BLOG: Digital conversations with patients

Did you know a computer can diagnose melanoma better than a board-certified dermatologist? Trained by machinery and artificial intelligence, a computerized camera system at Stanford University in a recent study accurately identified 72% of photographed cutaneous melanomas compared with only 66% accuracy by a group of board-certified dermatologists. And that’s just a first-generation computer system. In ophthalmology, computerized systems are already screening retinal fundus photographs of patients with diabetes to identify early-stage retinopathy and stratify risk for further examination. Other examples of automation will surely arise, and if we’re really serious about improving patients’ lives, we should reach for some of the “low-hanging fruit” — benefits we can achieve through simple computer automation.

Another obvious area where we can improve patients’ lives is through automating communication. In a typical 10-minute patient visit, we doctors must establish trust, interview the patient to understand the complaint, collect and update the medical history, examine the patient, develop a treatment plan, educate the patient, prepare prescriptions, answer questions, and enter everything into the electronic health record. With packed clinic schedules, it’s impossible to educate patients on every detail they need to know. And we never have time to call patients after office visits or surgery to follow up and find out how they’re doing. This is especially important for patients preparing for our most common procedure, cataract surgery, where the conversation about refractive options often takes a back seat or gets dropped entirely by a rushed surgeon. Patients who don’t thoroughly understand their refractive options usually opt for the “basic” package, often missing out on a great opportunity for a life with better vision.

Computer systems, though, can take all the time a patient needs to have routine “conversations” with patients. We began several years ago developing a system called MDbackline to help us close this gap in talking with patients. It’s now in full use in my practice and several others throughout the country. More than 10,000 patients have completed interactions, including learning how to take eye drops (who spends time talking about that?), what to expect before and after surgery, risks and, of course, premium lens options. Are patients better educated? Absolutely. We tracked one group of five doctors over a 10-month period after they began using MDbackline’s preop education tools. Their adoption of premium lenses rose from 22% to 36% over those 10 months — more than a 50% increase. In another group of patients, 72% reported less waste of eye drops after completing online instructions in how to use them properly. We have identified patients with complications of eye drops like beta-blockers, which have caused depression, sexual dysfunction, COPD exacerbations and fatigue in more cases than we ever would have identified through traditional communication channels. In other words, we are improving lives without personally spending any more time.

Do patients resist communicating with their doctor over a web-based app? They actually appreciate the additional touchpoint and regularly follow the links we offer to social media sites where they can express their gratitude. In fact, for new patients we are moving to collecting their entire pre-visit history through the online interface, allowing us to populate the EHR with structured history data and saving our staff about 45 minutes of time per patient. This allows patients a more relaxed encounter when they arrive in the office with less paperwork and a staff that is more informed of their background and history. Armed with educational material that reaches them even before the first visit, patients come in more relaxed with more informed questions for our staff. And as we expect, more of them are comfortable making refractive lens choices.

MDbackline is just one form of medical artificial intelligence that is changing patients’ lives. And the smarter these systems get, the more our patients benefit.

Disclosure: Hovanesian reports he is the founder of MDbackline.