Patient and Provider Experience in Real-Time Telemedicine Consultations for Pediatric Ophthalmology

Purpose

Telemedicine adoption hinges on positive experiences for patients and providers. We report participants’ experience from our prospective study.

Patients and Methods

Ophthalmic examinations for children 0–17 years of age were conducted by an optometrist using digital exam instruments and streamed to an ophthalmologist. The ophthalmologist, optometrist, parent, and patient (≥10 years) completed surveys capturing patient and provider experience outcomes.

Results

Three hundred forty-eight examinations were conducted with 210 patients in a hospital-based pediatric ophthalmology clinic. About 99% of parents were comfortable with exam quality, and 97% indicated they would have another telemedicine examination. Fifty-four of 55 consented for surgery during the initial telemedicine examination. Thirty-seven percent of families traveled ≥2 hours round-trip to their appointment; 1/3 of parents and patients missed a full day of work/school. Video glasses were by far the most useful instrument, while technical proficiency was most challenging with the digital indirect ophthalmoscope. Problem-focused examinations took 33 minutes of the ophthalmologist’s time on average. Equipment challenges caused delays in 40/348 (11.5%) of visits, with the majority lasting 5–10 minutes. In a few cases, a backup device was used. Despite seeing significantly fewer patients on telemedicine days, the ophthalmologist’s surgical volume increased 25%.

Conclusion

All participants were satisfied with telemedicine visits despite longer durations and learning curve. Results indicate an opportunity for telemedicine in community settings to improve access to specialized care. Telemedicine enabled the optometrist to manage or co-manage more complex patients with a pipeline to the ophthalmologist for surgical cases. In the right setting, collaborative telemedicine consultations may be beneficial to one’s practice.

Provider-to-provider synchronous telemedical consultations in ophthalmology: Advice for implementation

We previously demonstrated the non-inferiority of a synchronous (real-time) telemedicine model (compared to gold standard in-person examination) for pediatric ophthalmology consultations using a Polycom conferencing system, smart glasses, digital slit lamp, and digital indirect ophthalmoscope. Although we acknowledge there is a learning curve associated with becoming proficient with this system, we believe implementation of a synchronous telemedicine model is advantageous to both patient and provider in the right care setting. In conducting 348 such examinations over the course of our study and dozens of subsequent examinations after the implementation of our model in the community, we have gleaned many insights into optimizing the experience and efficiency. We wish to share these insights to help guide those interested in adopting such a model to expand access to specialists for underserved patients or improve efficiencies in their practice.

Reliability of telemedicine for real-time paediatric ophthalmology consultations

Background/aims

To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions.

Methods

Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies.

Results

210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%).

Conclusion

Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.