The promise of telemedicine

Malpractice Cases Arising From Telephone Based Telemedicine Triage in Ophthalmology

PURPOSE

To determine the allegation, precipitating medical issue, and outcome of telephone triage focused malpractice litigation among ophthalmologists.

METHODS

The WestLaw Edge database was reviewed using terms pertaining to ophthalmology and telemedicine. The search ranged from 4/7/30 to 1/25/22.

RESULTS

Of the 510 lawsuits, 3.5% (18/510) met inclusion criteria. 94.5% (17/18) alleged delays in evaluation and/or treatment. 61.1% (11/18) alleged incorrect diagnoses, 38.9% (7/18) claimed improper discussion of risks or informed consent, and 5.6% (1/18) alleged delayed referrals. The precipitating medical issues included retinal detachment in 33.3% (6/18) of cases, post-procedure and post-trauma endophthalmitis in 33.3% (6/18) of cases, ocular trauma without endophthalmitis in 22.2% (4/18) of cases, and bilateral acute retinal necrosis and allergic reactions each accounting for 5.6% (1/18) of cases.

CONCLUSION

Telephone triage creates potential malpractice litigation. Delay in in-person clinical evaluation and alleged failure to inform patients of possible irreversible vision loss may lead to potential malpractice litigation. We suggest offering the option of same day in person evaluation and informing the patient how delay may lead to irreversible vision loss.

Tele-ophthalmology as an aid tool for primary care physicians in the IDF, during the Covid-19 lockdown

PURPOSE

To describe tele-ophthalmology consultations for primary-physicians in the IDF during the Covid-19 lockdown.

METHODS

Retrospective cross-sectional study. Medical records of tele-ophthalmology consultations from March to June 2020 were reviewed.

RESULTS

The study included 245 cases in which an ophthalmologist was consulted. In 62.0% cell-phone camera photographs were used. The mean age was 21.5 ± 6.4 years. The most common diagnoses were acute-conjunctivitis (8.6%); conjunctival-hyperemia (non-specific diagnosis, 8.2%); scleritis/episcleritis (7.3%); chronic allergic-conjunctivitis (7.3%); chalazion (7.3%) hordeolum (6.5%); acute allergic-conjunctivitis (4.5%). 37.6% of patients received primary physician-based treatment, 24.9% of patients received specialist-based treatment. 13.1% were referred to the ER. The consult prevented ER referral for 39.2% and changed the physician's treatment plan in 70.6% of cases. Foreign-body sensation complaints were more likely treated by a primary-physician (p = 0.015). Cases with suspected foreign-body diagnosis were referred more to the ER (p < 0.001). For most cases of eyelid complaints and diagnoses, primary physician care was sufficient (p < 0.001). Conjunctival complaints and diagnoses received significantly more ophthalmologist-based treatment (p < 0.001). Corneal disorders were significantly referred more to the ER (p = 0.001).

CONCLUSION

Despite of possible ethical and legal problems and clinical limitations of this instrument, Tele-ophthalmology using objective aids such as smartphone photography can be an efficient tool in aiding the primary-physician, especially for patients with low access to ophthalmologists, with major impact on patient management.

Modifying UTAUT2 for a cross-country comparison of telemedicine adoption

The ongoing COVID19 pandemic has put digital health technologies in the spotlight. To gain a deeper understanding of patients’ usage intentions of virtual doctor appointments, the present research adapts the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) by integrating perceived security and perceived product advantage, two known barriers to successful telemedicine adoption. Applying age-stratified sampling, an online survey was distributed to 800 citizens in Germany and the United States of America. 710 completed and valid questionnaires were subsequently analyzed using SPSS and AMOS (versions 24).

Significant, direct, and positive effects of performance expectancy, hedonic motivation, perceived security, and perceived product advantage on the behavioral intention to use virtual doctor appointments were found. The analysis of the moderating variables, age and gender, showed significant differences in user's performance expectancy and effort expectancy, and perceived product advantage, respectively. With virtual health care models on the rise, these results are important for stakeholders such as policymakers, governments, employers, but also physicians, and insurance companies as they offer clear recommendations to design telemedicine adoption strategies to ensure successful patient engagement.

