Purchase this article with an account.
Saif Hamdan, Natalia Gabriela Morales, Stephanie H. Jian, Kathryn Carlson, Merrill Stoppelbein, Sean Donahue; Integrating Automated Preschool Vision Screening into the Medical Home. Invest. Ophthalmol. Vis. Sci. 2020;61(7):242.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The USPSTF recommends screening children for amblyopia and associated risk factors at ages 3 to 5 years old, and possibly even sooner. Challenges to implementing such programs in the medical home include coordinating referrals to eye care providers and follow-up. We describe a sustainable and replicable vision screening model that addresses these barriers.
In September 2018, the Vanderbilt Pediatric Primary Care Clinic (VPPCC) began automated photoscreening at 18 month and 3 year well child check visits. These visits were chosen because they have fewer required elements, allowing for integration of screening into workflow; photoscreening was added to the 4 years check later due to barriers in compliance at that age. We utilize a handheld, digital photoscreener (the PlusoptiX S12C) with electronic data storage and transfer via an SD card. Team members include providers, nurses and a referral coordinator.Prior to patient visits, providers place an automated order set to flag children for screening, which is performed by trained nurses during intake. A failed vision screening (FVS) triggers a Best Practice Advisory in the electronic medical record, which automatically sets up the referral order, adds “FVS” as a visit diagnosis, and auto-populates a plan in the clinic note. All referrals are sent to an in-house referral coordinator, who contacts the patient’s family and helps schedule an appointment with a Vanderbilt ophthalmologist or optometrist.Photoscreening completion and referral rates are monitored weekly through a report generated through the electronic medical record.
From April 2019 to November 2019, 1915 children were screened (on average, 70.9 children/week). The referral rate during this time was 28.5%. An in-house coordinator, who is familiar with the clinic patients, allowed for closed-loop communication during referral scheduling and follow-up. Billing used CPT code 99177; the aggregate amount of reimbursement for photoscreening since September 2018 has been $32,000.
An integrated automated photoscreening model that incorporates a best practice advisory in the EMR at this clinic represents an effective model that can be replicated by other primary care pediatric offices. This efficient and cost-effective approach allows primary care providers to keep up with the increasing burden of vision screening recommendations.
This is a 2020 ARVO Annual Meeting abstract.
This PDF is available to Subscribers Only