Data in optometry: collecting, utilising, and informing the future
OT takes a deep dive into the world of optical data with director of professional services at Leightons Opticians and Hearing Care, Andrew Bridges, and director of professional development at Specsavers, Paul Morris
19 October 2022
Data – how we gather it, secure it, and use it both in the short and longer term – is a subject that’s liable to bring about a headache for businesses. Compulsory GDPR certification aside, where do we start? And is data at scale even useful, especially to small companies?
So, how can optometry practices ensure they’re treading carefully in the data minefield? OT asked two of those with significant experience in this area – Andrew Bridges, director of professional services at Leightons Opticians & Hearing Care, and Paul Morris, director of professional development at Specsavers – for their insight…
Gathering and storing data
So, how do practices protect their data, once they have collected it from patients? Are there practical solutions for its gathering and ongoing safe storage?
At Leightons, the process starts with training staff: data management protection, with compulsory modules, that are revalidated on an annual basis. Staff understanding how to handle data, Bridges said, is priority. Meanwhile, a paperless system across Leightons’ practices means that everything is stored securely, in the cloud.
The group is also working towards Cyber Essentials Certification, as well as enlisting external agencies to test the security of its systems. Seeking advice from professional advisers and an external data protection officer, Bridges said, ensures that all the processes, policies, and procedures for meeting and exceeding regulatory requirements are in place.
We’ve all got an obligation to keep our patient data safe and secure, not just in the four walls of the practice, but also in in any way that it could be compromised
At Specsavers, Paul Morris emphasised the importance of following sector guidance, and ensuring that this is rolled out effectively at practice level. New patients are asked for their consent around data gathering and GDPR; if these questions aren’t answered or need to be renewed, a note will automatically be flagged within the system. If a patient exercises their right to be forgotten, the request is handled centrally rather than falling on local partners or practice staff.
An issue Morris raised is the use of mobile devices and the app-based versions of software, which can present “a real problem with having the good governance around what you're viewing on practice premises and what you're not.” Specsavers has a programme of mandated information governance security training, undertaken by “each and every one of our team members, both in the support office and in public facing roles,” on a yearly basis.
This training “reminds you about the basics,” Morris explained, “that everyone should remember in their life: when to raise a concern, and what to do to safeguard yourself, especially if you’re travelling on public transport or using coffee shop-style public networks.”
He added: “It's really important. We’ve all got an obligation to keep our patient data safe and secure, not just in the four walls of the practice, but also in in any way that it could be compromised.”
Decision making and the limits of dataAside from security concerns, it’s important to remember the value that data can have in guiding a business and the decisions that can be made within it. Can studying the demographics of patients influence decisions about what services a practice offers, for example?
Bridges explained that, at Leightons, data is used to provide insight on practice capacity, and, in certain areas, to guide decisions on “introducing a new service, product or level of instrumentation.” Eight years ago, Leightons invested in optical coherence tomography, and “consideration was made in the investment of that, and the initial rollout in the right practices.”
Data is not the be all and end all, however. In fact, Bridges explained, “Sometimes, data is almost disregarded in order for us to meet our needs and desires to provide the highest quality of clinical care. That can override data.”
He added: “Last year, we reinstalled Optomap across each of our branch practices. That decision was made to ensure our optometrists have the latest clinical technology, so that we can provide rigorous care and clinical excellence. In that case, data wasn't used – it was about quality of care for each patient.”
Bridges used the example of myopia awareness, which he explained should not be focused on one specific demographic as data might suggest, but should instead be spread as widely as possible.
“As eye care professionals, we’ve got a responsibility with the looming or current myopia pandemic,” he said. “We have to provide myopia management advice, even if that's limited to reducing screen use and close work and getting outside, through to providing processes, be it a contact lens product or a spectacle product.”
He added: “I don't think, in terms of speaking to patients, it should be limited to parents of a myopic child. It needs to be a widespread message, probably even more so with the grandparent power, where grandparents are often providing care for their grandchildren. They may well be the ones that are providing funds to deliver that care, and if that’s ultimately ensuring the child retains quality of sight and life, it is important that that communication gets out there to everyone.”
Leightons provides myopia management information in all its communications, rather than only to particular patients. This includes a 16-page colour publication called Talking Points, which goes out to all patients and has recently included a feature on the condition.
Making sure messages reach as many people as possible is also key for Specsavers. Morris explained how collecting data on patient recall amongst different groups led to an envelope being redesigned, which “increased the uptake of recall by a good few percentage points, because people felt that it looked important and that they should open it. They were then more likely to action it.”