Investigating the Receptiveness Attitude of the Patient With Diabetes Retinopathy Towards the Use of Teleophthalmology

Research on the attitude of diabetes retinopathy's (DR) patients towards teleophthalmology as a branch of telemedicine has not been examined in developing countries. This article examines the receptiveness attitude of the patients with DR towards the use of teleophthalmology using 400 questionnaires to examine patients in Calabar DR screening center in Cross River State, Nigeria. The hypotheses were tested using multiple indicators multiple causes (MIMIC) as a special case of the structural equation modeling (SEM). The findings in this study indicated high cost and excess time negatively affects patient attitude, information, knowledge, and experience significantly and positively predict patients attitude towards teleophthalmology. Furthermore, the result of the paper shows that convenience and knowledge for 35.7 percent of the receptiveness of patients towards teleophthalmology. This study contributes by identifying that among other factors positive factors to enhance patient's receptive attitude to being diagnosis with diabetes retinopathy through telemedicine.

Promise and peril-defining ethical telehealth practice from the clinician and patient perspective: A qualitative study

OBJECTIVES

We undertook a qualitative study to examine and compare the experience of ethical principles by telehealth practitioners and patients in relation to service delivery theory. The study was conducted prior to and during the recent global increase in the use of telehealth services due to the COVID-19 pandemic.

METHODS

We conducted semi-structured interviews with 20 telehealth practitioners and patients using constructionist grounded theory methods to collect and analyse data. Twenty-five axial coded data categories were then unified and aligned through selective coding with the Beauchamp and Childress (2013) framework of biomedical ethics. The groups were then compared.

RESULTS

Thirteen categories aligned to the ethical framework were identified for practitioners and 12 for patients. Variance existed between the groups. Practitioner results were non-maleficence 4/13 or (31%), beneficence 4/13 (31%), professional-patient relationships 3/12 (22%), autonomy 1/13 (8%) and justice 1/13 (8%). Patient data results were non-maleficence 4/12 (33%), professional-patient relationships 3/12 (33%), autonomy 2/12 (18%), beneficence 1/12 (8%) and justice 1/12 (8%).

CONCLUSIONS

Ethical principles are experienced differently between telehealth practitioners and patients. These differences can impact the quality and safety of care. Practitioners feel telehealth provides better care overall than patients do. Patients felt telehealth may force a greater share of costs and burdens onto them and reduce equity. Both patients and practitioners felt telehealth can be more harmful than face-to-face service delivery when it creates new or increased risk of harms. Building sufficient trust and mutual understanding are equally important to patients as privacy and confidentiality.

Do Hospitals Need to Extend Telehealth Services? An Experimental Study of Different Telehealth Modalities during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has changed health care systems and clinical workflows in many countries, including the United States. This public health crisis has accelerated the transformation of health care delivery through the use of telehealth. Due to the coronavirus' severity and pathogenicity, telehealth services are considered the best platforms to meet suddenly increased patient care demands, reduce the transformation of the virus, and protect patients and health care workers. However, many hospitals, clinicians, and patients are not ready to switch to virtual care completely.

OBJECTIVES

We designed six experiments to examine how people (as an actual beneficiary of telehealth) evaluate five telehealth encounters versus face-to-face visits.

METHODS

We used an online survey to collect data from 751 individuals (patients) in the United States.

RESULTS

Findings demonstrate that significant factors for evaluating five types of telehealth encounters are perceived convenience expected from telehealth encounters, perceived psychological risks associated with telehealth programs, and perceived attentive care services delivered by telehealth platforms. However, significant elements for comparing telehealth services with traditional face-to-face clinic visits are perceived cost-saving, perceived time-saving, perceived hygienic services, perceived technical errors, perceived information completeness, perceived communication barriers, perceived trust in medical care platforms' competency, and perceived privacy concerns.

