Integrated Royal College digital electronic patient record of cataract surgery audit

The Royal College of Ophthalmologists (RCOphth) developed the National Ophthalmology Database (NOD) to provide a national resource for audit and research of eye diseases and to support the development of robust quality standards for revalidation of ophthalmologists and quality improvement.

Situation

Cataract surgery is the most performed elective surgery in the UK, accounting for 6% of all surgery, and surgical outcome results need to be shared and audited nationally.

Aspiration

A system to enable seamless audit results of post-operative cataract visual and complication outcomes to be returned from primary care optometrists who conduct the final assessment of vision and refractive (glasses) function after cataract surgery. Traditionally there has been poor data quality or incomplete data when relying on data return from hospitals alone.

Solution and impact

To support full post-operative data return for the National Ophthalmology Database national cataract audit being conducted by The Royal College of Ophthalmologists, Medisoft developed a secure web portal for electronic data return direct to the hospital electronic medical record (EMR) from any registered primary care optometrist’s practice. Patients have a unique ID number provided by the hospital on the day of surgery which they take to their optometrist to allow the optometrist to input the data into that patient’s medical record securely.

The database provides individual surgeons, healthcare providers and the public with benchmarked reports on performance and surgical complications, with the ultimate aim of improving patient outcomes. Notably, the most recent NOD figures show a 38% reduction in the unadjusted posterior capsule rupture (PCR, the most significant intraoperative complication) rate, reduced from 2% in 2010 to 1.2% in 2017-2018 and equating to approximately 3,400 fewer complications per year suffered as a result of this surgery.

A questionnaire was sent to all participating optometrists in the Moorfields catchment area in December 2015 looking at the integration of Medisoft into the cataract pathway. Most optometrists who completed the survey agreed that the instructions on accessing the web portal were clear, showed good results on usability, and an improvement over paper forms. Several studies indicated a return rate, through the Medisoft web portal, of 93% to 97% regarding post-operative outcomes.

Functionality

Medisoft is a widely-used ophthalmic-specific electronic medical record system which efficiently records clinical data and can store clinical images or patient outcomes, effectively communicate with practitioners in the community, and provide a tool for clinical audit. mediSIGHT is the newer version and has an improved interface with faster data entry.

Capabilities

• Records clinic visits, assessments, investigations, and ophthalmic procedures. Investigations can be integrated within Medisoft with proprietary or non-proprietary software
• Instantly review patient history and progression of findings over time
• Consolidates records and scans from multiple sites and ophthalmic instruments
• Generates correspondence with patients and care professionals
• Reports on activity and clinical outcomes, in line with national datasets and audits
• Direct integration with ophthalmology imaging equipment
• Maintains an integrated digitised record regardless of where the patient had their episode of care
  

Scope

• Provides an ophthalmic-specific electronic patient record
• Hosted on a hospital server which can link to peripheral clinics. This avoids merging of multiple patient medical record numbers from different sites and interfacing with the hospital IT systems to retrieve patient demographic data
• Referrals scanned-in prior to clinic, and notes / letters / prescriptions for GP, optometrist and pharmacy printed immediately
• If optometrists have a licence and access, can be used for referral refinement and triage with direct communication into hospital electronic medical record (EMR) system
• Disease progression can be assessed quickly and easily. Images and scans can be compared over time with a few mouse-clicks, and charts highlight changes in treatment and how these affect outcomes
• Generate audits more easily and all information can easily be reviewed from any location, allowing outcomes reporting, research, and service demand forecasting. Audits in line with national ophthalmic audits and recognised/recommended ophthalmic outcomes
• Can be linked to community optometrists for follow up of post-operative cataract patients locally
• The optometrists can input their clinical data through a cloud-based secure portal directly into the hospital EPR, thus allowing feedback to the surgical provider and closure of the audit loop whilst maintaining an integrated patient record
• Can be used for optometrists with access or licences, or in community diagnostic hubs, to provide shared and community care with full integration into the hospital ophthalmic medical record system
  

Key figures/quotes 

• A survey published in 2017 found 45.3% of UK eye units use an EMR, with 79.1% of those being an ophthalmic-specific system. Medisoft was the most widely reported EMR in use, followed by OpenEyes
• “Complete postoperative feedback (ie data on refraction, visual acuity and intraocular pressure) was available in 97% of these patients compared to 50% of patients reviewed in the hospital.” Sligo University Hospital, Ireland

Find out more

Download further information from the Medisoft website (PDF, 149KB)

Read a case study about Medisoft on the National Ophthalmology Database website

eHealth Ireland talks about the ophthalmology electronic patient record

Springer Link talks about the impact of electronic patient records

Key contact

Martina Olaitan, NOD Cataract Audit Project Manager, The Royal College of Ophthalmologists

noa.project@rcophth.ac.uk