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How One Board-Certified Ophthalmologist Challenged the Status Quo on Documenting Risks for Retinal D

After 25 years in ophthalmology, busy Oregon-based glaucoma specialist J. Kevin McKinney, MD, had seen it all. But it was something the American Board of Ophthalmology diplomate didn’t see that troubled him — enough data on patients who could be at risk for retinal damage after taking hydroxychloroquine.

So, with his team at Eye Health Northwest, Dr. McKinney set out to develop ways to better identify and monitor patients considered high-risk for retinal toxicity. To start, Dr. McKinney sought the expertise of his clinical and administrative colleagues and analyzed the existing data in 199 recent electronic medical records to establish baseline data. The charts were reviewed for completeness and documentation in three key measures:

  1. Length of time on medication recorded (67%)

  2. Dosing adequate for real weight (30%)

  3. Tamoxifen use noted (41%)

He then looked to the recommendations issued by American Academy of Ophthalmology (AAO) in search of opportunities for improvement.

“The AAO had already published guidelines,” Dr. McKinney explained. “So, we took those recommendations and put them into a widget to ensure that we captured this information in our EHRs.”

Following the introduction of the widget, documentation for each measure jumped to 95%.

  1. “Length of time on medication recorded” increased by 28%

  2. “Dosing adequate for real weight” increased by 65%

  3. And “Tamoxifen use noted” rose by 55%

“Since then, we’ve continued to see a higher percentage of compliance,” Dr. McKinney said. “Now, when I see patients, I like to sit down with the checklist for high risk and make sure that I don’t miss anything.”

In recognition of his improvement efforts, Dr. McKinney earned this year’s John G. Clarkson, MD, Award for Quality Improvement, presented by the American Board of Ophthalmology, at AAO 2019. The annual award recognizes a diplomate for excellence in quality improvement work as part of the Maintenance of Certification program. In the image above, Dr. McKinney (center) is pictured receiving his award from Dr. Clarkson (left) and ABO Director Jane Bailey, MD (right). Photo credit: ABO Diplomate Francesca Giliberti, MD.

Dr. McKinney’s advice for other diplomates considering an improvement project is to reflect on what they see in their day to day practice.

“Quality is across the board,” he said. “Keep your eyes open for problems in practice that you see every week that you wish you had a better way to care for. You may just self-identify something you’re not tracking as well as you wish. Start there.”

While Dr. McKinney’s group practice benefits from strong administrative support and technical resources, he emphasized that improvement is always scaleable.

“I think there is so much opportunity for relevant projects at every level of resources,” Dr. McKinney said. “In my practice, back when we utilized paper charts (pre-EHR), one such improvement was making ink stamps for various processes (like initial complete eye exams and cataract pre-op & post-op exams), which standardized data collection for the technicians and docs. This can also be done with pre-printed exam or process forms. Paper checklists are also very helpful to standardize data collection, processes and patient care, even if using an EHR.”

The key, Dr. McKinney explained, is zeroing in on an area where you would like to do better and then thinking about a simple intervention that could increase performance.

“If you can't think of something, take a look at what’s being published as guidelines by the AAO,” he said. “There are good, solid recommendations on how patients should be managed and they could be different than what we're used to doing, so keeping up with those is important. Search your records in those areas and see how you’re doing, and if you’re not up to standards, then create a program to address that.”

Click here to read Dr. McKinney's project.

About Dr. McKinney

Dr. McKinney completed his undergraduate training at Baylor University followed by medical school at Baylor College of Medicine and a Masters in Public Health at Johns Hopkins University School of Hygiene & Public Health. He completed ophthalmology residency and glaucoma fellowship training at University of Iowa.

For three years before joining Eye Health Northwest in 1998, Dr. McKinney served on the glaucoma faculty at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. He is currently a member of the Executive Committee of the Oregon Academy of Ophthalmology, where he was president from 2010-2012. He is an oral examiner for the American Board of Ophthalmology and chair of the Patient Education Committee of the American Academy of Ophthalmology.

Dr. McKinney regularly participates in short-term international medical trips focused on support of and collaboration with local physicians and ophthalmologists in meeting the eye care needs of their communities.

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