Diabetes is a highly prevalent disease that affects multiple systems in the body. Patients benefit from routine preventative screening and care coordinated between multiple providers with various specialties.
One important aspect of care for the patient with diabetes is ophthalmology. Among diabetic patients, 40% have diabetic retinopathy. Diabetes is the leading cause of blindness between the ages of 20 and 74 in the United States and in many patients it is preventable. Studies have shown that strict control of sugar and blood pressure in this patient population can delay visual problems related to diabetic retinopathy.
Researchers hypothesized that a digital health solution could improve coordination of care between the patient, the diabetologist, and the ophthalmologist. They used the SightBook app, by Silicon Valley based DigiSight, that allows patients to create a HIPAA-compliant personal profile to which they could invite their diabetologist and ophthalmologist. Physicians participated by creating SightBook accounts so they could share data. As a result, patients and all participating members of their care team could see posted notes and results.
Additionally, the app allows patients to test their own visual acuity and visual field for deficits and post the results for providers to see. It’s worth noting that the DigiSight website only cites two posters validating the app for use in visual acuity testing; there’s no mention of validation of the other types of testing referenced in this study. We also didn’t see any mention of FDA clearance.
For the purposes of the study, participating patients were asked to fill out questionnaires relevant to their diabetes and each physician involved was asked to report the findings of at least one patient encounter for the patient. The primary outcome of the study was participation (more on that later).
Of the 60 patients in the study, 51 filled out the baseline questionnaires. For these patients, 49 patients’ diabetologists and 45 ophthalmologists provided reports about at least one encounter.
Of course, technology to improve coordinated care cannot work if the players involved are not willing to participate. While the results of this study are interesting, they have to be taken with a grain of salt as participation in the context of a clinical trial is very different than participating in the real world. In this trial, a study coordinator made several calls to participants to encourage follow up – that’s not going to happen in the real world. Also, participation is a soft endpoint of unclear value; what we care about is whether that participation pays off in outcomes for the patient.
Systems like this offer interesting opportunities to improve care by improving communication and making the patient a more active participant in their health management. It will be interesting to see how these types of tools integrate with EMRs, many of which are building in similar care communication modules. With the essentially ubiquitous use of EMRs today, integration of innovative systems that target specific needs like this can provide efficiencies that will make coordination easier and improve the lives of patients.
Hopefully, these investigators follow up this study with assessment of how this platform impacts meaningful clinical endpoints.