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Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care
  1. Christoph Kern1,2,
  2. Dun Jack Fu1,
  3. Karsten Kortuem1,2,
  4. Josef Huemer1,3,
  5. David Barker4,
  6. Alison Davis1,
  7. Konstantinos Balaskas1,
  8. Pearse A Keane1,5,6,
  9. Tom McKinnon7,
  10. Dawn A Sim1,5,6
  1. 1 Moorfields Eye Hospital, London, United Kingdom
  2. 2 Department of Ophthalmology, University Eye Hospital, LMU, Munich, Germany
  3. 3 Eye Departement, Tauernklinikum, Zell am See, Austria
  4. 4 Rawlings Opticians, Purley, UK
  5. 5 NIHR Biomedical Research Centre Biomedical Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  6. 6 Institute of Ophthalmology, University College of London, London, United Kingdom
  7. 7 Big Picture Medical, London, United Kingdom
  1. Correspondence to Dr Dawn A Sim, Medical Retina Department, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK; dawnsim{at}


Background Hospital Eye Services (HES) in the UK face an increasing number of optometric referrals driven by progress in retinal imaging. The National Health Service (NHS) published a 10-year strategy (NHS Long-Term Plan) to transform services to meet this challenge. In this study, we implemented a cloud-based referral platform to improve communication between optometrists and ophthalmologists.

Methods Retrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Main outcome measures was the reduction of unnecessary referrals.

Results After reviewing the patient’s data in a web-based interface 54 (52%) out of 103 attending patients initially classified into the referral pathway did not need a specialist referral. Fourteen (14%) patients needing urgent treatment were identified. Usability was measured in duration for data input and reviewing which was an average of 9.2 min (median: 5.4; IQR: 3.4–8.7) for optometrists and 3.0 min (median: 3.0; IQR: 1.7–3.9) min for ophthalmologists. A variety of diagnosis was covered by this tool with dry age-related macular degeneration (n=34) being most common.

Conclusion After implementation more than half of the HES referrals have been avoided. This platform offers a digital-first solution that enables rapid-access eye care for patients in community optometrists, facilitates communication between healthcare providers and may serve as a foundation for implementation of artificial intelligence.

  • telemedicine
  • teleophthalmology
  • optometrist
  • specialist referral
  • long-term plan

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  • Correction notice This paper has been amended since it was published Online First. The authors noticed there was a mistake with the affiliations and these have now been amended.

  • Contributors All listed authors contributed to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafted or revised the work critically for important intellectual content; and finally approved this version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CK and DS are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KB reports grants from Bayer AG, personal fees from Alimera, from Allergan, outside the submitted work; PAK reports other from Big Picture Eye Health, during the conduct of the study; personal fees from DeepMind, personal fees from Optos, personal fees from Novartis, personal fees from Bayer, personal fees from Allergan, personal fees from Heidelberg Engineering, personal fees from Topcon, personal fees from Carl Zeiss Meditec, personal fees from Haag Streit, personal fees from Santen, grants from National Institute for Health Research, grants from Fight For Sight UK, outside the submitted work; TM reports other from Big Picture Medical, outside the submitted work; In addition, TM has a patent 2016265973 pending; KK reports personal fees from Big Picture Eye Health, during the conduct of the study; grants and personal fees from Novartis Pharma, grants and personal fees from Bayer Pharma, personal fees from Zeiss, personal fees from Allergan, personal fees from Alcon, personal fees from Google Deepmind, AD has nothing to disclose; outside the submitted work; DS reports other from Big Picture Eye Health, during the conduct of the study; personal fees from Allergan, personal fees from Novartis, personal fees from Bayer, personal fees from Big Picture Eye Health, personal fees from Haag Streit, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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