Taking the right steps to drive IT connectivity for optometry

What’s happening?

Optometry and ophthalmology capture a significant volume of valuable data on patients. In optometry, approximately 20 million sight tests are conducted per year, and each of these tests gathers data on the history and health of the patient as well as their refractive information, alongside their eye health status. In addition, millions of contact lens appointments, and hundreds of thousands of enhanced service appointments, are carried out each year in the community. Ophthalmology conducts a further eight million patient episodes.

However, the millions of data points on patients that are collected are not gathered and connected effectively. Instead the data exist in silos and this limits the ability of and opportunities for clinicians across disciples to collaborate, and to share the patient care. In turn, this creates unnecessary referrals, either because clinicians cannot collaborate, or in many cases simply because previous history or status that has been captured in one place is inaccessible in another place.

These silos prevent new ways of working, contribute to waiting lists, hinder patient care and limit the transformation of eye care services.

What needs to change?

Improved connectivity between primary care optometry and secondary care, as well as GP practices, would transform the way patients are cared for. It is the data that should be ‘moving’ between primary and secondary care, wherever possible avoiding the need for the patient to ‘move’ between the locations where clinicians are providing the care needed.

We believe a significant number of referrals could be avoided, via a number of mechanisms:

• The ability to ascertain the status of the patient. This could include information such as if they are already under the care of the hospital, where they are in the care pathway and when they are due for review, as well as any current or pending treatment
• Enabling optometry to be able to liaise, collaborate and consult with colleagues, be those optometrists with specialist qualifications or with ophthalmologists, in order to allow patients to be retained, monitored and managed in a primary care setting
• Access to the demographic services which provide information on the patients’ full details including their NHS number and real time waiting list data will enable greater detail to be included in any referrals and facilitate better conversations about which referral destination is most appropriate for the patient
• Connectivity that permits two types of data sharing: synchronous, real time data sharing; and asynchronous, non-real time data sharing. The former is needed to permit real time interactions and collaboration between colleagues; the latter is needed to enable clinicians to ask for advice and guidance, or seek a second opinion on imaging such as OCT

What are we calling for?

We believe that there are two steps to take, both with limitations, but ones that would nonetheless provide important improvements.

1. All practitioners have access to NHS mail to ensure there is a robust, secure mechanism of communication between primary and secondary care

The basic option would be to ensure that all practitioners have access to NHS mail. This approach provides a safe and secure way for clinicians to interact. To do this, we recognise there are two challenges to resolve:

• Currently locums can only access NHS mail via a GOS contract holder. This is not tenable. We believe that access to NHS mail should be at least partially linked to the individual providing services, not just the practice
• Access to NHS mail accounts is restricted to businesses that operate from 10 sites or fewer. While there are mechanisms to accredit email solutions as compatible with NHS mail, we argue that this is burdensome and only open to those businesses with large IT teams. This means that there are businesses that are neither small providers nor large corporations who are caught in the middle and are unfairly disadvantaged

We recognise that NHS mail is in effect a safety net and at best a workaround, which can only achieve limited success, and would only permit asynchronous interaction. This solution wouldn’t solve the issue of lack of access to additional information such as previous records or current hospital status, but would in many instances be an improvement over the status quo.

2. Roll out access to ERS for all practices to create a true national referral system

We believe a more integrated and effective approach is to provide all practices with access to the NHS Electronic Referral Service (ERS). This solution contains far more features than NHS mail, it is the system used by GP practices, and is already available on a national scale and in many instances is already integrated with secondary care providers. ERS also has the ability for asynchronous advice and guidance, and permits – or will shortly permit – the attachment of large size files.

Other fringe benefits of ERS include better visibility of how quickly a patient will be seen, for example by providing the current time to appointment for cataract patients. The other requirement needed is access to hospital discharge letters and the patient history; these can be enabled be extending existing products such as summary care record access to primary care optometry.