Using electronic referral with digital imaging between primary and secondary ophthalmic services: a long term prospective analysis of regional service redesign

Eye (Lond). 2013 Mar;27(3):392-7. doi: 10.1038/eye.2012.278. Epub 2012 Dec 21.


Purpose: Demands on publicly funded ophthalmic services worldwide continue to increase with new treatments, waiting time targets, working time limits, and restricted budgets. These highlight the necessity to develop innovative ways of utilising existing capacity more effectively.

Method: A new regional, fully electronic ophthalmic-referral service with digital imaging was trialled using existing information-technology (IT) infrastructure. Following successful pilot study, the service was rolled out regionally. Service delivery data was prospectively collated for all the attendances in the year prior to (2006) and the year following (2008) introduction.

Results: Comparing 2006 against 2008, median waiting times reduced (14 vs 4 weeks), and fewer new patients were observed (8714 vs 7462 P<0.0001), with 1359 referrals receiving electronic diagnosis (e-diagnosis). New patient did not arrive (635 vs 503 P<0.0001) and emergencies also reduced (2671 v 1984 P<0.0001).

Discussion: Novel use of existing IT infrastructure improves communication between primary and secondary care. This promotes more effective use of limited outpatient capacity by retaining patients with non-progressive, asymptomatic pathology in the community, whilst fast-tracking patients with sight-threatening disease. Resultant significant, sustained improvements in regional service delivery point to a simple model that could easily be adopted by other providers of universal healthcare globally.

MeSH terms

  • Adult
  • Aged
  • Appointments and Schedules*
  • Diagnostic Imaging*
  • Electronic Health Records / organization & administration*
  • Female
  • General Practitioners*
  • Health Care Surveys
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Ophthalmology / organization & administration*
  • Outpatients
  • Pilot Projects
  • Primary Health Care / organization & administration*
  • Prospective Studies
  • Referral and Consultation / organization & administration*
  • Regional Medical Programs
  • State Medicine
  • Telemedicine
  • United Kingdom
  • Waiting Lists