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Judith E Goldstein, Xinxing Guo, Kerry Smith, Michael V Boland, Bonnielin K Swenor; Using an Electronic Health Record Advisory to Identify Patients for Referral to Vision Rehabilitation Services. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4045.
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© ARVO (1962-2015); The Authors (2016-present)
Design and test an electronic health record (EHR) “Best Practice Advisory” (BPA) to notify physicians of patients whose visual acuity or diagnosis indicates they are a candidate for low vision rehabilitation (LVR) services.
We designed a BPA within the Epic EHR to collect data on LVR referral decisions. This BPA notification alerts the user when visual acuity is worse than 20/40 in better eye or when specific visual field diagnoses are selected (such as hemianopia). Criteria were set to suppress the BPA notification to minimize unnecessary alerts. A total of 15 ophthalmology faculty physicians representing 8 subspecialties at the Johns Hopkins Wilmer Eye Institute main hospital and network locations participated in this ongoing study, which collected data on physician referral responses of “order referral”, “do not order”, “already under low vision care”, etc. No further intervention was performed to connect patients to LVR services beyond usual care.
Out of 263 clinic days (November 2017 to 2018) representing 46,627 encounters, the BPA alert appeared in 2899 (6.2%) of encounters, following suppression of the alert in 14,829 (32%) for reasons of age less than 5 years, concurrent surgery, prior LVR visit, or prior BPA actions, and 1,639 (3.5%) for invalid VA data. Choosing the option “order referral” occurred in 417 (14.4%) of eligible encounters (range 1.2% to 26.9% across physicians) representing 392 patients. False positives (alert appeared in error) were present in 37/14,829 (0.3%) of encounters meeting suppression criteria and in 160/28,910 (0.6%) of encounters where VA was 20/40 or better. False negatives (did not fire when VA was worse than 20/40) occurred in 190/2991 (6.4%) encounters. To improve ease of BPA use based on physician feedback, the number of EHR BPA decision options was reduced from 7 to 3 and an additional notification option was implemented earlier in the EHR documentation flow.
An EHR can be leveraged to identify patients with vision impairment and track recommendations regarding LVR services. The BPA ease of use by physicians and execution accuracy are critical for feasibility of implementation across relevant EHR ophthalmology platforms.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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