Morris added: “That's all part of not only a business ideology, but more importantly a public health ideology. The more people respond practically to recall the better, because it means that they're engaging more readily in eye care.”
He also acknowledged the limits of data, however, and how easy it can be to rely too heavily on it.
“Data is only good provided you’re using it in a positive way,” Morris said. “It’s pointless collecting data for data’s sake. Very often in my role, at the point of clinical data collection, I ask, ‘What are you going to use this for?' You could get it X percent more accurate, or you could find out X percent more or you could investigate this, but would it change what you’re actually looking to do?”
Critical thinking and forward planning are clearly key. Knowing what information will be used for, before it is gathered, appears essential. An area that Specsavers has found useful to collect data for includes forward booking.
“Online availability of appointments is a huge driver in [to store],” Morris explained. “We find that practices that have good online availability and make those slots available tend to have a much better uptake of appointments than practices that don't. It shows how easy and frictionless the public want to access services now. We’re able to look at that kind of data on almost an hourly basis if we wish to, and that comes from investing in the right systems.”
He added: “That's a big part of what we do. We’ve got data streams daily, which combine into weekly reports to help us look at not just commercial aspects of the business, but also the clinical outputs that we have.”
Post-pandemic, Morris said, data analysis has allowed Specsavers to see which practices the previous patients of city centre stores, now largely working from home, are visiting.
“They're accessing care closer to home, rather than going during lunchtimes to the practice in London Wall, for example,” he explained. “It’s interesting to be able to help those stores in their recovery after COVID-19, because some of them are still seeing 20%-30% less volume.”
Advice on using data to guide clinical choices
Andrew Bridges: “We would ensure that any clinical data we’re using is made up of randomised controlled trials, not historic reviews, so that we can deliver that evidence-based approach. A good example is the Contact Lens Evidence-based Academic Report from the British Contact Lens Association, around the fitting and aftercare of contact lenses, and recently the seven-year data from CooperVision on the use of MiSight. We need to be careful that we are utilising the right information when we are talking to a patient about a clinical scenario.
“Financial investment in instruments is quite different to the clinical side. There are significant pitfalls that, if you’re not evidencing or using the right research or the right paper, can trip you up.”
Paul Morris: “With any data, you should always ask how reliable it is and what the sources are. Taking one study or one data point in isolation can sometimes not tell you the full story. Be careful about who is paying for any studies. We should be evidence-based in our practice – but are you sure how the evidence base is being used, particularly by certain companies trying to sell you things, and do they pass muster?”
Patients and staff benefitsMorris described a “deep vein of data” that Specsavers has collected, which can be extremely useful for several things – especially because clinicians can access the information themselves.
The number of data points Specsavers has, taken from real patient examinations – the biggest repository of optometry data in the world
“They can see the difference in the types of referrals that they make and the numbers of them,” Morris said. “It genuinely allows them to reflect, and not in a way that is negative. It’s to say, ‘Why do I do this and how can I do it better? How can I better serve the public that are coming in to see me?’”
The report revealed that 14% of patients have a visual fields test done during their eye examination, Morris said, and “On a sample of many millions, we think that’s about as accurate as you will get.” Knowing this allows clinicians to look at their own numbers, in the context of their own demographics and health economy, and “reflect and be supported” if changes need to be made to the way they are practising.
Morris emphasises the need “to make sure we are having a needs-based approach to eye care, and not a tick box system. We have to make sure that this data is positive, we have to make sure that it’s used in the right way. Doing only the tests that are required for a patient is the right way to do things, both as a clinical philosophy, but also in terms of what that patient experiences when they come to you.”
Patients, meanwhile, are regularly surveyed after their visits: whether anything could be improved, whether certain things were explained effectively, and whether they were made to feel like their problem was solved.
“That's something that we’re really proud to be able to say,” Morris explained. “One of the questions we ask is, ‘Did your optometrist make you aware that a sight test is more than just checking your vision?’ That’s important, because that’s the future of our business. When people are tempted with an internet offer, we want them to know that coming in is important, because 50% of all blindness is preventable. We could publish 400,000 responses to these surveys every year, so statistically, they’re massively significant.”
He added: “We ask whether the tests undertaken were adequately explained. An optometrist might be explaining things perfectly well, in the vernacular of an optometrist, but when you reflect that for most people coming in for a sight test is a two-yearly thing, it can be confusing. Me saying ‘you’re myopic, you’re going to need to wear these glasses for long distance’ doesn't really cut the mustard. But if I say, ‘you’re short-sighted, that means things are blurry in the distance and these glasses are going to make things clearer again.’ That's the kind of change this data allows for.”
