title: Improving patient access to prevent sight loss: ophthalmic electronic referrals and communication (Scotland).
abstract: BACKGROUND
  With the number of people with sight loss predicted to double to four million people in the UK by the year 2050, preventable visual loss is a significant public health issue. Sight loss is associated with an increased risk of falls, accidents and depression and evidence suggests that 50% of sight loss can be avoided. Timely diagnosis is central to the prevention of sight loss. Access to care can be a limiting factor in preventable cases. By improving referrals and access to hospital eye services it is possible to treat and minimise the number of patients with preventable sight loss and the impact this has on wider society.
  In 2005, NHS Fife took part in a flagship pilot funded by the Scottish government e-health department to evaluate the feasibility, safety, clinical effectiveness, and cost of electronic referral with images of patients directly from community optometrists to Hospital Eye Service (HES). The pilot study showed that electronic referral was feasible, fast, safe, and obviated the need for outpatient appointments in 128 (37%) patients with a high patient satisfaction.
  The results of the pilot study were presented and in May 2007, the electronic referral system was rolled out regionally in southeast Scotland. Referrals were accepted at a single site with vetting by a trained team and appointments were allocated within 48 hours. Following the implementation of electronic referral, waiting times were reduced from a median of 14 to 4 weeks. Significantly fewer new patients were seen (7462 vs 8714 [p < 0.001]). There were also fewer casualties (1984 vs 2671 [p < 0.001]) and 'did not arrive' (DNA) new patients (503 vs 635 [p < 0.001]).
  In 2010 the Scottish Government Health Department committed £ 6.6 million to community and hospital ophthalmic services forming the Eyecare Integration Project in 2011. The main aim of this project was to create electronic communication between community optometry practices and hospital eye departments. Five electronic forms were specifically designed for cataract, glaucoma, macula, paediatric and general ophthalmic disease. A Virtual Private Network was created which enabled optometrists to connect to the Scottish clinical information gateway system and send referrals to hospital and receive referral status feedback. Numerous hurdles have been encountered and overcome in order to deliver this project.
  
  
  CONCLUSIONS
  An efficient unique system has been described within the NHS whereby the provision of eye care has been modernised by creating a user-friendly electronic interface between the community and HES. This system ensures patients are vetted into the correct specialist clinic and thus will be less likely to go blind from treatable conditions. Urgent conditions will continue to be prioritised and savings made with efficiencies gained can be re-invested towards better overall patient care.
authors.affiliation: Queen Margaret Hospital, Dunfermline, Fife, UK. Electronic address: ashraf.khan@nhs.net.
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Queen Margaret Hospital, Dunfermline, Fife, UK.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Mustafa
authors.affiliation: Queen Margaret Hospital, Dunfermline, Fife, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sanders
mesh_terms: D001766:Blindness / Q000517:prevention & control*; D003142:Communication; D003151:Community Health Centers / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D005240:Feasibility Studies; D006297:Health Services Accessibility / Q000458:organization & administration*; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D009885:Ophthalmology / Q000458:organization & administration*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010865:Pilot Projects; D012017:Referral and Consultation / Q000458:organization & administration*; D012606:Scotland; D013222:State Medicine
keywords: Electronic referral; Imaging; Telemedicine