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TheMarker Interview With Prof. Anat Lowenstein on GistMD's Intravitreal Injections Module

GistMD's intravitreal injections module featured in TheMarker article with Prof. Anat Loewenstein Director of the Ophthalmology Division at the Tel Aviv Medical center (Ichilov Hospital). Below is a full translation of the article. The full magazine can be read here.


"Patients who understand their ophthalmology procedures are more likely to be compliant and achieve better results"

TheMarker l June 2022 I Illustrations: GistMD

Personalized educational videos empower patients and increase their involvement in their treatment and recovery process; including in ophthalmology. Introducing the next system of visual, customized healthcare – vibrant animated videos by GistMD: An interview with Prof. Anat Loewenstein, Director of the Ophthalmology Division at Ichilov Medical Center.

Increasing patient involvement in their own medical treatment and recovery is a major but crucial challenge for the healthcare system in Israel and abroad. The realization that the key for enhancing patient involvement might be personalization inspired GistMD to develop their innovative technology. Gist’s Personalized Engagement Management System allows animated content to be assembled in real time based on the specific needs and characteristics of each and every patient, without compromising patient confidentiality. In order for a patient to identify with the animation, the visual features of the main character in the animation are adapted to match the patient's age, gender, and ethnicity. The characters speak the patient's native language, and the content is adapted to the patient's specific medical condition; including the scheduled procedure, comorbidities, medications, and more. In an effort to empower the patient and increase involvement, GistMD developed these educational videos to tell a story that makes medical information clear and accessible to patients and alleviates fears and concerns.

Over the past three years, GistMD has released educational videos for 15 procedures in conjunction with the Ichilov Medical Center in Tel Aviv. The videos include cardiological, anesthesia, gastroenterological, ophthalmological, obstetrical, and gynecological procedures. Dozens of additional educational systems are under development, including imaging tests, pain management, and coping with the side effects of

oncology treatments. Behind each system is a complicated algorithm that can generate thousands of versions of each video, customized for the viewer. The videos are instructional and guide patients through their entire medical journey by sending text messages to remind them to watch the relevant video when to come in for their appointments when to start fasting before the procedure if necessary, and what exactly they have to do on the day of the procedure. The platform gives patients access to the informed consent form they will need to sign, so they have time to read it carefully in advance. The educational program designed by GistMD is an especially effective tool that the healthcare system can use to guarantee equal access to medical information.

Education through the eyes of the patient

Israel's ophthalmologists are world leaders in the innovative field of intravitreal injections. This is the most effective and safest treatment available for a range of retina diseases, and the most common one as well. Hundreds of millions of intravitreal injections are administered each year, and several hundred thousand of them are done in Israel. The GistMD videos about this procedure were developed with the support of Prof. Anat Loewenstein, Director of the Ophthalmology Division at Ichilov Medical Center and in collaboration with Bayer. The program tries to see the situation from the eyes of the patient on the visual level by using animation to demonstrate how the patient's vision deteriorates as a result of retina disease, and on the emotional level by identifying exactly what the patient needs to know about the process. When creating the program with Dr. Loewenstein, GistMD learned that despite patients' concerns about the procedure, the desire to enjoy visual experiences again remains. As the intravitreal injection patients are often older, GistMD found that anticipation to be able to see their beloved grandchildren properly again is strong enough motivation to persist with their treatment. Therefore, the background story chosen for the educational videos show a patient visiting a museum with a young granddaughter. This emotional, empathetic connection serves as the basis for the educational program.

Prof. Loewenstein, what made you choose GistMD to produce educational videos for patients receiving intravitreal injections?

When the idea of developing an educational program for patients first emerged, our main objective was to

encourage patients to become involved in their treatment. In addition to understanding the potential risks and challenges of the procedure, they must also understand the advantages and why their involvement is so important. The idea of an intravitreal injection can cause anxiety and fear in patients, often due to lack of knowledge. I believe that when patients know and understand what to expect, they have a better understanding of the procedure and why it is necessary. That is exactly why we developed the unique GistMD educational videos.

Clinical studies show that patient compliance tends to be quite low. Many patients who are referred for intravitreal injections postpone the procedure or do not complete the protocol because they do not have enough information about the procedure and why it is so important, or because they have fears surrounding the injections.

