Covid-19 accelerated the use of technology across many aspects of life and work. Eye care professionals had to ensure the delivery of eye care was maintained as best as possible, which meant novel methods of triage and pre-screening were explored. With practice team members furloughed and face-to-face consultations limited, approaches to existing technology platforms changed and investment in equipment was made.
Video calls were widely used for consultations and practice management systems were accessed remotely to book appointments and reduce the number of people in practice. However, it is perhaps more familiar technology, such as phone calls and emails, that will have the longest-lasting impact on the way optical practices work post-pandemic.
At David Burghardt Vision Care, optometrist and practice owner David Burghardt triaged patients who required emergency services using tele-practice management software. While carrying out consultations from home, he accessed patient records and previous scans. ‘I’d do it on the phone, or we also used software so we could do video conferencing,’ Burghardt recalls. Richard Spencer, dispensing optician and practice manager at the Lincoln-based practice, adds: ‘We used a telephone system that allowed us to log in to the system from home to triage and book appointments.’
Burghardt says some patients only had basic phones, but he got their relatives to take a picture and email images of the eye, if necessary. ‘We used email quite a lot. We could evaluate and decide whether we needed to see them or not. In the first few months, we saw very few people. Most people were scared to come out. If the symptoms suggested that we needed to see them in person then I would go to the practice and get them in, but the practices had locked doors,’ Burghardt says.
When a face-to-face appointment was required, existing technology was used, but the method of relaying information to the patient changed to reduce the amount of time spent in practice. ‘We used OCT and Optomap a lot and could send a photo of the scan, then call to explain. We don’t need to sit down in front of them and we use that way a lot more,’ he explains.
Modified use
Prior to the pandemic, remote use of technology happened on odd occasions, such as when a colleague sought a second opinion from Burghardt. ‘I was at a conference in Prague. I could see the images and advise them while away for work. It became much more useful during the pandemic,’ Burghardt says.
When necessary, patients were video called, but while some practitioners might experience limits to what could be assessed, Burghardt made use of his therapeutic optometry training. ‘Just talk to the patient, find out their symptoms, find out what their problems are. We did not have to look at the patient. Then, you’re given the opportunity to look at the patient, but you can’t ask them any questions. It was invaluable being able to actually determine what’s going on without actually having the patient in front of you and being able to diagnose from triage with history and symptoms,’ he explains.
An appointment system was already used for eye examinations at David Burghardt Vision Care, but Covid measures meant it was applied to dispensing too. ‘The idea was to keep contact to a minimum, to see people as little as we could and to keep the number of people in the practice down. We knew exactly when patients were coming. We made it clear to them that we wanted them to turn up precisely at 10 or 12 o’clock, and patients were very good. They showed up when they should. We’ve still got that appointment system in place, but patients aren’t as compliant now,’ Burghardt shares.
David Burghardt, left, and Richard Spencer
Although much of the technology was already available at the practice, its use was accelerated during the pandemic and new ways of using it were introduced. Spencer says: ‘There were things that we did that we perhaps wouldn’t have thought of doing because it never came up. It never needed to be done and we’ve done it since. We’ve either adopted it permanently or in a modified way.’ For example, some of the team still work from home to book patient appointments as they can link into the PMS. Video calls are being used less now but for more specific cases. Spencer adds: ‘Triaging for a medical emergency, for example. It might be a video call or telephone call rather than an immediate appointment in practice. A five-minute call is better than making an elderly patient come into practice sometimes.’
Burghardt explains that patients are open to using technology as part of the practice experience and preferred receiving professional advice remotely. Since restrictions have eased, some patients have opted to return to face-to-face visits. ‘It depends on the person and their condition, but we are using it more than we did,’ he adds.
