The Eye-Q Factor

Raising Your Patients’ Knowledge Through Automated Education

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Using automated communication tools, doctors can now direct relevant education to their patients, wherever and whenever, on their preferred electronic device. In the information age, while the good news is that patients have access to a wealth of information, the bad news is that the information can often be random and disorganized.

Now, the latest patient education tools ensure that eyecare professionals can focus the information they provide their patients’ based on their diagnoses and treatment in a more personalized way. In fact, the government is requiring this electronic sharing of information as mandated by Meaningful Use requirements.

The ability to access educational materials at home, either through a practice’s patient portal or via email or text messages, has effectively revolutionized the patient education process, according to the practitioners VM spoke to for this article.

“Educated patients understand the importance of their eye health,” said Jay Henry, OD, MS, partner at Hermann and Henry Eyecare in Pickerington, Ohio. “They come in regularly for eye exams, and they want our recommendations for treatments, whether it’s eyeglasses, contact lenses or prescription medications, that are best for them.”

Indeed, Henry believes educating his patients has helped drive sales of premium products in his practice. He also credits it with improving the care patients receive, because it allows them to make more informed decisions about their vision care. But, of course, that is not the only reason why he makes sure his patients are educated.

Since 2012, Meaningful Use has placed renewed focus on patient education among all health care providers, including optometrists and ophthalmologists. Part of the American Recovery and Reinvestment Act of 2009—also known as the “stimulus package”—Meaningful Use effectively established financial incentives designed to encourage doctors to transition to electronic health record (EHR) systems and/or related add-on software products that not only digitize patient case files but assist in the delivery—and, perhaps most importantly, the documentation of said delivery—of educational communications relevant to these patients, based on the diagnoses and treatments they receive.

According to Henry and other eyecare practitioners who spoke to Vision Monday for this article, companies offering EHR and related technologies have made significant improvements to their offerings in recent years, making them easier to use and providing a simple and effective way to meet Meaningful Use requirements while providing invaluable assistance in educating their patients on a multitude of ocular conditions and treatments. Some even credit the technology with helping them modernize their interactions with their patients, improving the care and service they provide both in the real world and online.

“Most eyecare professionals have always been educating their patients, long before Meaningful Use came along,” Henry said. “I know we were in our practice. Yes, Meaningful Use has changed the game a little bit, but it shouldn’t be a huge departure for most practices, as long as they are doing the patient education they should be doing. Still, EHR and the patient education capabilities offered by some of these systems can help you better position your practice for growth.”

“I know the educational resources offered through my EHR have really helped me improve patient care,” added Peter J. Cass, OD, of Beaumont Family Eyecare in Beaumont, Texas.

So how are some eyecare practices educating their patients in the digital age?

Using systems such as the 4PatientCare patient communications tool, patients can now be educated anywhere they feel comfortable.
Patient Education and Meaningful Use
In 2010, the Centers for Medicare & Medicaid Services (CMS) established three stages of its EHR Incentive Program “designed to support eligible professionals and hospitals with implementing and using EHRs…” The program awarded financial incentives to health care providers who complied with each of the three stages for Meaningful Use of EHR, within the timeframe established by CMS, with monetary payments intended to effectively reimburse practices for the costs (and loss in productivity time) associated with the transition to EHR.

Practices hoping to qualify for incentives under Stage 2, which established criteria for the use of EHR systems for the development of treatment plans and the education of patients regarding these treatment plans, have until the end of this year to incorporate certified Stage 2 EHR technology. After 2015, Medicare will require that all eligible health care professionals—including optometrists and ophthalmologists—meet Meaningful Use EHR requirements, or face financial penalties. With that in mind, it’s important to note that Meaningful Use also requires practitioners to document their efforts to meet these metrics.

The patient’s Compulink health record indicates what type of education was provided, how it was delivered and on what date.
EHR and Education: an Overview
Although eyecare practitioners have been training staff on how to educate patients for decades, electronic education has changed the way that this can be accomplished. Practitioners still educate patients while they are sitting at the exam chair or at the dispensing table, and many still rely on brochures and other materials, which they typically review with patients in person or give them to take home, or both.

However, thanks to improved EHR technology, more and more of these educational efforts are being conducted in front of a computer screen, or using other electronic devices. This new mode of communication has meant that even experienced eyecare practice staff members have had to effectively re-learn how to educate patients. This is no easy task, even though EHR and other software vendors typically provide free—and comprehensive—training programs included in the purchase price.