"I believe that once the patient understands the procedure, the likelihood of compliance can increase significantly. Better compliance means that the patient will stop postponing treatment, which will yield much better results," says Prof. Loewenstein.

The field study that was done to design the videos and write scripts identified another challenge that can inhibit patient involvement. The immense pressure on the medical staff often makes it difficult for them to find the time to give patients the detailed, personalized information they would have liked to offer. "There are times when the medical staff doesn’t have time to give patients the personal attention they need. The detailed explanations in the video save lots of time and give patients accessible information to help them understand their upcoming procedures, without relying on the availability of the medical staff," adds Prof. Loewenstein.

What does this program contribute from the perspective of patient safety?

Patients who fully understand the medical procedures they undergo understand what they have to avoid. They learn to identify problematic signs and symptoms in themselves and know when to seek immediate medical assistance. This increases patients' confidence in the procedure and its outcomes. The videos show visual images of normative conditions after an injection, what requires an urgent examination, and what to expect after the injection. For example, there is a scene in which the patient is about to go swimming in the sea but stops when he sees a sign that reminds him that he cannot swim in standing water during the first week after the injection. This enhances patients' understanding because visual messages are often easier to internalize. Understanding how the active ingredient in the drug affects retina disease increases patients' confidence in the treatment and the likelihood of compliance, thus improving the efficacy of the treatment. Even the fact that the informed consent form that the patient will sign is available on the GIstMD user interface to be downloaded and viewed, contributes to patient safety. The patient's signature on the form is an indication of the patient’s understanding of the procedure , the alternatives, and the risks involved. When patients have the opportunity to read the form carefully ahead of time, there is more of a likelihood that the consent they give will truly be "informed."

The Ophthalmology Division at Ichilov is the first in the world to develop and launch a program designed to increase patient involvement and understanding. Now that you've been running this program for several months, can you describe how people respond to it?

The responses are amazing. We get feedback from patients who are very happy with the program and understand the procedure upon receiving their first intravitreal injection, as well as from returning patients who are hearing these explanations for the first time. After watching the videos, they report that after years of treatment, they finally understand what retina disease is, how it damages their vision, why they need the injections, and why it is so important to receive the treatment regularly.

Are the videos helpful for returning patients as well?

Absolutely. We can already see that patients who watch the videos are less likely to skip treatments in the short term. However, in order to check whether the program really does reduce the prevalence of skipped treatments and increase patient compliance, we will have to run a long-term study.

What are the challenges?

It always takes time to adjust to new things, and it's not always an easy process. Some of the para-medical teams, like the administrative and support teams, resisted the new program at first, but it is very important for me to involve all the teams in my division in patient care. Having all the teams involved makes patients feel much more comfortable when they arrive for treatment. Our secretary is the one who sends the GistMD interface to the patient, asks questions, and reads the medical records to see the diagnosis and recommended treatment. The secretary is much more involved in the process than she used to be, and the personalization process starts with her.

What is your vision for educational videos on ophthalmology treatment?

"We have already created videos for additional types of procedures for treating retina disease, and they will be integrated into the system in the next few days. The next thing I'd like to do is to work with GistMD to develop educational videos for surgical procedures such as cataract surgery which are very common but cause concern due to lack of knowledge. There are places around the world that perform as many as 50 eye surgeries each day, and sending educational videos of this kind to patients can save lots of precious time for physicians, without compromising the patient's understanding of the procedure. When we're done with the cataract videos, the sky is the limit. Although preparing these videos requires a huge investment of time and resources, I enjoy every minute of the process, and seeing how the results of our efforts enhance the patient's experience tremendously. It makes it all worthwhile," says Prof. Loewenstein.

What do the patients think?

"I have been receiving intravitreal injections for the past two years, and when I saw the video I was amazed!” says a 58-year-old patient from central Israel. “I liked the explanation it gave about the substance that is injected into the eye and how it helps. I suddenly understood what the treatment was all about.”.

"The explanation in the video that explained the difference between AMD and other diseases is very important because it helps the patient understand his own condition,” says a 73-year-old patient from central Israel.“You did a good thing.”

"The first time I came in for a procedure I was terrified,” says an 81-year-old patient from Tel Aviv. “I was literally shaking. I have no doubt that if I had seen the video before that procedure, I would have felt much better, especially because it talks about how skilled the doctors are at Ichilov and how often they perform these injections.”



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