January 21, 2020

3 minutes to read


Edmonds is Senior Medical Advisor and Eye Care Manager at United Healthcare, Co-Director of Low Vision / Contact Lens at Wills Eye Hospital in Philadelphia, and a member of the PCON Editorial Board.

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The hot topic of discussion in healthcare reform this winter revolves around patient access to their medical information.

One of the founding principles of patient-centered primary care is patient education and providing patients with their personal information and the tools they need to take better care of themselves. Because we now take vital signs regularly as part of a comprehensive eye exam and provide OCT wellness tests, the data in our charts is invaluable to the overall health of our patients.

With an increasing number of optometrists using electronic health records and trying to meet Merit-Based Incentive Payment System (MIPS) standards, providing our patients with access to their medical information should be a widespread practice. However, when I speak to my colleagues, it is a rare event.

We are not alone. In a retrospective study of National Hospital data conducted by Sunny C. Lin et al, only 10% of patients with access used it to obtain their health data.

Hospitals are also not the only ones not providing patients with usable access to their health data. In one of the health affairs blogs featured by Christine Bechtel and colleagues, she points out that most providers have resisted the movement to make patient health data easily accessible. Providers claim that patients will not be able to understand their medical records or that data security will be compromised. For optometrists, there is a fear that a patient might get their glasses or Rx contact lenses and use them to obtain optical products from other retail resources or online.

However, patients have a great interest in obtaining their medical data. In a survey commissioned by the National Partnership for Women and Families, an overwhelming majority said they would use and value their health data to improve their health. While the survey indicated there was some concern about the privacy of their protected health information, they felt that the benefits of accessing their health data outweighed the risks. People are very accustomed to shopping, banking and other financial transactions online, but access to healthcare and related data is still limited.

So where is the disconnection? First, after a lot of the hype about patient-centered healthcare, the standard of meaningful use for providing patients with access to their medical data was extremely low. Having to give access to a single patient to comply with the measure was only a nuisance. The Patient Portal may have been operational but not promoted or used other than for the demonstration required for MIPS.


The second problem relates to the economics of the traditional fee-for-service system which remains dominant in health care in general, and almost exclusive in eye care. This and the physical retail aspect of optometry that rewards us for harboring information creates a barrier to open access to our medical records.

There are a number of things we can do to close this gap and help our patients leverage their own clinical data to improve their health. You may have to go against the grain, but you can set your practice apart by filling this gap in care.

First, you need to complete your evolution from primary eye care to primary health care. You should make sure to collect vital signs and take a complete health history for all of your patients.

The second is to list all of the appropriate diagnostic codes and management plans in the health record. Your medical record is not complete unless you list systemic diagnoses that may lead to vision loss.

The last suggestion will bring it all together, and that is to open your patient portal and promote it to your patients as part of your doctorate at the end of the meeting. Your patients will appreciate it and be more comfortable with you as a member of their primary care team.

The references:

Bechtel C, et al. Health affairs. 2019;doi: 10.1377 / hblog2020108.82072.

Lin SC, et al. Health affairs. 2019;doi: org / 10.1377 / hlthaff.2018.05437.

National Partnership for Women and Families. Engaging Patients and Families: How Consumers Appreciate and Use Healthcare IT. Published December 2014. Accessed January 20, 2020.

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