Abstract
Purpose :
Many patients with visual impairment can benefit from specialty low vision services, but access to this level of care is limited within most outpatient ophthalmology practices. To bridge this gap, we introduced a best practice advisory (BPA) tool and integrated referral system within our electronic medical record (EMR; Epic Systems™, Verona, WI) to help clinicians at Montefiore Medical Center connect visually impaired patients with services at the Lighthouse Guild International (LGI), a non-profit in New York, NY that provides services for the visually impaired. This EMR-based referral system has been used as a model for expansion to other institutions in New York City (NYC). This retrospective study assesses the impact of workflow modifications and enhancements in Epic Kaleidoscope on referral patterns to specialty low vision care at LGI.
Methods :
We performed an analysis of referrals to LHG from the Department of Ophthalmology at Montefiore, along with an aggregate referral count from all other local institutions in the tristate area between 2015-2022. EMR data was collected from Montefiore, and referral volumes from external sources were provided by LGI. Data was trended over time to determine the impact of sequential workflow modifications along with regional expansion in 2021.
Results :
The electronic referral process to LGI that began in 2016 increased annualized referrals by an average of 320% (p=0.087) over a three-year period (2016-2019 vs. 2015). An additional workflow modification to alert providers of a patient’s visual status resulted in an additional 80% increase in 2019 (p=0.80) compared to 2016-2019. The addition of a BPA in 2021 and expansion of this EMR-based referral system to neighboring institutions in Manhattan has increased total referrals by an average of 106% (p=0.004) compared to prior years.
Conclusions :
The introduction and expansion of an EMR-based system designed to alert clinicians of visual deficits and to enable seamless, real-time referrals has dramatically improved access to low vision services in NYC. Future work will involve further integration of services within the EMR to help clinicians coordinate care more efficiently for patients with visual impairment.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.