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. 2020 Mar;104(3):312-317.
doi: 10.1136/bjophthalmol-2019-314161. Epub 2019 Jul 18.

Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care

Christoph Kern  1   2 , Dun Jack Fu  1 , Karsten Kortuem  1   2 , Josef Huemer  1   3 , David Barker  4 , Alison Davis  1 , Konstantinos Balaskas  1 , Pearse A Keane  1   5   6 , Tom McKinnon  7 , Dawn A Sim  8   5   6
Affiliations

Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care

Christoph Kern et al. Br J Ophthalmol. 2020 Mar.

Abstract

Background: Hospital Eye Services (HES) in the UK face an increasing number of optometric referrals driven by progress in retinal imaging. The National Health Service (NHS) published a 10-year strategy (NHS Long-Term Plan) to transform services to meet this challenge. In this study, we implemented a cloud-based referral platform to improve communication between optometrists and ophthalmologists.

Methods: Retrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Main outcome measures was the reduction of unnecessary referrals.

Results: After reviewing the patient's data in a web-based interface 54 (52%) out of 103 attending patients initially classified into the referral pathway did not need a specialist referral. Fourteen (14%) patients needing urgent treatment were identified. Usability was measured in duration for data input and reviewing which was an average of 9.2 min (median: 5.4; IQR: 3.4-8.7) for optometrists and 3.0 min (median: 3.0; IQR: 1.7-3.9) min for ophthalmologists. A variety of diagnosis was covered by this tool with dry age-related macular degeneration (n=34) being most common.

Conclusion: After implementation more than half of the HES referrals have been avoided. This platform offers a digital-first solution that enables rapid-access eye care for patients in community optometrists, facilitates communication between healthcare providers and may serve as a foundation for implementation of artificial intelligence.

Keywords: long-term plan; optometrist; specialist referral; telemedicine; teleophthalmology.

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Conflict of interest statement

Competing interests: KB reports grants from Bayer AG, personal fees from Alimera, from Allergan, outside the submitted work; PAK reports other from Big Picture Eye Health, during the conduct of the study; personal fees from DeepMind, personal fees from Optos, personal fees from Novartis, personal fees from Bayer, personal fees from Allergan, personal fees from Heidelberg Engineering, personal fees from Topcon, personal fees from Carl Zeiss Meditec, personal fees from Haag Streit, personal fees from Santen, grants from National Institute for Health Research, grants from Fight For Sight UK, outside the submitted work; TM reports other from Big Picture Medical, outside the submitted work; In addition, TM has a patent 2016265973 pending; KK reports personal fees from Big Picture Eye Health, during the conduct of the study; grants and personal fees from Novartis Pharma, grants and personal fees from Bayer Pharma, personal fees from Zeiss, personal fees from Allergan, personal fees from Alcon, personal fees from Google Deepmind, AD has nothing to disclose; outside the submitted work; DS reports other from Big Picture Eye Health, during the conduct of the study; personal fees from Allergan, personal fees from Novartis, personal fees from Bayer, personal fees from Big Picture Eye Health, personal fees from Haag Streit, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Referral refinement by consultant ophthalmologist where each of the 103 cases were labelled as no referral, routine referral, or urgent referral.
Figure 2
Figure 2
Distribution of clinical diagnoses by consultant ophthalmologist.
Figure 3
Figure 3
Primary care referrals can be triaged into virtual or face to face clinic settings under tertiary care. This decision is made by a specialist within the cloud-based referral platform and based on patient history and scans.
See this image and copyright information in PMC

Comment in

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