Integrated digital system for assessing outcomes in a shared care cataract pathway

Moorfields Eye Hospital NHS Foundation Trust is one of the largest providers of ophthalmology services in Europe, with around 800,000 outpatient attendances per year. It sees patients across more than 20 sites, including eight surgical centres which perform a range of surgery, including cataract surgery.

Situation

Cataract surgery is the most common operation performed in the NHS and surgical outcome results need to be shared and audited nationally. Traditionally however post-operative data to assess outcomes has been poor. Moorfields implemented an integrated cataract pathway at two of its surgical sites with the need for primary care optometrists to return outcome data reliably and easily. They did this on paper-based returns which are time consuming for both the returner and hospital specialist optometrists who then have to input the data manually into the electronic patient record (EPR).

Aspiration

A system to enable seamless auditing of the results of post cataract refractions and visual outcomes within an integrated cataract pathway.

Solution and impact

Moorfields Eye Hospital sites at Bedford and Potters Bar have run their shared care cataract pathway with primary care optometrists for several years. Optometrists have undertaken additional professional development locally and link closely with the hospitals to ensure good clinical governance.

The primary care optometrists are funded to undertake referral filtering and shared decision making preoperatively to ensure only patients who want and will benefit from surgery are referred. The optometrists also undertake an enhanced and funded post-operative assessment. They then use Medisoft’s web-based portal to return the post-operative outcome data.

  • Web-based transfer of a small clinical data set for the post-op cataract outcome is secure and maintains confidentiality
  • Patients bring their unique ID code from the hospital provider to the optometrist to allow secure and accurate data input to the correct hospital record
  • Web-based transfer requires no difficult hardware or software changes at practices and is done over the internet
  • Community optometrists are able to use the portal (a small fee is paid for doing the post-operative assessment)
  • Electronic data transfer saves staff time in the primary care practice and in the Hospital Eye Service (HES) and provides almost instant clinical data transfer from primary to secondary care
  • It enables fast, efficient collection of data for post-op audit and surgeon revalidation without the need for hospital-based post-operative cataract clinics, or manual entry from paper-based returns

Functionality

  • Widely-used ophthalmic-specific electronic medical record system which efficiently records clinical data, stores clinical images and patient outcomes, can effectively communicate with practitioners in the community, and provides 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

  • Provide an ophthalmic suitable electronic patient record (EPR)
  • 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 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 (such as 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 UK Ophthalmology Alliance website  (PDF, 3.6 MB)

Key contact

Melanie Hingorani, consultant ophthalmologist, Moorfields Eye Hospital

m.hingorani@nhs.net