Prototype app to revolutionise glaucoma treatment

Funding helps Moorfields develop OpenEyes open source electronic patient record system for opthalmology

A prototype app that will remotely collect data from glaucoma patients and send it to be viewed by specialists in another location has been developed by experts at Moorfields Eye Hospital.

OpenEyes is a collaborative, open source electronic patient record (EPR) system for ophthalmology developed by Moorfields clinicians in conjunction with Charing Systems and Black Pear Software.

Virtual clinics are a way of improving living with glaucoma by reducing patients’ need for regular travel to a central hospital and freeing up more of the consultants’ time to concentrate on treating the condition

The pilot application, designed for use with iPads, is seen as a way of enabling the running of virtual glaucoma clinics, which can potentially save patients numerous and often inconvenient trips to hospital, and will free up glaucoma specialists’ time.

Development of the solution was funded by a £75,000 award from NHS Connecting for Health‘s Interoperability Toolkit (ITK) Information Sharing Challenge Fund (ISCF).

Glaucoma is a chronic condition of the eye characterised by raised intraocular pressure and progressive damage to the optic nerve. It is one of the major causes of visual loss in the UK and involves regular examinations for patients, typically every four to six months, to ensure their treatment, usually eye drops, remains effective in preventing further loss of vision. Frequent visits to hospital for examinations can be inconvenient for patients and also means high workloads for glaucoma clinics in hospital.

The medical management of glaucoma is dependent on the monitoring of discrete and relatively small sets of clinical data, looking for changes over time and/or relative to individualised standards. For example, a patient may have a ‘target’ intraocular pressure, above which the risk of visual loss becomes much greater. Therefore, decisions about treatment can in most cases be made based on the values of those measurements. This makes the running of remote clinics possible as data can be acquired by clinical staff who are not necessarily trained to make management decisions, with the decision-making made in ‘virtual clinics’ by expert consultants.

The prototype solution uses iPads in remote community clinics to enable a Black Pear app called iRIS to capture the metrics associated with glaucoma assessments. The patient data is then messaged using ITK from the iPad to the Moorfields OpenEyes patient record system, from where a specialist consultant can diagnose glaucoma. Working closely with Charing Systems, data was collected and stored through use of openEHR archetypes. The combination of ITK and use of openEHR archetypes has proven to be an effective method for collecting and transferring clinical data.

Interoperability with OpenEyes coupled with specialist functionality on iPads will reduce administrative burden, resulting in an efficient service and an increase in capacity to see more patients

The team now hopes to develop the prototype further and set up a series of virtual clinics making use of the tablet software in peripheral centres, with decision-making being carried out by experienced consultants at Moorfields’ City Road branch.

Consultant ophthalmologist and head of the OpenEyes team at Moorfields, Bill Aylward, said: “The funding has allowed us to develop and trial this pilot and work with external partners to extend the reach of OpenEyes to other clinical areas and enable us to move closer to the internationally-accepted standard of openER, which in turn will improve the sharing and analysis of clinical data.

“Virtual clinics are a way of improving living with glaucoma by reducing patients’ need for regular travel to a central hospital and freeing up more of the consultants’ time to concentrate on treating the condition.”

Dr David Jehring, chief executive of Black Pear, added: “We are delighted to be involved in this pioneering mobile set-up, which allows us to bring glaucoma assessments closer to the patient, allowing them to rapidly gain access to the required optimal care. Interoperability with OpenEyes coupled with specialist functionality on iPads will reduce administrative burden, resulting in an efficient service and an increase in capacity to see more patients.”

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