An 8-year retrospective review of all the patients who presented across the three-tier eye care network of L.V. Prasad Eye Institute (LVPEI) was performed from August 2010 to August 2018. The patient data were retrieved using the information captured through the in-house EMR system eyeSmart™. The study was approved by LVPEI's Institutional Review Board on 11.9.2018 with reference number of LEC 09-18-150 and adhered to the tenets of Declaration of Helsinki. A standard consent form for electronic data privacy was filled by the patient or their parents or guardians at the time of registration.
The three-tier eye care model of LVPEI includes 176 Vision Centers that provide primary care in the districts and villages of Andhra Pradesh, Telangana, Odisha, and Karnataka. These are linked to 18 Secondary Eye Care Centers, which are, in turn, linked to LVPEI Tertiary Centers in Visakhapatnam, Vijayawada, and Bhubaneswar. LVPEI's Center of Excellence at Hyderabad is at the apex of the Eye Care Pyramid. The medical records of all patients who presented to any of these Centers during August 2010 to August 2018 were reviewed retrospectively using the eyeSmart EMR database.
In total, 2,270,584 patients were captured on the EMR system and their total consultations were 4,730,221 in this 8-year period. All the patients who were registered onto the EMR system were included in the study. The variables in the collected data include age, gender, geographical location, laterality of eye affected, and ocular diagnosis. The geographical location and country as reported by the patients at the time of registration were documented in the EMR system and were included in the study.
Each eye of the patients was diagnosed separately, and each individual diagnosis was considered cumulatively for the analysis. The LVPEI coding diagnosis developed in-house was used for the patients, which includes a comprehensive list of ocular disorders, and the ICD-11 coding was automatically mapped to the relevant diagnosis. The ocular diagnosis made were categorized into different ocular disorders, such as amblyopia, cataract, cornea, and anterior segment disorders, glaucoma, neuro-ophthalmology, ocular trauma, refractive error, retina, uvea, and strabismus.
The age, gender distribution, demographic details, and proportion of ocular disorders were calculated through an SQL query written to extract information from all the databases of the centers across the network during the 8-year period. The individual numbers and percentages of the parameters to be studied were calculated through the query and exported to an excel sheet for further analysis. A detailed representation of the process is provided in the supplementary material. No identifiable information of the patient was used for analytical purposes. The de-identified information was replicated into another database from where analytics were visualized using tools for the same in real time. “eyeSmart EMR” is an indigenously built EMR system at the LVPEI, India. This system was developed in-house by using open source tools such as PHP (Zend Technologies, Cupertino, CA, USA) for programming and MySQL (Oracle Corporation, Redwood City, CA, USA) for database management. The eyeSmart App was developed on the Android platform (Google LLC, Menlo Park, CA, USA). The system allows the documentation of clinical information of patients significantly in a structured format that allows analysis for research purposes, and unstructured information is also captured. The information from the database was analyzed to provide a real-time overview. All tables for age, gender, location, and diagnosis category were drawn by using Microsoft Excel.
The three-tier eye care model of LVPEI includes 176 Vision Centers that provide primary care in the districts and villages of Andhra Pradesh, Telangana, Odisha, and Karnataka. These are linked to 18 Secondary Eye Care Centers, which are, in turn, linked to LVPEI Tertiary Centers in Visakhapatnam, Vijayawada, and Bhubaneswar. LVPEI's Center of Excellence at Hyderabad is at the apex of the Eye Care Pyramid. The medical records of all patients who presented to any of these Centers during August 2010 to August 2018 were reviewed retrospectively using the eyeSmart EMR database.
In total, 2,270,584 patients were captured on the EMR system and their total consultations were 4,730,221 in this 8-year period. All the patients who were registered onto the EMR system were included in the study. The variables in the collected data include age, gender, geographical location, laterality of eye affected, and ocular diagnosis. The geographical location and country as reported by the patients at the time of registration were documented in the EMR system and were included in the study.
Each eye of the patients was diagnosed separately, and each individual diagnosis was considered cumulatively for the analysis. The LVPEI coding diagnosis developed in-house was used for the patients, which includes a comprehensive list of ocular disorders, and the ICD-11 coding was automatically mapped to the relevant diagnosis. The ocular diagnosis made were categorized into different ocular disorders, such as amblyopia, cataract, cornea, and anterior segment disorders, glaucoma, neuro-ophthalmology, ocular trauma, refractive error, retina, uvea, and strabismus.
The age, gender distribution, demographic details, and proportion of ocular disorders were calculated through an SQL query written to extract information from all the databases of the centers across the network during the 8-year period. The individual numbers and percentages of the parameters to be studied were calculated through the query and exported to an excel sheet for further analysis. A detailed representation of the process is provided in the supplementary material. No identifiable information of the patient was used for analytical purposes. The de-identified information was replicated into another database from where analytics were visualized using tools for the same in real time. “eyeSmart EMR” is an indigenously built EMR system at the LVPEI, India. This system was developed in-house by using open source tools such as PHP (Zend Technologies, Cupertino, CA, USA) for programming and MySQL (Oracle Corporation, Redwood City, CA, USA) for database management. The eyeSmart App was developed on the Android platform (Google LLC, Menlo Park, CA, USA). The system allows the documentation of clinical information of patients significantly in a structured format that allows analysis for research purposes, and unstructured information is also captured. The information from the database was analyzed to provide a real-time overview. All tables for age, gender, location, and diagnosis category were drawn by using Microsoft Excel.