After investing in Rodenstock’s DNEye Scanner, the practice found information gathering was quicker and reduced time spent in practice for the patient. ‘Even if they come in for an emergency visit, we immediately see whether their prescription’s close or whether they have a problem,’ Burghardt notes. Spencer adds they pair it with a Rodenstock Impressionist 4, a 3D measuring system that was initially brought in for higher end, bespoke lens dispenses but has been used for all patients since the pandemic because it enables social distancing. ‘When I speak to patients, they don’t feel like we’re invading their space. We’re also showcasing our investment. It shows the importance of technology for the future and I think we were ready to go. We just had to use what we had differently. We’ve always been a technological practice,’ Spencer says.
‘I think we utilised tech in different and better ways, some of which is going to stay,’ Burghardt adds.
Enhancing existing tools
Website use increased during the pandemic at Andrew & Rogers Optometrists in Beverley with patients requesting consultation appointments online. Andrew Scott (pictured below), optometrist and co-founder of the practice, says with doors shut but the clinic still operational, online bookings became more important.
‘We redesigned our online booking to include telephone enquiry appointments, emergency appointments and appointments with specific people at specific times. We increased the complexity of what people can book online. Patients could book a phone call where we could answer everyone’s queries without being in the practice,’ he explains.
Upgrading the practice’s website proved worthwhile and more services were added to the website, which have been adopted by patients. ‘People are using it now as the norm. We’ve been busy, so to get people booking themselves in when they want with the right person, on the right day is a godsend,’ Scott says, adding that the system is flexible and versatile. In the last year, Scott’s practice also invested in a measuring device that provides accurate facial measurements while social distancing.
Scott notes NHS England’s refinement of the referral process, particularly the switch to email, as effective use of technology. He does not miss paper referrals and the associated administrative tasks, such as following up to check the referral has been received. Scott says emailing referrals has been effective for patients and improved communication with colleagues in secondary care.
Direct advice
At the start of the pandemic, Gordon Hay, A&E service director at Moorfields Eye Hospital, set up direct dial phone lines; one for GPs and one for optometrists seeking immediate advice and guidance. ‘It’s been a game-changer. I put them in as a Covid solution, but they’ve been so useful for our local optometrists to talk to us immediately that we’re keeping it forever,’ Hay says.
‘The optom’s got a patient sitting in front of them, those who were still seeing emergencies, and quite a number of units put in hurdles like having to email referrals and then they’d contact the patient. I thought this was absolute nonsense. As always, I will do the exact opposite of everybody else.’
Gordon Hay, A&E service director at Moorfields Eye Hospital
Optical practices in the catchment area of the London-based hospital could call for advice, which Hay says solved a huge number of problems. ‘It’s scary if you’re on your own in a practice and you don’t know what to do. It avoided them being in that situation and using the default option of going to eye casualty just in case.’
Optometrists shared images with Hay, who advised if the patient needed to be urgently seen in A&E or booked in for an appointment at the relevant clinic on a later date. He says this method fit the Getting It Right First Time programme’s ethos of bypassing A&E if the patient’s condition was not sight or life threatening. The phone lines receive around 150 calls a day, with between 30 and 40 calls a day from optometrists, and are answered quickly as it avoids going through the hospital’s switchboard.
Within three days of lockdown starting, the hospital was providing video consultation via the Attend Anywhere app, which Hay says created a more nuanced consultation. ‘I remember after the third or fourth that I’d done, it felt completely natural. It didn’t feel different from having the patient sitting in the triage cubicle with me.’ Concerns about elderly patients not being able to access services were allayed as relatives helped them log on, he adds.
Over 26,000 patients have used the services and 78% of patients have been able to get the treatment they need without travelling to Moorfields. ‘For years we’ve always thought ophthalmology probably wouldn’t have much utility for digital platforms and, all of a sudden, we discovered that a really detailed, nuanced history could suss out quickly whether it was a same day emergency, if the patient needs to come immediately, purely based on the symptoms. When we audited this after a couple of months, I don’t think we found a single case where patients were harmed,’ Hay says.