Tele-Neuro-Ophthalmology Utilization, Availability, and Attitudes: update 1 year into the COVID-19 public health emergency
Moss, Lai & Ko
Journal of Neuro-ophthalmology 2022
Supplement
• Survey Questions page 1
• Supplemental Table 1 page 8
• Supplemental Table 2 page 8
• Supplemental Table 3 page 8 Survey Questions
1. What state/province AND country are you currently practicing neuro-ophthalmology? (List all US states and country options based on NANOS membership list)
2. What is your age?
A. <35 years B. 35-44 years C. 45-54 years D. 55-64 years E. 65+ years
3. How do you describe yourself?
A. Female B. Male C. Other
4. What is your primary board certification?
A. Ophthalmology B. Neurology C. Both
D. Other (fill in)
5. How would you describe your primary practice setting?
A. Private solo/group practice B. Private hospital based C. Academic based D. Government based
6. What proportion of your gross income is based on clinical collections? (i.e. percentage of income that would be eliminated if your clinical volume was zero)
A. 0-25%
B. 26-50%
C. 51-75%
D. >75%
7: What changes have you made to your practice workflow as a result of the COVID-19 pandemic?
(choose all that apply)
A. Decreased waiting room capacity B. Enhanced cleaning protocols
C. Personal protective equipment (PPE) mandates for providers D. PPE mandates for patients
E. Exam room modifications (e.g. air filtration) F. Equipment modification (e.g. slit lamp shields) G. Decreased in-person clinical volume
H. Limitations on patient companions
I. Provision of telehealth (any of separate testing visits, video visits, phone visits, patient portal communication)
INFORMATION PAGE
The following questions ask about your utilization of different telemedicine services pre-COVID, early COVID and currently.
For US respondents, use reference dates of:
pre-COVID: before March 1, 2020 early-COVID: March-May, 2020 Current: As of March 1, 2021
For non-US respondents, use dates referencing the initial COVID surge and stay at home orders in your geographical area
pre-COVID: Month before government/institutional restrictions in activity in 2020 Early-COVID: 3 months following start of government/institutional restrictions in activity Current: As of March 1, 2021
8. Please indicate your utilization of live video (synchronous) telemedicine visits in your practice for each time period?
Matrix question (one column selection per row) Columns:
Yes;
No - It was available to me, but I did not use it;
No - It was not available, but I wanted to use it;
No - It was not available and I didn’t want to use it Rows:
pre-COVID, early-COVID, Current
(If they selected yes in current row, go to 8a)
(If they selected any no in current row, skip to question 9)
A. Telemedicine platform integrated with my EMR B. Zoom
C. Doxy.me D. Webex E. Facetime F. Skype
G. Doximity Video H. AmWell I. Other (fill in)
8b. Approximately how many video visits do you currently perform per week? (If the number of video visits average out to less than 1 per week, provide a decimal value.)
8c. Compared to peak use of video visits during the past year, my current use is A. Increased
B. Decreased C. About the same
8d. Assuming reimbursement continues to cover live video (synchronous) telemedicine visits, do you plan to continue this after the COVID-19 public health emergency subsides?
A. Yes B. No C. Undecided
8e. Below is a list of proposed benefits to telehealth. Indicate if you disagree with these benefits. If you agree, indicate if the extent of each benefit has increased, decreased, or stayed the same during the course of the past year.
Matrix question (allow 1 column selection per row)
columns: not a benefit, increased benefit, decreased benefit, similar benefit Rows:
A. Increased access to care for patients B. Improved interprofessional communications
C. Continuity of care for patients unable to be seen in the office D. Decreased overhead expenses
E. Increased appointment efficiency for patient (no travel rooming/screening/check in) F. Increased appointment efficiency for doctor
G. Increased clinical volume
H. Improved patient-physician relationship I. Other (fill in)
9. Below is a list of proposed barriers to telehealth. Indicate if you disagree with these barriers. If you agree, indicate if the extent of each barrier has increased, decreased, or stayed the same during the course of the past year.
Matrix question (allow one column selection per row)
Columns: not a barrier, increased barrier, decreased barrier, similar barrier Rows:
A. Difficulty with implementation (eg, finding appropriate technology services, integration with EHR, learning curve for providers and staff, etc.)
B. Institutional “buy-in”
C. Reimbursement concerns D. Medical liability concerns E. Patient privacy concerns
F. Disruption of in-person clinic workflow
G. Limitations in types and quality of data collected (including exam limitations) H. Patient technology barriers
I. Other (fill in)
9b. Indicate the suitability of the following components to support medical decision making in a video visit.
On video: synchronous examination led by the provider.
Done separately: examination or testing documented asynchronously (e.g. by another provider or in office testing)
Matrix question (choose 1 column per row) Columns
Usually suitable Sometimes suitable Rarely suitable Never suitable Rows
Visual acuity (on video) Visual acuity (done separately) Color vision (on video)
Color vision (done separately) Red desat (on video)
Red desat (done separately)
Confrontation visual fields (on video) Confrontation visual fields (done separately) External ophthalmic exam (on video) External ophthalmic exam (done separately) Cranial nerve exam (on video)
Cranial nerve exam (done separately) Pupil exam (on video)
Pupil exam (done separately) Range of eye movements (on video)
Range of eye movements (done separately) Ocular alignment (on video)
Ocular alignment (done separately) Ocular oscillations (on video) Ocular oscillations (done separately) Fundus exam (done separately) OCT (done separately)
HVF (done separately)
10. Please indicate your utilization of remote interpretation of diagnostic testing (e.g. formal interpretation of fundus photography, visual fields, OCT without having a face to face encounter with the patient) in your practice for each time period?