CONCLUSION

Although the in-person visit was reported as the most preferred care practice, there was no significant difference between people's willingness to use face-to-face visits versus virtual care. Nevertheless, before the widespread rollout of telehealth platforms, health care systems need to determine and address the challenges of implementing virtual care to improve patient engagement in telehealth services. This study also provides practical implications for health care providers to deploy telehealth effectively during the pandemic and postpandemic phases.

Genetic counseling practice for inherited eye diseases in an Israeli medical center during the COVID-19 pandemic

Inherited eye diseases (IED) are among the most common causes for childhood and young adulthood blindness in developed countries. Genetic counseling and testing have become an essential part of caregiving for families affected by one of these severe ocular pathologies. The objective of our study is to describe our experience during the 2020 (COVID‐19) pandemic, following a practice protocol of safe genetic counseling for inherited ophthalmic diseases. We conducted a review of the genetic counseling practices from January until December 2020 in a multidisciplinary clinic for patients with visual impairment, in a tertiary hospital. The new protocol covered patient screening, required personal protective equipment, and the implementation of telemedicine.

One hundred and eighty‐three counseling sessions were done in this period of time; 33/183 were telemedicine counseling. The results of this study indicate that the practice of genetic counseling in regard to inherited eye diseases in the era of COVID‐19 is effective and safe. Despite the high risk of infectivity that threatened healthcare professionals, safety measures adopted to reduce the risk of infection allowed us to prevent the cancelation of routine counseling, while keeping patient care our priority. The use of telemedicine was a very useful tool for providing counseling during lockdown periods in 2020.

The Future Is Now: Incorporating Telemedicine into Glaucoma Care

Purpose of Review

The field of teleglaucoma has expanded rapidly in recent years with several large-scale teleglaucoma screening programs in existence throughout the world. Additionally, teleglaucoma programs for use in disease management are under study. The limited access to care that resulted from the COVID-19 pandemic highlighted the need for expansion of such programs. This article reviews the literature on teleglaucoma for screening and management of glaucoma, discussing considerations for incorporating teleglaucoma into clinical practice.

Recent Findings

Teleglaucoma screening reduces the rate of false-positive referrals and can accurately screen at-risk populations with accuracy similar to in-person screening. The use of teleglaucoma for the management of glaucoma shows promise for low-risk patients with early disease. Furthermore, teleglaucoma is cost-effective and reduces travel burden for patients resulting in high patient satisfaction.

Summary

Teleglaucoma offers potential for improving access to glaucoma care, reducing the burden on patients and health care systems.

Telemedicine for the Spine Surgeon in the Age of COVID-19: Multicenter Experiences of Feasibility and Implementation Strategies

STUDY DESIGN

Multicenter study.

OBJECTIVES

The COVID-19 pandemic has obligated physicians to recur to additional resources and make drastic changes regarding the standard physician-patient encounter. In the last century, there has been a substantial improvement in technology, which over the years has opened the door to a new form of medical practicing known as telemedicine.

METHODS

Healthcare workers from three hospitals involved in the care for COVID-19 patients in the united states were invited to share their experience using telemedicine to deliver clinical care to their patients.

RESULTS

Since the appearance of this worldwide outbreak, social distancing has been a key factor in preventing the spread of the virus, for which measures have been taken to limit physical contact. Because of the ongoing situation, telemedicine has been progressively incorporated into the physician-patient encounters and quickly has become an essential component in the day-today medical practice.

CONCLUSIONS

It is feasible to deliver viable spine practice with the use of telemedicine. A proper patient selection of patients requiring virtual treatment versus those requiring in-person visits should be considered.

The Value of Applying Ethical Principles in Telehealth Practices: Systematic Review

Background

As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can lead to reduced effectiveness, noncompliance, and harm, undermining the best intentions of governments and clinicians.

Objective

Our aim was to explore how ethical considerations or impacts may be different, greater, or more variable in information and communication technology methods versus face-to-face health care delivery models, and how they may be applied in practice.

