NHS England - Transformation Directorate

A tele-ophthalmology system for remote consultation for urgent eye care problems

NHS Forth Valley is 1 of 14 regional health boards in Scotland which caters for a population of approximately 300,000.

Situation

Within the NHS, GPs and community optometrists are usually the first point of contact for most patients with an eye problem. However, they often do not have the necessary equipment, or see a large enough volume of eye emergencies, to effectively diagnose and treat complex acute eye conditions.

As it's become harder to get a GP appointment, patients have also had to go to A&E when they have a problem. This has increased pressure on A&E services.

Aspiration

To create a tele-ophthalmology system which allows for:

  • a remote consultation
  • examination and live discussions with the treating optometrist for urgent eye care services

It will also support enhanced communication between:

  • ophthalmologists (junior to senior and secondary to tertiary care)
  • community optometry and hospital eye services
  • emergency hospital services and hospital eye services

Solution and impact


The University of Strathclyde and NHS Forth Valley developed a tele-ophthalmology system. This was used in 13 emergency treatment centres across Scotland (over 3 trusts) run by optometrists.

The tools included:

  • an iPad camera
  • an optical coherence tomography (OCT) mirroring
  • Optosmap mirroring
  • a video slit lamp combined with desktop mirroring
  • Attend Anywhere (also known as NHS Near Me) video consultation in combination with OpenEyes

Any computer used to view OCT volume scans with a webcam can be used. These scans represented close to 50% of all decision support calls. Solutions with smartphones and tablets bracketed to the slit lamp optics were also in use.

The tele-ophthalmology system allows for a remote 3-way consultation, examination and discussion with the treating optometrist, ophthalmologist and the patient.

  • Over 300 video consultations were completed which prevented 64% of hospital appointments pre-COVID-19 and 86% post-COVID-19.
  • 39% of patients were treated and followed up within primary care by an optometrist or GP.
  • 20% of patients were treated with no further follow-up required.
  • 63% of video consultations took less than 5 minutes with high satisfaction scores from patients.
  • 98% of patients said that they would recommend video consultations.
  • 100% optometrists said they would recommend this format of consultation in the staff satisfaction assessment.

As COVID-19 restrictions ease, the team continues to use the same digital tools (NHS Near Me, powered by Attend Anywhere). Around 1 in 3 optometric practices in NHS Forth Valley are using the network for decision support.

NHS Grampian uses tele-ophthalmology tools for long wait 'hospital in the community' models. NHS Forth Valley is going to use a similar model to address the long waits caused by the pandemic.

Functionality

A tele-ophthalmology system is a combination of tools and set up that uses a live video feed to securely connect doctors, opticians and patients. It can be used for a fully integrated remote video consultation with examination.

The system can also share the clinical images and examination from the slit lamp.

During the COVID-19 pandemic, optometry training was transmitted to medical students live. The team were able to screenshare multimodal imaging from the eye clinic including:

  • the video feed of patient and clinical team
  • the video feed from the video slit lamp and OCT
  • Electronic Patient Records

This meant clinical teaching and training could continue despite social distancing restrictions and a reduction in face-to-face teaching.

Another benefit was students who were self-isolating could also watch the live transmission.

Capabilities

  • Clinicians can perform live remote video consultations and examinations.
  • Assistance and advice are available from Attend Anywhere.
  • It runs entirely on a web browser, allowing patients and clinicians to sign in from anywhere.
  • It’s able to embed video call access into websites, existing systems, workflows and patient pathways, or existing software.

Scope

Remote consultations and communication can be performed with this platform linking patients to clinicians.

It allows communication from clinician to clinician, including primary and secondary care, with both clinicians live on the video call with the patient.

Key figures

  • Prevented 64% of hospital appointments pre-COVID-19 and 86% post-COVID-19.
  • High satisfaction amongst patients, optometrists, and ophthalmologists.
  • 91% of consultations took less than 15 minutes, with 63% completed in under 5 minutes.

Find out more


Download the full case study from the NHS Scotland website (PDF, 1.5MB)

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