Digitalisation is advancing rapidly in ophthalmology too. However, patient education as it is still practised in many places today has considerable shortcomings. Prof. Dr. med. Lothar Schweigerer explains what these are, how they can be remedied and which future developments lie ahead. He is professor emeritus and former chair of paediatrics and works as “senior medical officer” at medudoc, the complete solution for preoperative patient management.
Interview with Professor Schweigerer
Professor Schweigerer, what fundamental challenges does ophthalmology face?
Schweigerer: In ophthalmology, the challenges are fundamentally very similar to those in the other clinical disciplines: the DRG system causes scarce financial resources, while the feminisation of the medical profession and the growing desire for a “work-life” balance cause scarce human resources. The aim must therefore be to use the available medical staff as economically as possible by freeing them from redundant non-medical tasks. For example, the staff responsible for patient education have to hold essentially identical consent discussions with patients before planned procedures several times a day. Purpose-built hardware or software could reduce the time required.
How important is patient education, and what is the current legal situation?
Schweigerer: In principle, every medical procedure constitutes bodily harm with corresponding legal consequences. These can only be avoided through the patient’s valid consent following an oral consent discussion. The law prescribes no particular form for consent; written documentation serves as proof. Whereas in the past the rules on patient education were laid down solely by case law and could not be looked up explicitly by either patients or physicians, in 2013 the physician’s duty to inform was codified for the first time in the German Civil Code (BGB) in the form of the Patients’ Rights Act.
For the staff responsible for patient education, it is essential to know that, in the event of complications and demonstrably incomplete patient education, the burden of proof lies with the person who informed the patient. Comprehensive patient education that laypeople can understand, and its unambiguous documentation, are therefore indispensable.
What are the disadvantages of analogue patient education?
Schweigerer: Digitalisation has now reached the medical sector as well. Many hospitals and practices already have digital patient documentation systems, yet in many cases patient education is still carried out in analogue form using paper forms. These analogue solutions are not compatible with the already digitalised patient record; they are time-consuming, redundant and usually not very comprehensible for patients. Some providers have converted the paper forms into digital (PDF) forms. Their advantages are a broad range of indications and the variety of languages. Some manufacturers offer the option of handwritten and/or photographic entries in the form and the digital capture of the patient’s medical history and signature. The disadvantages of all these solutions are their limited capacity for individualisation, low comprehensibility for patients, a high time requirement and – depending on the experience of the person informing the patient – variable quality of patient education.
What are the benefits of digital patient education?
Schweigerer: Fully digital patient education solutions offer the following benefits in principle: a reduction in the time required of those informing patients, consistent quality of patient education and comprehensibility for patients, smooth integration into the electronic patient record and, finally, legal certainty. medudoc’s patient education software offers all these benefits.
How does patient education with the medudoc solution work?
Schweigerer: Once the medical staff responsible for patient education have established the indication for the procedure, they use a few clicks on screen to put together, in less than a minute, a complete video tailored to the patient, their procedure and their pre-existing conditions from an extensive library of short video clips. Each video has its own QR code or internet link, which the patient can use to watch their own video at home or in the hospital or practice as often as they wish.
Which ophthalmic indications are available?
Schweigerer: medudoc offers patient education material for all common ophthalmic procedures, including blepharoplasty, intravitreal operative medication injection (IVOM), capsulotomy, cataract surgery, laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), refractive lenticule extraction (ReLEx) and iridotomy.
What benefits does the medudoc solution offer in hospital and practice workflows?
Schweigerer: medudoc was initiated by practising surgeons on the basis of their personal experience. They recognised that the analogue patient education previously available has four fundamental disadvantages: it is 1. time-consuming, 2. redundant, 3. variable in quality and 4. incompatible with digital patient information systems. Accordingly, with the medudoc solution, physicians need less than a minute on average to create a tailored patient education video. Many questions no longer arise, which shortens the preoperative personal consent discussion. Patient education is standardised, quality is consistent and largely independent of the experience of the person informing the patient. The software is web-based and offers interfaces for all patient information systems.
Can older people use the product?
Schweigerer: Most older people today also have their own smartphone. They can therefore watch the patient education video, provide medical history information and sign digitally. Where intellectual understanding is limited, the procedure is the same as with conventional patient education, where patients are supported by the relatives present. If there is no smartphone, all information can also be printed out on paper and given to the patient.
Are patients’ protection rights safeguarded?
Schweigerer: Yes. The video handed out to the patient, together with its “modular” clips, is numbered, anonymised and stored on a central server outside the hospital or practice. As required by law, it can be regenerated for at least ten years.
Is the patient education legally sound?
Schweigerer: With the medudoc solution, all video content is documented and stored digitally and/or in analogue form. The patient signs (digitally) that they have understood all the content of the video and of the oral consent discussion. The signature is also stored digitally. The procedure is therefore legally sound.
What hardware is needed?
Schweigerer: As already mentioned, medudoc’s patient education software is web-based and therefore platform-agnostic. There is no need to purchase separate hardware or software.
How do you see the future of patient education?
Schweigerer: The electronic patient record is already part of everyday patient care in many places. However, patient education is often not yet digitalised and not integrated. Fully digitalised, video-animated, customisable solutions that save time (such as the one offered by medudoc) will prevail in future.
