Enabling teleophthalmology during the COVID-19 pandemic in the Province of Trento, Italy: Design and implementation of a mHealth solution

Abstract

Background: Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients.

Objective: In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative-albeit restricted-experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits.

Methods: A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician's requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow.

Results: Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems.

Conclusions: The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.

Fig 1. Process phases.

a sequential approach was adopted. The first phase consisted in the requirements analysis followed by the co-design of the technological solution and definition of the operative protocol for teleophthalmology. The third phase comprised the implementation of the digital solution (TreC Oculistica system) and the fourth phase the testing of the system and protocol. A continuous exchange of feedback between the implementation and testing phases allowed to identify and implement possible improvements.

Fig 2. Examples of Patient’s App screens.

A: Patient’s App Home screen: The main functionalities embedded in the platform are listed in the Home screen of patients’ mobile application. B: Televisit preparation screen: each required measurement is listed in the Televisit’s preparation screen. A red cross beside the measurement name indicates a non-completed task, a green tick indicates a completed task.

Fig 3. Clinical dashboard: For each scheduled televisit, the list of the requested measurements is displayed within a structured grid in the clinical dashboard.

For each televisit, clinicians can visualize the state of the task (completed: green square; non-completed: red square), the name of the measurement, the data entry date, the suggested material, the patient’s data uploaded on the App.

Fig 4. Televisits data.

A: Types of televisits performed: the graph shows the percentage of the types of televisits performed. The orthoptic screening represents the majority of the televisits performed (54.1%), followed by follow-ups visits (40.5%). B: Patients’ age distribution: The graph represents the age distribution of the patients that underwent a televisit. Most of the represented patients are 5 years old childrens.