Evaluation of Eye Care Electronic Referral Systems

In 2017/18 ophthalmology outpatient activity was reported to be greater than any other NHS speciality. This high demand has been linked to the aging population, new treatments, eye conditions requiring multiple appointments a year, unwarranted variation in referrals, as well as a lack of discharge pathways for stable and lower risk patients. Demand-driven pressures on ophthalmic services have also risen further in the wake of the COVID-19 pandemic, and have been compounded by services suffering workforce supply challenges, with persistently low ophthalmologists per capita across the UK. It is, therefore, becoming increasingly important that processes to relieve pressure on ophthalmology services are developed and successfully deployed.


There has been growing interest in the potential benefits of using Eye Care Electronic Referral Systems (EeRS) and transfer of full volume scans/images in ophthalmology to improve pathways from primary care optometrists to specialist ophthalmologists in a Hospital Eye Service (HES). Through implementation of EeRS there is the hope that some of the pressures on both primary and secondary care could be alleviated.


Several pilots have been commissioned across the UK to test the use of EeRS, however, there remains a gap in the literature on the real-world benefits of this intervention. With expertise in both qualitative and quantitative research methods, Edge was commissioned to evaluate the use of one EeRS at the 6-month stage in its pilot. Interviews were held with optometrists, consultant ophthalmologists, optometry service delivery managers, clinical commissioners, optometry clinical technology managers and the EeRS provider, to understand the impacts that the technology could have on patient pathways. In parallel, cost data and CCG-level demand data were used to identify the potential cash and non-cash-releasing benefits to the system.


Quantitatively, it appears there have only been marginal cost and time efficiency gains. However, the pilot was in its infancy, and referrals and user sign-ups continued to grow month-on-month. Qualitatively, optometrist and ophthalmologist feedback suggested significant potential with many citing patients were seen quicker at HES, patients were more likely to be sent to the correct clinic for their first appointment, saving patient time and health system resources, as well as patients being less likely to get lost in the referral pathway.


This analysis also identified several next steps for the current pilot as well as key learnings for expansion and further roll-outs. These findings will be used to inform decisions makers on the real-world benefits of EeRS and help ensure future regional or national roll-outs have the data needed to deliver maximal benefit for the NHS.



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