Using electronic Certificates of Vision Impairment to improve patient experience

Post date: 
Wednesday, 4 October 2017
Sign for Eye Clinic in hospital

After a four-year pilot to computerise patient certification, project lead and Head of Partnerships at RNIB, Philippa Simkiss, talks about how digitising the process can save time and improve information accuracy.

When a person’s sight reaches the level when they can be formally certified, a paper Certificate of Vision Impairment (CVI) form is completed. However, worryingly, evidence shows that sometimes CVI forms can be filled out with vital information missing, be misplaced, and at worse, get lost before it reaches social services. 
Into the bargain, it can take several months for a completed CVI form to get from the eye clinic to social services. This is all before the registration process kick-starts and the patient gains access to the support they need. 

How can technology help?

In 2013, a project was set up by RNIB with Moorfields Eye Hospital NHS Foundation Trust and Medisoft Limited, a tech company that supplies Electronic Medical Records (EMR), to develop and pilot two different electronic Certificate of Vision Impairment (eCVI) systems. 
Funded by the Department of Health, four NHS Trust hospitals in England and two social services used the eCVI systems to transfer patient information via email. 

The aim of the pilot was to simplify and speed up the certification process and enable blind and partially sighted people to access help and support more quickly, at the point of certification.

How did the pilot work? 
By 2014, the necessary IT software was developed and implemented to allow the four participating hospitals to record the information as EMR.
Two electronic patient record systems tested the new eCVI - Medisoft Limited and Openeyes. The eCVI form captured the same information required on the paper version,  however, importantly, the eCVI could not be emailed to social services until it had been completed accurately and in full. 
What were the results of the pilot?
Over the pilot duration, a total of 26 ophthalmologists and numerous eye clinic staff used the eCVI to complete 470 patient records. The full evaluation of the pilot includes interviews with health and social care staff (ophthalmologists, optometrists, Eye Clinic Liaison Officers (ECLOs), secretaries, social services staff and providers). 
Across the four hospitals, the evidence showed that:
  • all 26 consultants agreed an eCVI would make the current certification process more reliable and accurate
  • the two participating social services confirmed all eCVI forms received were complete and accurate
  • social services staff agreed the time taken to complete the process was reduced, meaning they could act immediately when they received the eCVI to contact patients and not waste time chasing missing or inaccurate information.   
The report also outlines that all of the practitioners involved were supportive of the potential of the eCVI to improve patient healthcare. 
Once people had received training on the new system it became really well-embedded. Even though eye clinics are extremely busy, staff at all levels responded positively to the introduction of this new practice. 
What were the difficulties? 
We encountered three main difficulties during the pilot:
Time: - Implementing the IT infrastructure took a lot longer than we originally intended. It took a year to complete which then had a knock-on effect with the number of patient’s records captured via the eCVI. 
IT and information governance complexities: Each hospital had different IT systems, some of which needed updating in order to “speak” to the eCVI form. Other delays were caused by difficulties with information governance and getting consent from the Trusts to transfer patient data. 
Number of patients participating: The volume of patients taking part in the eCVI pilot was not as high as expected due to the time taken to establish the new systems. Therefore, it is difficult to ‘prove’ that patient choice and control over their certification was increased as a result of the pilot. However, interviews with staff suggested that ECLOs remained an integral part of completing the CVI form process and that they themselves have a key role in increasing patient choice and control. 
What are the next steps?
Now the project has finished, we’ve presented the learnings to NHS England and we’d like to see a specification developed whereby all hospitals are supported to introduce electronic patient records for completing CVI forms. We’re delighted that Moorfields has already included eCVI in its specification for a new EMR.
By developing a specification for all hospitals, we hope that across England, fewer patients will be left waiting months for a referral to social services and, from a practitioner point of view, time spent on administration will be reduced.

What others say about using EMR

Mr Mike Burdon, President of The Royal College of Ophthalmologists, said: “The principle of electronic dissemination of information is laudable but in practice it can be difficult to implement within an NHS which can struggle with IT issues. 


“Ophthalmologists should encourage their managers to engage in projects such as this that have the potential to make a real difference to the quality of care to their patients.”

Christian Martin, Managing Director at Medisoft Limited, explained: “Electronic Medical Records are all about reducing the burden of duplicate data entry, and we have always found it frustrating that busy doctors should enter clinical information into their own notes, then have to copy much of the same information onto a CVI form in order to certify the patient as sight impaired.  

“Medisoft are delighted to have been involved in the eCVI pilot. It was rewarding to learn that the project helped to ensure that CVI forms were completed more often and more accurately. We were particularly pleased that the system worked so well for local councils, and that the accessibility measures in the software allowed visually impaired Eye Clinic Liaison Officers to complete the forms for themselves rather than relying on an assistant.” 

Further information 
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