Setting up a virtual evaluation clinic for follow-up glaucoma patients

Bolton NHS Foundation Trust provides a range of hospital and community health services in the north west sector of Greater Manchester, delivering services from the Royal Bolton Hospital (RBH) site in Farnworth, in the south west of Bolton, close to the boundaries of Salford, Wigan and Bury; as well as providing a wide range of community services from locations within Bolton.

The Trust covers a population of 262,000 and a catchment of 320,000. In 2017/18 there were 115,929 A&E attendances of which 32,535 arrived by ambulance. There were 86,229 inpatient admissions and 32,5117 outpatient attendances.

Situation

The clinical commissioning group (CCG) and Trust were aware of increasing difficulties with timely appointments and the growing follow up backlog created a risk of patient harm, including loss of vision for patients with high risk conditions such as glaucoma.

Aspiration

To have an electronic patient record (EPR) which allows input of information and images which can be viewed on multiple devices across the Trust to support efficient virtual services, including in non-traditional sites.

Solution and impact

To address this, virtual glaucoma clinics were set up in 2017. Virtual diagnostic assessment clinics started with patients attending a community health centre where investigation data was collected by a technician and an optometrist with a specialist interest in glaucoma.

OpenEyes ophthalmic EPR was essential in providing a paperless system with all data collected in OpenEyes along with Zeiss Forum for imaging and CompLog for vision which is a validated measure of visual acuity. 114 patients are seen in the glaucoma evaluation clinic per week over three days.

The results are triaged by a specialist hospital optometrist or orthoptist and patients were also reviewed by ophthalmologists where required. Patients were notified of results by personal letter. Over a one year period (November 2017-2018) the glaucoma follow-up backlog reduced by 68%. Patient feedback showed that 94% thought that staff attention and professionalism was good or better than expected.

Functionality

OpenEyes is a widely-used open source EPR application specifically for ophthalmology. It runs on a web browser so that it can be accessed in multiple locations and on multiple devices. It can be customised to suit local needs and will scale to seamlessly connect primary and secondary eye care.

OpenEyes consolidates patient information from clinical examination results to images, pathology or correspondence into one easily accessible record. OpenEyes provides fast entry of Systematised Nomenclature of Medicine – Clinical Terms (SNOMED CT-coded) diagnoses and results as well as decision support, outcome analysis and easy-to-interpret summary views of the patient’s care.

Capabilities

• Records clinic visits, assessments, investigations, and ophthalmic procedures
• 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
• DICOM (Digital Imaging and Communications in Medicine) integration
• Maintains an integrated digitised record regardless of where the patient had their episode of care
• Electronic Certificate of vision impairment (CVI) forms
• A portal allows optometrists to upload cataract surgery outcome data
• OpenEyes version 3 can submit directly to the National Ophthalmology Database (NOD) national cataract audit
  

Scope

• Provides an ophthalmic suitable EPR
• Shared fully-integrated clinical record system for primary care, community care and secondary care
• Images and visual fields can be viewed but may show limited information depending on device. One solution will be to use OpenEyes with a non-proprietary software to integrate multiple devices
• Referrals and advice and guidance messaging can be performed on the system
• Runs on a web browser so no carrying of patient records with merging of multiple patient medical record numbers from different sites and interfacing with the hospital IT systems to retrieve patient demographic data
• Disease progression can be assessed quickly and easily with graphs showing progression. Images and scans can be compared over time with a few mouse-clicks, and charts highlight changes in treatment and how these affect outcomes
• Generates 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
  

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

Find out more from the NHS Futures website (account required)

Key contact

David Haider, consultant ophthalmologist and chief clinical information officer

David.Haider@boltonft.nhs.uk