“Now, if I hire new staff people, I have to be sure I am hiring people who are computer savvy,” noted Mary Anne C. Murphy, OD, of Front Range Eye Associates in Broomfield, Colo. “That’s how we’re communicating with our patients now.”

VueCare’s VueSimulator integrates with EHR systems to provide animation, graphic and video technology to demonstrate
ocular conditions and treatments.
System Successes
Available software systems designed to assist eyecare practitioners in the delivery of patient education typically fall into one (or more) of the following categories: comprehensive EHR systems that include patient education components or can be integrated with separate patient education software platforms; patient education platforms that can interface with separate EHR systems; and patient “engagement” (i.e., communications) programs that can interface with separate EHR systems.

It’s important to note, however, that not all EHR systems and patient engagement programs are certified for Stage 2—or the provision of patient education—under Meaningful Use, even though many non-certified software programs can still help practices educate their patients. Also, many EHR systems integrate with patient engagement programs, thereby enabling both to be an integral part of a certified system.

EHR systems that include patient education components typically feature either on-board patient education platforms or allow for integration with separate software systems offering educational resources for patients. The best systems, practitioners say, offer comprehensive educational materials on a wide variety of ocular diseases and treatments, using compelling graphics and state-of-the-art video and imaging technology.

Most of the patient education materials offered by software manufacturers are developed either by experienced eyecare practitioners or are sourced by established medical information suppliers, such as the National Library of Medicine’s MedlinePlus database, the world’s largest medical library that provides an online resource for information on diseases, conditions and treatments using non-technical language. Most are customizable according to the needs of individual practices. Indeed, Murphy said that the system in use at her practice, for example, provides what she describes as “comprehensive” materials, and while she believes that more information is always better, she also likes that she can tailor certain messages to fit individual patients and/or the practice’s preferred treatment approaches.

“Initially, we found that a lot of the materials provided by our software company were generating more patient questions than we anticipated,” she explained. “A patient with cataracts would call us in a panic saying things like, ‘It says I can go blind from this!’ We want our patients to be informed and to know the importance of their eye health and adhering to prescribed treatment, but we want to make sure we’re providing them with the information they actually need, not all of the information available.”

In general, Murphy recommends that practitioners assess the content of the educational materials before deciding which systems to use in their practices. For example, for her practice, it was vital that educational materials should be available in multiple languages—particularly Spanish—and written in a way that is easy for patients to understand, using “appropriate tone and analogies.”

Patients can access videos, tutorials and other educational resources, such as those from Eyemaginations, using the electronic device of their choice.

Systems should also offer flexibility in the way educational information is disseminated to patients, Henry said. Several companies’ systems enable the creation of individual patient portals for all patients in a practice, which allow patients to access their profile information and any relevant educational resources, online, at any time. Patient engagement systems assist practitioners in crafting customized emails and/or text message to patients, as well as regular mail, either in the form of detailed messages with links to educational resources or newsletters.

“Whether it’s through the patient portal, or email, our educational messages reach our patients in the way they want to be reached,” Cass explained. This ability to review this information at home or anywhere an electronic device provides access has revolutionized the patient education process, according to practitioners.

According to Murphy, by being able to access information on their condition and/or treatment at home, patients can share the materials with their friends and families and, if necessary, seek their advice or additional resources. Many of the patient education components currently available for eye-care practices even enable patients to ask their doctors questions via email and/or instant messaging. For many practices, this has reduced the amount of phone traffic and phone consults.

“When we go to the store to buy furniture, the salespeople hand their customers a handheld device to collect information and display product options,” Murphy said. “So why shouldn’t we as health care providers be doing the same thing?”

Designs of the Times
The same technology that has powered high-tech graphics for computers and hand-held devices has also brought patient education materials into the 21st century.

According to Cynthia Matossian, MD, of Matossian Eye Associates, an ophthalmology/optometry group practice with three locations in southern New Jersey and eastern Pennsylvania, her practice EHR system uses “beautifully rendered” animated videos to explain dozens of common ocular conditions. Each exam room in the practice is now equipped with multiple computer monitors. The images displayed on the monitors as a patient enters the exam room are determined by the content of his or her electronic record. A patient with diabetic retinopathy, for example, will see scans of their retina as well as educational videos highlighting the progression of the disease and the risks associated with not treating it. Other videos also explain commonly used treatment approaches.

