MEMBER BLOGS

Ian Rodrigues

PRSB advisory board member, Royal College of Ophthalmologists
Date: 10th January 2019

Good quality records allow different services to work more efficiently together, providing the best possible care for patients. We speak to our new advisory board member from the Royal College of Ophthalmologists, Ian Rodrigues, about the benefits of using information from care records to undertake quality audits and why digitising information is so crucial.

What are the current challenges of information sharing in ophthalmology?

Ophthalmologists, or eye doctors, work in a high volume specialty. Ophthalmology have the highest number of outpatient appointments of any specialty, providing 7.6 million outpatient appointments every year. Cataract surgery is the most commonly performed operation worldwide and is often carried out as an outpatient procedure, with over 400,000 cataract operations taking place in the UK annually. The work we do is high volume, and the good thing about ophthalmology is that a lot of the records are already structured and contain numerical data. This means that our records are naturally well-suited to coding and digital records. As hospital specialists, it’s important for us to be able to share information with a patient’s GP, as well as any other professionals that might be treating them. For us there’s also a third group- the high-street optometrists, like Specsavers and Boots. They’re a third care provider, but not strictly within the NHS so they don’t all have access to NHS email accounts and very few can access patients digital hospital records. We usually do try to share information with them after a person has been treated by us, with implied consent from the patient. It can be a challenge because of the different systems we use, and there’s nowhere to hold optometrist details in our patient information systems.

What has been done to make information more accessible?

I am involved with an electronic health record system called OpenEyes, which is a web-based, cloud-hosted platform, used for specifically for ophthalmology. It was originally set up six years ago and we are using it at Guy’s and St Thomas’ NHS Foundation Trust where I work as a consultant ophthalmic surgeon, as well as several other hospitals.

It allows us to share the information contained in a record digitally, with GPs and other hospital professionals who may be involved in care.

However, while we have made steps towards making information more accessible for NHS staff, it would also be helpful if we could gain more patient data from high street optometrists. To take some of the burden off hospitals and keep people healthier in the community, optometrists are dealing with more patients who might previously have been seen in hospital. For example, cataract surgery is usually routine, and follow ups can often be done in the community. As well as cataracts, another common, age related problem is glaucoma, which is a lifelong condition. Again, some of the more stable patients are being seen by optometrists in the community. However, as this evolves it will be important to ensure that the right information is being made accessible, particularly for follow ups with people who have glaucoma as they require several tests. At the moment we’re using paper

summaries, so it would be good to be able to share the important summary information digitally between hospital consultants and optometrists in the community.

How can digital records support this?

Digital records are incredibly important and ophthalmology has already gone a long way with supporting this. We really recognise the need for better sharing between different services involved in care. A few years ago, the Royal College of Ophthalmologists began running the National Ophthalmology Audit (NOD). All units that perform cataract surgery in the UK are obliged to submit data on the outcomes of cataract surgery back to the national audit. This has already led to improvements in surgery, thanks to the audit data that has been produced. It’s been sponsored by the Healthcare Quality and Improvement Partnership (HQIP) and the results have been really beneficial. Any complications from surgery are recorded, as well as positive changes to vision. It’s made it easier for people to recognise common complications and improved the quality of these operations as a result. Before that we didn’t know how often issues were arising, and we didn’t know the full extent of the improvements from the operations, because we weren’t able to compare outcomes in a standardised way. The next step is to include patient reported outcome measures, to show the changes they’ve experienced.

What changes can we expect in future?

I’m positive about the future of digital health and care. At the moment we are trying to use the OpenEyes platform to expand the information we are able to make accessible for professionals. For example, this will mean that optometrists in the community will be able to complete small sections of information, which can be relayed back to hospitals. The information that’s entered automatically goes into a patient’s record, which is really important for auditing purposes. Not everywhere is able to do his yet, but we’re hoping with appropriate security measures, more optometrists in the community will be able to gain access to the information. The forms are standardised too, so we can ensure that the right information is being collected. We need to get everyone using digital records- because there’s so much you can gain from that. Better access to information makes care safer, as well as allowing professionals to streamline and improve services.