National ophthalmology workstream: hospital eye services

6. Eyecare Integration Network

The Eyecare Integration Programme was initiated some years ago with the objective of sending electronic referrals from the high street optometrist to Hospital Eye Services via pathways in the following conditions: cataract, glaucoma, paediatric, medical retina and general ophthalmology. It was intended that this system would supersede the paper system that had been utilised until this point. To this end the programme has been largely successful with varying degrees of implementation across primary / secondary care, and with work ongoing to ensure all high street practices have the IT infrastructure to send their referrals electronically. This has ensured referrals are received instantaneously in a similar way as other electronic referrals from general practice. Consequently, patients can be triaged quickly, and if an appointment is deemed to be clinically indicated, the patient will be seen as required.

However, given technological advances in other settings, the Eyecare Integration network is unable to handle some fairly basic functions required of it, in terms of the ability to readily upload and share images, to offer electronic feedback on the quality and appropriateness of individual referrals and to serve as a conduit for advice only dialogue, treatment planning or discharge information. Early solutions-oriented dialogue suggests that a mixture of technical and change-management actions could lead to a significantly more agile network and subsequent use.

For example, unlike GP referrals where a feedback loop allows the secondary care clinician to respond to their colleagues in primary care, with advice regarding appropriate treatment / interventions, the system adopted by the Eyecare Integration Programme, simply acknowledges receipt of referral when sent by the optometrist. Limitations in technology mean that in the few places where the advice only function is utilised, it is transmitted to the GP system and not to the optometrist who has made the referral. This has been a source of frustration for many secondary care practitioners who are unable to utilise a function which could in practice avoid unnecessary referrals and could serve as a conduit for advice only dialogue, treatment planning or discharge information. These technological issues extend to IT systems' inability to readily upload and share images that have been undertaken in primary care and consequently, duplication of tests are undertaken in secondary care.

One of the Test of Change projects was to explore a dedicated clinical care session being available to provide local optometrists with advice via SCI Gateway and in doing so assess the benefits of the feedback loop, for example, if this enables patients to be appropriately treated in the community without having to attend secondary care unnecessarily. Further information and outputs will be disseminated to HES as this project progresses and embeds locally.

Recommendation: Proactively address, in the medium term, a parallel way forward, linking efforts across the Community Eyecare Review and the National Ophthalmology Workstream to harness and progress a solution based outcome to these technical challenges.