The Interoperability Proving Ground has been archived and is no longer actively maintained. All information identified as archived is provided for reference, research or recordkeeping purposes.

Interoperability Proving Ground (IPG) submissions within the ONC Tech Lab are submitted by healthcare, technology and development organizations that are invested in Health IT and Interoperability and want to share, learn and collaborate with similar stakeholders in the US, and around the world.

To view all submissions, please view the IPG link located within the ONC Techlab.

Connectivity Improves Quality Metrics for Annual Diabetic Eye Exams

Objective:  Assist health systems with meeting important quality metrics by providing their community members who continue to fax with an easy and affordable standards-based interoperability solution. 

Description:  This particular project centers around connecting the optical community to the health system as they transition to value-based care. Patients who fit the criteria for comprehensive diabetic eye care require an annual diabetic eye exam1.  Normally, these exams are performed by ophthalmologists or optometrists who are not part of the health system’s physician network and who bill claims against a vision plan rather than a health plan. The health system would receive documentation as a fax or letter asynchronous to the visit, making it difficult to track.  Kno2’s interoperability platform solves this issue by bringing the data into the patient’s hospital health record at the time of service as a Direct message, driving better patient outcomes and greater visibility into care delivered outside their walls – lowering the total cost of care, while supporting the shift to alternative payment models. Combining the technology of Kno2 with the influence of a health system and a proven community outreach program, we are helping to accelerate interoperability within entire geographies by raising awareness, driving adoption and removing the historical barriers that have prevented electronic care coordination between providers.  

In this use case, the optometry clinic activates their Kno2 account.  They can then receive referrals electronically on patients who need a diabetic eye exam.  The clinic contacts the patient to schedule the exam.  Results of the eye exam are consistently delivered back to the PCP via Direct message and can be incorporated directly into the patient’s electronic medical record. The PCP can determine the next course of action for the patient as well as document that the requirements for the annual exam were met to meet quality metrics.
Start Date
Projected End Date
Project Tags
  • bundled payments
  • direct secure messaging
  • EHR
  • Epic
  • Expected Outcomes: • Improve referrals and follow-up for diabetic patients requiring an annual eye exam • Improve quality measu
  • eye
  • Health Systems
  • interoperability
  • Kno2
  • NQF
  • ophthalmology
  • quality metrics
  • quality reporting
  • retinopathy
  • Value-based Care
  • vision
Project Point of Contact:
Project Results
- Yearly eye exams increased from 33.8% to 36.1%, as a result of just the 4 pilot clinics
- Improved open-ended referral process of 4-12 weeks to 7-10 days closed-loop process
- Well coordinated appointment process
- Consistent and efficient delivery of results back to the ordering provider
- Improved quality metrics reporting

Based on the success of the pilot, Vision Source has now extended Kno2: Interoperability as a Service connectivity not only to all of its 16 clinics in the St. Louis market, but into other markets served by SSM Health in Oklahoma and Wisconsin. This helps both organizations provide comprehensive diabetic care more effectively. The relationship has turned out to be mutually beneficial, as SSM Health has been able to significantly improve its reporting capabilities and demonstrate its true performance to payers while reducing the workflow burden on providers at both SSM Health and Vision Source. 

Read full case study here:
Read Press Release here:

This project was also presented at HIMSS18 as a part of SESSION 101: INTEROPERABILITY SETS THE FOUNDATION FOR CARE COORDINATION.  You can view session handouts here: