Patient and Provider Experience in Real-Time Telemedicine Consultations for Pediatric Ophthalmology

Carly Stewart; Josephine Coffey-Sandoval; Erik A Souverein; Tiffany C Ho; Thomas C Lee; Sudha Nallasamy

doi:10.2147/OPTH.S374811

Patient and Provider Experience in Real-Time Telemedicine Consultations for Pediatric Ophthalmology

Clin Ophthalmol. 2022 Sep 1:16:2943-2953. doi: 10.2147/OPTH.S374811. eCollection 2022.

Authors

Carly Stewart¹, Josephine Coffey-Sandoval¹, Erik A Souverein², Tiffany C Ho^{1

3}, Thomas C Lee^{1

3}, Sudha Nallasamy^{1

3}

Affiliations

¹ The Vision Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
² Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
³ USC Roski Eye Institute, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.

Abstract

Purpose: Telemedicine adoption hinges on positive experiences for patients and providers. We report participants' experience from our prospective study.

Patients and methods: Ophthalmic examinations for children 0-17 years of age were conducted by an optometrist using digital exam instruments and streamed to an ophthalmologist. The ophthalmologist, optometrist, parent, and patient (≥10 years) completed surveys capturing patient and provider experience outcomes.

Results: Three hundred forty-eight examinations were conducted with 210 patients in a hospital-based pediatric ophthalmology clinic. About 99% of parents were comfortable with exam quality, and 97% indicated they would have another telemedicine examination. Fifty-four of 55 consented for surgery during the initial telemedicine examination. Thirty-seven percent of families traveled ≥2 hours round-trip to their appointment; 1/3 of parents and patients missed a full day of work/school. Video glasses were by far the most useful instrument, while technical proficiency was most challenging with the digital indirect ophthalmoscope. Problem-focused examinations took 33 minutes of the ophthalmologist's time on average. Equipment challenges caused delays in 40/348 (11.5%) of visits, with the majority lasting 5-10 minutes. In a few cases, a backup device was used. Despite seeing significantly fewer patients on telemedicine days, the ophthalmologist's surgical volume increased 25%.

Conclusion: All participants were satisfied with telemedicine visits despite longer durations and learning curve. Results indicate an opportunity for telemedicine in community settings to improve access to specialized care. Telemedicine enabled the optometrist to manage or co-manage more complex patients with a pipeline to the ophthalmologist for surgical cases. In the right setting, collaborative telemedicine consultations may be beneficial to one's practice.

Keywords: patient experience; provider experience; real-time teleophthalmology; synchronous tele-ophthalmology.