Matrix question (one column selection per row) Columns:
Yes;
No - It was available to me, but I still opted to see the patient in person for whom I interpret testing;
No - It was not available, but I wanted to use it;
No - It was not available and I didn’t want to use it Rows:
pre-COVID, early-COVID, Current
(if Yes for any row, go to 10a) (if B or C, skip to 12)
10a. What types of diagnostic testing were you performing formal remote interpretation of?
Matrix question (select any that apply) Columns:
pre-COVID, early-COVID, Current Rows:
A. Fundus photography B. Visual Fields
C. Optical coherence tomography D. Visual evoked potentials E. ERGs
F. Other (fill in)
11 Presently, approximately how many formal remote interpretations of diagnostic testing do you perform weekly?
Numerical response
11a. Compared to peak use of remote testing interpretation during the past year, my current use of remote testing interpretation is
A.. Increased B. Decreased
C. About the same
11b. Do you plan to continue remote interpretation of diagnostic testing after the COVID-19 public health emergency subsides?
A. Yes B. No C. Unsure
12. Please indicate your utilization of fee-for-service asynchronous telemedicine “second opinions,”
defined as record based review without direct interaction with the patient, including a report to the patient in your practice for each time period.
Matrix question (one column selection per row) Columns:
Yes;
No - It was available to me, but I did not use it;
No - my institution does not allow it;
No - It was not available and I didn’t want to use it Rows:
pre-COVID, early-COVID, Current
13. For each of the telehealth modalities below please indicate your use of the following in your practice for each time period.
Interprofessional consultations (also called eConsults) refers to those without direct interaction with the patient with a follow up verbal or written report to the referring doctor? (US Members: these would include CPT codes 99451 or 99446-99449)
Matrix question (choose all that apply) Columns:
Used pre-COVID, Used early-COVID, Using Currently Rows
Interprofessional consultations/eConsults Phone visits
On-line portal communication
Remote interpretation of patient submitted data
14. Did you view the 2021 NANOS Telemedicine symposium on February 20, 2021?
A. Yes B. No (If A, go to 15a) (If B, go to 16)
15a. Did you participate in the Zoom polling questions during the 2021 Telemedicine Symposium Q&A?
A. Yes B. No
16. Did you complete the 2020 NANOS telemedicine survey?
A. Yes B. No
C. Don’t recall
17. Do you utilize an electronic medical record for documenting patient care?
A. Yes B. No (If A, go to 17a) (If B, skip to 18)
17a. Which EMR do you use? (checkbox) Allscripts
AthenaHealth Cerner CPRS
eClinicalWorks EPIC
Eye Care Leaders (MedFlow/Medcare/iMedicWare/Integrity) Greenway
Kareo
Modernizing Medicine MDIntellesys
NextGen/TSI Healthcare Practice Fusion
Other EMR
18. Do you have any additional comments?
Free text
Supplemental Table 1: Electronic Medical Record (EMR) Software Used by Survey Participants
EMR Platform Video telemedicine providers responding to question (n=104) n (%)
Epic
Other (not specified) Cerner
NextGen Allscripts
Modernizing Medicine CPRS
Eye Care Leaders Greenway
MDIntellesys/NexTech
69 (66.7%) 19 (18.3%) 7 (6.7%) 4 (3.8%) 3 (2.9%) 3 (2.9%) 1 (1.0%) 1 (1.0%) 1 (1.0%) 1 (1.0%)
Supplemental Table 2: Platforms Used for Video Telemedicine by Survey Participants Reporting Video Visit Utilization 1 Year Into the COVID-19 Pandemic
Platform Video telemedicine providers responding to question (n=67) n (%)
Integrated with EMR Zoom
Doximity Other*
Doxy.me
34 (50.7%) 31 (44.8%) 15 (22.4%) 15 (22.4%) 8 (11.9%)
*Android, Bluejeans, Care convene, Cliq soft, DATOS, Eyecare Live, Health Connect Anywhere, In touch, “in early,”
Teams, OTTO, Sightcall, Statleaf, Vsee
Supplemental Table 3: Types of Remote Test Interpretation Offered by Neuro- Ophthalmologists According to Time Period (n=108-110)
Test Pre-COVID
n (% of participants responding to
question)
Early COVID n (% of participants
responding to question)
1 Year COVID n (% of participants
responding to question)
Fundus photography 17 (17.5%) 31 (32.0%) 36 (36.7%)
Visual field 30 (28.3%) 44 (41.5%) 43 (40.6%)
Optical coherence
tomography 30 (28.0%) 44 (40.7%) 47 (43.1%)
Visual evoked potentials
9 (10.3%) 14 (17.7%) 17 (21.3%)
Electroretinogram 8 (9.3%) 12 (15.4%) 15 (19.5%)
Other reported tests: corneal topography, fluorescein angiography