title: Service innovation in glaucoma management: using a Web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.
abstract: OBJECTIVE
  To assess the importance of specialist supervision in a new model of glaucoma service delivery.
  
  
  METHODS
  An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: 'normal', 'stable', 'low risk', 'unstable' and 'high risk'. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist.
  
  
  RESULTS
  24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists' interim decisions resulting in an overall reduction in review appointments by 2.4%.
  
  
  CONCLUSIONS
  Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need.
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, East Melbourne, Victoria, Australia.
authors.forename: Heathcote R
authors.initials: HR
authors.lastname: Wright
authors.affiliation: Bristol Eye Hospital, Bristol, UK.
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Diamond
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D005901:Glaucoma / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D020407:Internet; D009885:Ophthalmology / Q000458:organization & administration*; D009907:Optometry / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D010808:Physical Examination; D013222:State Medicine; D017216:Telemedicine / Q000458:organization & administration*; D014584:User-Computer Interface; D014786:Vision Disorders / Q000175:diagnosis; D014794:Visual Fields
keywords: Epidemiology; Glaucoma; Public health; Telemedicine