Methods

We undertook a systemic literature review to provide a critical overview of existing research into the incorporation of ethical principles into telehealth practice. Six databases were searched between March 2016 to May 2016 and again in December 2020 to provide the benefit of currency. A combination of broad terms (“ethics,” “ethical,” “health,” and “care”) with the restrictive terms of “telehealth” and “telemedicine” was used in keyword searches. Thematic analysis and synthesis of each paper was conducted, aligned to the framework developed by Beauchamp and Childress.

Results

From the 49 papers reviewed, authors identified or discussed the following ethical principles in relation to telehealth practice: autonomy (69% of authors, 34/49), professional–patient relationship (53% of authors, 26/49), nonmaleficence (41% of authors, 20/49), beneficence (39%, of authors, 19/49), and justice (39% of authors, 19/49).

Conclusions

Although a small number of studies identified ethical issues associated with telehealth practice and discussed their potential impact on service quality and effectiveness, there is limited research on how ethical principles are incorporated into clinical practice. Several studies proposed frameworks, codes of conduct, or guidelines, but there was little discussion or evidence of how these recommendations are being used to improve ethical telehealth practice.

Utility of teleconsultation in accessing eye care in a developing country during COVID-19 pandemic

OBJECTIVE

To evaluate the utility of teleconsultation in the provision of eye care services during the COVID-19 lockdown. Disparities in the consultation burden of sub-specialities and socio-demographic differences in teleconsultation utilization were also assessed.

METHODS

Al-Shifa Trust Eye Hospital Rawalpindi began audio and video teleconsultation using broadband telecommunication services during the lockdown. Patients' and consultations' data gathered during the first three weeks after the commencement of this programme were compared with data from the four weeks prior to lockdown. The weekly consultation ratio and overall consultation burden of sub-specialities were measured. Chi-Square tests of association determined the relationship between different variables (socioeconomic status and consultation characteristics) and consultation modality (on-site vs online).

RESULTS

In total, 17507 on-site consultations (4377/week) were conducted compared to 1431 teleconsultations (477/week), which maintained 10.89% of the weekly pre-lockdown eye care services. The post-lockdown teleconsultation programme saw a relatively higher percentage of service utility among female (47.09% vs 44.71%), younger-age (31.33±19.45 vs 41.25±23.32 years) and higher-socioeconomic-status (32.21% vs 0.30%) patients compared to pre-lockdown on-site consultations. The most common indication for teleconsultation was red-eye (16.70%). While cornea and glaucoma clinics maintained most of the pre-lockdown services (30.42% and 29% respectively), the highest dropout was seen in optometric and vitreoretinal services supporting only 5.54% and 8.28% of pre-lockdown services, respectively.

CONCLUSION

Digital initiatives could partially maintain eye care services during the lockdown. Focused strategies to improve teleconsultation utilization are required during the pandemic and beyond.

Telemedicine Practice: Review of the Current Ethical and Legal Challenges

Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including "Telemedicine," "Ethics," "Malpractice," "Telemedicine and Ethics," "Telemedicine and Informed consent," and "telemedicine and malpractice." Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle-Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.

Role of teleophthalmology to manage anterior segment conditions in vision centres of south India: EyeSmart study-I

Purpose:

To study the role of teleophthalmology (TO) in the diagnosis and treatment of anterior segment conditions (including adnexal conditions) in rural areas.

Methods:

This is a pilot study of 5,604 patients, who visited primary vision centres (VCs) for 1 week from 1-7 September 2018. The patients were examined by a vision technician (VT) to identify those who may need teleconsultation. The centres were located in 16 districts of four Indian states of Andhra Pradesh, Telangana, Odisha, and Karnataka. The demographic profile, along with the role of teleconsultation was reviewed.