Morris believes this is “a timely reminder for us about the impact that we’re having in our communities, which is overwhelmingly positive. But it ultimately also shows that we’re looking to be aware of what we're doing and to improve it when necessary, and to plan our development around that.”
He added that seeing the data in front of them has made clinicians aware that they might not be seeing many contact lens patients, leading them to book into contact lens clinics to avoid losing that skill. Others have realised that progressing to a professional certificate in glaucoma could be beneficial, after realising that this comprises most of the referrals they are making. Specsavers also uses this data to target its continuing professional development offering at the needs of its employees.
“We’re making sure our directors are having those development conversations with their clinicians to make sure they do the very best they can to fulfil their career ambitions and to reduce risk, and also to make sure that they’re fulfilled and having regular discussions about what matters to them,” Morris said. “Most optometrists didn’t get into this to look at percentages. They’re interested in making a difference in their communities and doing a really good job.”
What is the most important piece of data to get from a patient?
Andrew Bridges: The first thing we’re always going to collect is the reason for the visit: what brought them in for an eye examination, or a contact lens assessment? Part of that is around the history and symptoms and their lifestyle needs, so we can provide them not only with continuous care, but assurance that we understand them as a person and that we can provide patient-centred care that is individualised for their needs.
Without a full history and symptoms, clinical decision making will be limited and that potentially puts patient care at risk. By maintaining high quality of care, you can retain that patient.
More and more now, there are optometrists and dispensing opticians with high levels of qualifications. We are ensuring that we are referring that patient to the most suitable person to give them the ultimate outcome.
Influencing the future of the profession
With Optometry First on the horizon and considering the progression of the profession as demonstrated during the pandemic, Bridges and Morris agree that data can be used to successfully present the profession's value for the years ahead.
Bridges believes that data is key as part of the sector’s lobbying efforts, alongside a demonstrated and clinical collaborative approach that highlights “support and collaboration from secondary care.”
He cites the COVID-19 Urgent Eyecare Services (CUES), where often patients’ only option for eye care was via their community optometrist. Reflecting on the value of CUES is important in demonstrating its value, Bridges said: “We need that endorsement to ensure that we're getting the right public funding, which will continue to be a challenge, particularly at the current time. We can't have certain aspects subsidising other areas of the optometry business; it has got to be appropriately funded. If some of these services have meant the patients have been able to be seen on time, and if it’s reducing the waiting lists, then that's great.”
We need that endorsement to ensure that we're getting the right public funding, which will continue to be a challenge, particularly at the current time
Glaucoma and post-operative cataract schemes, he added, “are supporting patients in getting quality care, locally to them, that’s convenient. That’s something we need to do for the profession. There is a rising number of people gaining additional qualification and certification in independent prescribing (IP), medical retina, and glaucoma.
“To ensure that there’s a robust way of being able to get the message across to the government, we've got to stand up and gain those qualifications to ensure that we've got a workforce that's able to deliver hospital level care on the High Street.”
If the profession can demonstrate that an increasing number of IP optometrists are taking the strain away from GPs and A&E in terms of glaucoma, and if that means patients aren’t missing out on regular or even sight-saving care at hospital, Bridges believes it’s something “absolutely vital that, collaboratively, all the professional bodies come together to drive forward.”
Linking this upskilling of the profession to data, Morris pointed out that “we are able to catalogue and demonstrate just how many referrals we make from people who would otherwise not come in.”
With less than half of all glaucoma detected, he added, “We’ve got a big job to do to be able to ensure we are better at finding it, but also to ensure that people who haven’t accessed regular eye care now do.”
Data making a case for better and more consistent funding for what we do, particularly in England, where there is less congruity than you see another devolved healthcare systems, is vital
He said: “I used to do a bit of triage for ophthalmology. They don’t realise that as a sector we see about 20 million people per year for eye care. Whilst lots of things end up in their clinic, there are many things that we manage in our own four walls or between local enhanced services. This data set gives us the ability to go ‘no, actually, this is what happens.’ It's vital that we have this, and we start talking about it and using it.”
“Ultimately,” Morris added, “I think that data making a case for better and more consistent funding for what we do, particularly in England, where there is less congruity than you see in other devolved healthcare systems, is vital. It’s also about making the case to the public that they are best served with a clinical professional looking after their care and making sure that their eyes are fit and well, not just now, but long into the future. If we can use our data to do that, that can only be a positive thing.”