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Y. Dsouza, A. Tufail; The Role of Telemedicine in Improving the Referral Service for Consideration of Treatment for Age Related Macular Degeneration (ARMD) in a Tertiary Referral Centre. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5097.
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An audit at Moorfields Eye Hospital (MEH) identified a mean delay of 4 weeks between primary presentation to an ophthalmic provider and their subsequent attendance at MEH. A significant factor in this time lag was secondary to manual processing of referrals. The delay resulted in some patients losing more than 3 lines of vision (ETDRS), which rendered them ineligible for treatment. We sought to investigate if electronic patient image referrals would reduce this delay
A customized software package (Digital Healthcare Ltd, Cambridge, UK) was created for referring patients from multiple referral centres to MEH using web based technology. This provided the referral centres the opportunity to securely upload onto the web based solution the encrypted referral packages holding patient demographics in a template and associated images. All colour fundus photographs and the complete fluorescein run are able to be transmitted. These packages were then safely submitted from the networked computer attached to the fluorescein camera to a dedicated web server at MEH. The central site (MEH) then had the ability to import and unpack each package into the telemedicine software programme. Arrival of a referral package at MEH triggered an email to the referring centre confirming receipt of the images and referral information. Information packages were placed in queues in workflow software which is reviewed daily. As the patient passed through the system the software package triggered the appropriate letter according to the plan of management. This process terminated once the patient had been accepted or rejected by MEH. The time taken for the images to be reviewed, acted on and the patient treated were recorded in the software and are being audited
The beta version of the software fulfils the design specifications of being able to package the complete fluorescein run and colour images from the main camera manufacturers. The software meets the required NHS security standards. Images are able to be acquired by the PDT treating centre (MEH) the same day as taken in the local referring centre.
until the advent of this system there was a mean delay of 4 weeks to be seen at the treating centre. This system allows the treating centre to review images obtained at remote offices the same day.
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