Results:

Teleconsultation was advised in 6.9% of the patients, out of which 59.6% were referred to a higher level of care, and 40.4% were treated directly at the VC. Teleconsultations were higher among males (7.0% as compared to 6.6% in females), though not statistically significant (P = 0.55). Teleconsultation was higher in the older population, that is, 60 years and above (14.5%); those with severe visual impairment (VI) (21%) and blindness (31.1%); and in the states of Telangana (11%) and Andhra Pradesh (6.3%). It was noted that 45% of the patients who underwent teleconsultation had pathologies related to ocular surface, cornea and lid, and adnexa-related conditions.

Conclusion:

Teleconsultation has a significant role in the management of anterior segment conditions in bridging the gap between the patients and ophthalmologists in rural India. TO can also play an important role in the diagnosis and management of anterior segment, lid, and adnexa-related pathologies.

[Ethical issues in primary care during the coronavirus (SARS-CoV-2) pandemic]

Las emergencias de salud pública, como la que estamos viviendo con la pandemia originada por el coronavirus SARS-CoV-2, han originado trágicas limitaciones de recursos que impiden salvar vidas. Provocan tensiones en la atención sanitaria centrada en el paciente como eje del sistema en condiciones normales, y en la misma atención sanitaria en situaciones de emergencia originadas en la COVID-19. En esta revisión abordamos algunos de los problemas asistenciales, organizativos y éticos que este escenario ha provocado en la atención primaria, como: cancelación de actividades programadas; escasa atención domiciliaria y seguimiento de pacientes ancianos, enfermos crónicos e inmovilizados; desabastecimiento de EPI y exposición al riesgo de los profesionales sanitarios, y finalmente los problemas asociados a la telemedicina y a la atención telefónica a los pacientes.

Image quality and diagnostic accuracy of a handheld nonmydriatic fundus camera: Feasibility of a telemedical approach in screening retinal diseases

BACKGROUND

A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases.

METHODS

A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists.

RESULTS

A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera (p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis (p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera.

CONCLUSION

This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.

Detecting Common Eye Diseases Using the First Teleophthalmology GlobeChek Kiosk in the United States: A Pilot Study

PURPOSE

The aim of this study was to assess the benefit and feasibility of the teleophthalmology GlobeChek kiosk in a community-based program.

DESIGN

Single-site, nonrandomized, cross-sectional, teleophthalmologic study.

METHODS

Participants underwent comprehensive evaluation that consists of a questionnaire form, brief systemic evaluation, screening visual field (VF), and GlobeChek kiosk screening, which included but not limited to intraocular pressure, pachymetry, anterior segment optical coherence tomography, posterior segment optical coherence tomography, and nonmydriatic fundus photography. The results were evaluated by a store-and-forward mechanism and follow-up questionnaires were obtained through phone calls.

RESULTS

A total of 326 participatents were screened over 4 months. One hundred thirty-three (40.79%) participants had 1 condition in either eye, and 47 (14.41%) had >1 disease. Seventy (21.47%) had glaucoma, 37 (11.34%) narrow-angles, 6 (1.84%) diabetic retinopathy, 4 (1.22%) macular degeneration, and 43 (13.10%) had other eye disease findings. Age >65, history of high blood pressure, diabetes mellitus, not having a dental examination >5 years, hemoglobn A1c measurement of ≥5.6, predibates risk score of ≥9, stage 2 hypertension, and low blood pressure were found to be significant risk factors. As for the ocular parameters, all but central corneal thickness, including an intraocular pressure >21 mm Hg, vertical cup to disc ratio >0.7, visual field abnormalities, and retinal nerve fiber layer thinning were found to be significant.

CONCLUSIONS

GlobeChek kiosk is both workable and effective in increasing access to care and identifying the most common causes of blindness and their risk factors.

Ophthalmology practice during the COVID-19 pandemic

OBJECTIVE

To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS AND ANALYSIS

Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice.

RESULTS

A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety.

CONCLUSION

Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.

Factors influencing behavior intentions to telehealth by Chinese elderly: An extended TAM model

BACKGROUND AND PURPOSE

Telehealth bring significant benefits including improved quality of healthcare, efficiency and cost containment, especially for chronic patients and the elderly. China is the second largest country of investment in telemedicine systems, but the acceptance and behavioral intentions of the technology are still low in the elderly. The objective of this study is to explain the micro-mechanism that determines the behavioral intentions to use telemedicine systems from the perspective of elderly patients based on an extended Technology Acceptance Model.

