Examining Comprehension of Eye Exam Notes by Non-Eye Care Providers to Improve Diabetic Retinopathy Care Coordination

Abstract

Purpose : This pilot study examines comprehension of eye care notes by primary care and endocrinology physicians to improve diabetes care coordination. While acronym-laden notes ease documentation burden on eye care providers, anecdotal evidence suggests that such notes may pose communication challenges during care coordination between specialties.

Methods : A survey was administered to 15 primary care and endocrinology physicians at UC San Diego to assess their understanding of eye care notes in the electronic health record (EHR). A Likert scale was used to collect and analyze answers regarding level of confidence in assessing eye care notes. Participants were also asked to review 3 sample eye care notes and determine whether a dilated fundus exam was performed and diabetic retinopathy (DR) status. Analysis was performed using Qualtrics and Microsoft Excel (Version 16.68).

Results : Of the 15 participants, the most represented specialty was endocrinology (7, 54%). Most participants did not have ophthalmology rotations in medical school or residency (9, 64% and 12, 86%, respectively).
Overall, 10 (83%) did not feel confident understanding eye care notes, 11 (92%) did not feel confident understanding eye exam findings, but 8 (67%) did feel confident understanding the assessment and plan of eye care notes. When providers did not understand eye care progress notes, most (9, 45%) relied on online search engines, few (4, 20%) asked eye care colleagues, and fewer (3, 15%) asked the referring eye care provider.
When asked to interpret sample eye care progress notes, the surveyed primary care physicians and endocrinologists correctly determined dilation status 100% of the time but were unsure about DR status 33% of the time.

Conclusions : Interpretation of eye care notes may be challenging for non-eye care providers. Further understanding of these challenges and development of EHR-embedded tools for facilitating clear documentation of DR should be investigated to improve care coordination for patients with diabetes.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.