A Novel approach for Enhancing management of chronic eye conditions -lessons from piloting cloud based registries in primary eye care centres in south India Ganesh Babu BS, Mohammed Gowth, Sriharinath MG, Thulasiraj RD LAICO - Aravind Eye Care System. Madurai, INDIA

Background: - Aravind Comprehensive Eye Survey – 2003 Utilization of Eye Care services among patients identified with Glaucoma - Aravind Comprehensive Eye Survey – 2003 Follow-up rate of new patients diagnosed with PACG and PDR in 2010 at Aravind Eye Hospital, Madurai Last exam within 2 yrs Before 2 years Had received any treatment No treatment

Aravind Primary Eye Care Centres Tertiary care centre 5 Secondary surgical centres 6 Outpatient centres Primary Eye care Centres 61 Madurai centres (15)Outpatients-2015 173,224 Patients referred to Base hospital 20,745 % Referral (Treatment/Specialty) 12%

Background: Develop registry of patients with chronic eye diseases Provide a tool for easy access to the registry to generate details of patients due for follow-up or treatment Ultimately, enhance the compliance of chronic patients and save their vision

Methods Unique Identification Number (UIN) was introduced and assigned to all the patients getting registered across the system To link patients data with various MR Numbers assigned when they got registered at various satellite hospitals of our hospital A web platform was developed to retrieve the patients due for clinical interventions and sending text reminders to mobile phone Challenging to make sure every patient gets identified uniquely within our system, we came up with this….

Registry Development Process (daily) INSERT UIN, DEMOGRAPHIC, DIAGNOSIS, ADVISE, TREATMENT PROCEDURES Base hospital -MR No, UIN New Patient Com.Centre -MR No,UIN Registry -UIN Vision centre -MR No,UIN Review Patient Using UIN Whenever registration happens, in the background, a rqeuest goes to server which generates a UIN and sends back even before the patient registration is completed With registry, we are able to generate data in all aspects…. Speciality, vision centre wise… UPDATE VISIT DIAGNOSIS, ADVISE, TREATMENT PROCEDURES

Methods List of patients for follow-up from the registry is generated Visit to each village and reminding patient for eye care Verified if patient is under Medications Status is noted and then updated into registry

Results: Glaucoma patients follow-up rate

Results (secondary outcome) Case finding per million population / year Diagnosis Before the Intervention After the Intervention Change Diabetic 1,431 1,937 35% DR Cases 184 377 105% Glaucoma 431 732 70% Has also resulted in rapid increase in case detection.

Conclusion Registry enabled to get real-time data Enabled field workers to plan their activities more precisely Increased compliance and chronic case detection rate Still, It is too early to conclude the impact of registry Should work on this further and implement appropriate process to improve the compliance rate We should explore how best registry could be leveraged In the past, we will get this kind data usually on a project mode with a lot of effort. Now we can get this in real time whenever we want it.. Enable field workers We need to understand mechanism behind this to leverage this Increased compliance rate

Thank you