METHODS

A sample consisting of 436 elderlies selected through multistage cluster sampling from four cities in mainland China. The empirical study was conducted to examine the proposed model by two aspects: measurement model and structural model.

RESULTS

The study determined that medical service satisfaction (t = 6.770, β = 0.332), ease of use (t = 5.200, β = 0.179), information quality (t = 12.540, β = 0.639) had a significant impact on the elderly patients' acceptance to telehealth, and the acceptance had a significant impact (t = 14.356, β = 0.697) on the elderly patients' behavior intentions of telehealth. The results also show that the variable of acceptance has significant mediating effects among the theoretical model.

CONCLUSIONS

This study confirms the applicability of the extended Technology Acceptance Model in the behavioral intentions among elderly people in China using telehealth systems. The results indicate that relationship between telehealth systems and physical medical services are mutually reinforcing rather than alternative. The study will help technology developers better understand the behavioral characteristics of the elderly and encourage healthcare providers to better understand the true need of telehealth systems. These findings provide valuable information to telehealth system developers, governments, investors, and hospitals to promote the use of this technology by elderly patients.

Teleophthalmology in Practice: Lessons Learned from a Pilot Project

INTRODUCTION

Ophthalmology is a medical specialty which may benefit from using telemedicine and teleophthalmology services. Such services are significantly important in the poor, remote, and impassable geographical areas, where there is no access to the ophthalmology services and ophthalmologists. This study aimed to design and implement a teleophthalmology system using the method of store-and-forward.

METHODS

The study was conducted in 2015 and consisted of two main phases. The first phase was based requirement analysis, and in the second phase, after designing the prototype, an initial usability testing was undertaken in a teaching hospital. The participants of the study were 10 optometrists and 10 ophthalmologists (cornea specialists). For each phase of the research, a questionnaire was used to collect data, and the collected data were analyzed using descriptive statistics.

RESULTS

In this study, users' requirements were initially investigated. Then, the teleophthalmology system was designed based on the literature review and the results derived from the requirements' analysis. Finally, usability testing showed that the users were relatively satisfied with the system.

CONCLUSION

According to the results, it can be concluded that the teleophthalmology technology can be used in the country by optometrists and ophthalmologists to improve eye health care services and to prevent the prevalence of curable eye diseases.

Reaching the Unreachable: Novel Approaches to Telemedicine Screening of Underserved Populations for Vitreoretinal Disease

Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.

Electronic Referrals and Digital Imaging Systems in Ophthalmology: A Global Perspective

Ophthalmology departments face intensifying pressure to expedite sight-saving treatments and reduce the global burden of disease. The use of electronic communication systems, digital imaging, and redesigned service care models is imperative for addressing such demands. The recently developed Scottish Eyecare Integration Project involves an electronic referral system from community optometry to the hospital ophthalmology department using National Health Service (NHS) email with digital ophthalmic images attached, via a virtual private network connection. The benefits over the previous system include reduced waiting times, improved triage, e-diagnosis in 20% without the need for hospital attendance, and rapid electronic feedback to referrers. We draw on the experience of the Scottish Eyecare Integration Project and discuss the global applications of this and other advances in teleophthalmology. We focus particularly on the implications for management and screening of chronic disease, such as glaucoma and diabetic eye disease, and ophthalmic disease, such as retinopathy of prematurity where diagnosis is almost entirely and critically dependent on fundus appearance. Currently in Scotland, approximately 75% of all referrals are electronic from community to hospital. The Scottish Eyecare Integration Project is globally the first of its kind and unique in a national health service. Such speedy, safe, and efficient models of communication are geographically sensitive to service provision, especially in remote and rural regions. Along with advances in teleophthalmology, such systems promote the earlier detection of sight-threatening disease and safe follow-up of non-sight-threatening disease in the community.