs who do not utilize a registry believe their exam has little or no effect on preventing a diabetic patient from developing a retinopathy. The analytics show that isn’t true. In fact, the way most eyecare providers tell a patient they don’t have retinopathy actually significantly increases the risk of the patient developing a retinopathy. Providers utilizing a clinical outcome registry quickly learn to identify ways to help the patient and the rest of the patient care team achieve better outcomes and effectively lower the HbA1c to reduce the risk of both ocular and systemic diabetic complications.
Move Past Your Assumptions to Achieve Better Outcomes
The eyecare profession is rapidly being segmented into providers who utilize a registry and those who don’t. Those who don’t utilize a registry assume they are delivering high-quality care. Those who measure their clinical outcomes are actively improving the outcomes of the care they deliver.
An article in the Wall Street Journal, “Walmart will eventually beat Kmart,” was published years before Walmart stores appeared in many parts of the country. We all know how that story ended. The article basically said that Walmart had a better business model that would slowly, but eventually, become more successful than Kmart. We are in the same situation in healthcare now. Those providers who measure their clinical outcomes, and use those outcomes to improve their care delivery, will be using a better healthcare model than those who do not.
Take action to utilize a registry to create better clinical outcomes for your patients and strengthen relationships with your patients’ care team.
James E. Grue, OD, is a health-care reform speaker and consultant. To contact him: JimGrue@HealthCareRegistries.com
Ronald P. Snyder, OD, FAAO, is the president and CEO of HealthCare Registries, LLC. To contact him: RonSnyder@HealthCareRegistries.com
Michael J. Lipson, OD, FAAO, is the chairman of the OrthoK Advisory Panel of HealthCare Registries, LLC.
