Supporting clinical decisions in triage

COVID-19 has accelerated an existing challenge in triage. It gave us a big opportunity to try new technologies and ways of working in eye care, which is exciting as it accelerated something that would have happened in the future. It is not positive to think that there is a big backlog of patients that need to be seen for examinations and check-ups. However, it was definitely something that advanced the implementation of new technologies.

During the pandemic, we saw COVID-19 Urgent Eye Services (CUES) and Minor Eye Conditions Services (MECS) grow in popularity in several regions of the UK, where we are using the competencies of optometrists to help address this large demand and the limited number of ophthalmologists that we have here in the UK and everywhere. Already important for primary care and screening, I think optometrists will be seen as an important part of referrals from primary care to secondary care.

The Government is encouraging optometrists to take more responsibility with triage, recognising red flags, and providing the right referrals at the right times, to the right specialists. But it is not going to happen very fast if we don’t have support from technology. Some optometrists have been working on eye examinations for their whole lives, so they might not be used to assessing acute conditions.

Technology can support and enhance their abilities – never replacing clinical judgement – but augmenting their clinical decisions and supporting them with answers to questions, such as, what is the best time to refer these patients? Which patients can I advise and treat here in the High Street? I think triage technologies will be very important to support the transformation of the eye care service.

I believe that we are only going to achieve a good feat of technology when we enhance the abilities and skills of the healthcare professionals who know the patients

A big challenge in implementing triage technology is that the referral system is not unified; different services use different platforms. One thing that would help to implement these new technologies would be the implementation of a unique platform that gets referrals from all High Street optometrists, GPs, and primary care services into the hospitals. That would facilitate referrals but also the implementation of technologies that can filter and support clinical decisions.

Several technologies are being developed that aren’t available yet in a clinical setting but aim to help triage. Some companies have been working on transferring optical coherence tomography (OCT) scans into secondary care to provide advice and a second opinion straight away from ophthalmology, so the patient doesn’t need to leave the optometry service and can be treated there.

The biggest opportunity here is that the new services being developed are giving more autonomy to the optometrist. Right now, we need to support clinical decisions so no-one feels overwhelmed with this change in the role of the primary care service. This is what Dem Dx is trying to address. We are trying to give information, adding technology with the expertise of someone who has the clinical experience and judgement, to identify when a patient’s issue needs referral.

I believe that we are only going to achieve a good feat of technology when we enhance the abilities and skills of the healthcare professionals who know the patients.

• As told to Kimberley Young.