Furthermore, as patients leave following their exam, the front desk staff at Matossian Eye Associates will confirm their email addresses and send applicable educational videos to them immediately after they check out. Like most systems certified for patient education under Meaningful Use, the software used by Matossian Eye Associates tracks the dissemination of educational messages and records them in patients’ electronic records.

With one entry during annotation, Uprise by VisionWeb automatically populates diagnosis, treatment, orders, special testing and education messaging for individual patients.
“Patients can get overwhelmed and feel pummeled by all of the information we’re throwing at them during their eye exam,” Dr. Matossian explained. “We can’t expect them to absorb all of the information we give them. With the system we use, we can send them educational videos that they can review later, in the privacy of their own homes, with family and friends, if necessary, and they can watch them multiple times. As a result, we find our patients understand their eye health much better. When they come back for follow-up appointments now, we’re no longer starting from scratch. It’s no longer, ‘What’s a cataract?’ It’s, “I think I have a cataract. What are my options for intraocular lens implants?’”

Other systems use high-quality medical images developed by graphic designers. Some of these even include interactive components that allow eyecare professionals to draw on-screen to emphasize a specific point and enable patients to zoom in on specific aspects of the material to gain further understanding.

The Acuitas activEHR by Ocuco’s patient education suite lets ECPs
select from a menu of conditions and treatments.
“The materials we have access to are so professionally done we really see them as a continuation of what we had always been trying to do in the exam room,” Murphy said. “With our system, as you are documenting in the patient chart, the appropriate educational materials are automatically selected once you select the patient’s diagnosis. So if the patient is nearsighted, or has cataracts, we can review the appropriate materials with them immediately in the exam room and then place them in the patient portal or email them directly to the patient so they can access them later.”

Best of all, Murphy noted, having its patient education guided by a practice-wide software system has made the “messages” patients at Front Range Eye Associates receive “more consistent.”

“Because we are a multiple-doctor practice, and we try to have our patients see more than one doctor in the practice so that there are multiple people familiar with their vision needs, we no longer have to ask, ‘Did you remind this patient not to go swimming in their contacts?’ or, ‘Did you tell the patient how to clean their lenses?,’” she explained. “The software tells us. As a result, patients are getting the same messages from all of us and we are providing all of our patients with a consistently higher level of care.”

Through EHRs such as MaximEyes and others, users have direct access to patient education resources from MedlinePlus, an online resource for informationon diseases, conditions and treatments
The Benefits of an Educated Patient
Tamara Maule, OD, who runs her private practice in Boca Raton, Fla., said she has found that the patient education initiatives she has been able to use with her software system have really “helped highlight the importance” of vision care to her patients. She has seen increases in the sales of premium spectacle and contact lens products in her practice as a result.

“When we have a patient who is a smoker, for example, our software reminds us to address ways of minimizing risk of the effects of smoking on the eyes with them, like, say, wearing sunglasses,” she explained. “We can talk about these issues while they are still in the exam chair and then send them materials to review later electronically. It’s helped my practice standardize the care we offer, and patients think it’s really cool.”

Dr. Matossian added that, in general, her patients with eye health issues are now more proactive in the treatment of their conditions, more compliant with prescribed medical therapy (when applicable) and more apt to select the best products and/or treatments to address their vision needs, since the practice began using its EHR in educating them. “We are seeing more patients select toric implants after they are better educated about their astigmatism,” she noted about her cataract patients. “In general, we have found that patients are coming away impressed with the education we provide and are recommending us to family and friends because of it. It’s helping us grow our practice.”

A provider-led, cloud-based patient relationship management platform, Solutionreach integrates with an eyecare
practice’s existing practice management software system to manage targeted patient outreach.
Experts expect the “digital” patient education trend to continue, if only because Meaningful Use EHR requirements specify that by 2018, 35 percent of all patient educational communications must be transmitted electronically. Currently, the requirement is still only 10 percent.

“Meaningful Use isn’t perfect and there are aspects of it that could be better, but I generally believe it’s a good thing for eye-care,” said Henry, who lectures nationally on the topic. “In the end, you’re giving patients the information they need to help them understand their health condition, whether there’s a new diagnosis or they are dealing with something they’ve had a long time. We’re providing them with knowledge that helps them improve their ability to manage their health care and to make the decisions they’ll need to make with their treatment in a way that most people are using to communicate now. How many people do you know who aren’t online or using email?”