By: Swetha Chakravarthy, Dora Mugambi, Karim Keshavjee
Diabetic retinopathy (DR) is one of the most common complications of diabetes mellitus (DM) and is the leading cause of vision loss (VL) in Canada. By 2040, it is expected to escalate by 55%. We propose that it can be prevented using proactive health informatics related interventions that can identify and screen those at risk of vision loss, lower the costs, and treat large numbers of patients at risk of going blind in Canada.
Currently, data about screened individuals is siloed and trapped in patient records. If a patient consults an optometrist for retinopathy screening, the screening status is recorded in the optometrist’s electronic medical record (EMR). Documentation of this information rarely makes it back to the family doctor. Data may be shared within an integrated practice that comprises physicians, optometrists, and ophthalmologists, but this is a rare combination. Exchanging the relevant data from an optometrist’s EMR to a family doctor’s EMR can save thousands from severe DR.
In Ontario, 440K were not screened between 2016 & 2020 making 30% susceptible to DR in 3-5 years, and 50% may go blind in 5 years. A recent study in Ontario revealed a continuing, accelerated decline in DR screening due to the pandemic, to as low as 20% in some populations which was influenced by their age group, ethnicity, and income. The most vulnerable are at greatest risk.
Also, this problem is associated with a massive cost for the government and society. Treating one patient with retinopathy and its complications can cost anywhere between $3000 and $11000, amounting to a total healthcare spending ranging between $180M to $280M.
We propose that minimal data interoperability between optometrists and family physicians to identify and screen those at risk of vision loss can lower the costs and increase the screening rates, thus treating large numbers of patients at risk of going blind in Ontario. Interoperability and data exchange is possible using clinical communication and collaboration tools that are now increasingly used in practices. Communicating a patient’s screening status to the family doctor will enable tracking of unscreened patients who can then be informed of the need to visit an optometrist. Tools such as eReferral, Secure-Mail and Health Report Manager, which already exist in Ontario, can enable optometrists to share a patient’s screening data.
Multi-stakeholder engagement is vital to address this burning problem. Incorporating digital technologies to improve processes involved in DR screening will require involvement of the 4 Ps: Patients, Providers, Policymakers and Private partners. Patients and Providers form the pillars of patient centred care and will bear a massive influence on the diabetic individual’s health outcomes. Implementing digital tools as a sustainable solution will require strong public-private partnerships. Also for this implementation to be successful, Policymakers will play a crucial role as we will need rules and regulations that foster a well-chalked out ‘Data Governance and Data Interoperability’ structure.