Ophthalmologists are not surprised at the ongoing difficulties the District Health Boards (DHBs) are having with timely ophthalmology follow-up appointments. ‘Fight the queue’ has always been a challenge for all eye clinic workers, made worse by the advent of anti-VEGF treatments, which have massively increased clinic work. Government directives that departments would be penalized if they did not see new patients within defined time intervals forced administrators to bounce follow-up appointments in favour of first specialist assessments, creating a now well-known backlog of unserviceable follow-up loads, and a forced ‘denial of care’ for many distressing eye conditions.
This is now hopefully being addressed. But, in my view, the state of our medical records remains a serious impediment to improving care and efficiencies in our DHB clinics. Apart from ‘contracting’ clinics, DHB clinics are still creating paper notes in manila folders. For some, the number of folders and paper within them has accumulated to such a degree that retrieving one nugget of relevant patient information is often not practicable given the time constraints of a typical clinical interview. To try and bring some order to this, some DHBs insert a piece of paper into the patient’s folder with different ‘boxes’ printed on it, to be filled in by hand each time a patient attends a clinic. This is truly expensive in paper space and doesn’t solve the underlying problem; in fact, it exacerbates it.
A debilitating inability to access today’s screening tools
In most DHBs, there are also no ‘on-screen’ electronic representations of images or reports from today’s all-important assessment devices which are now used routinely to help diagnose and monitor our patients. Often these can only be retrieved by going to the device directly and browsing manually, or sorting through paper in overloaded manila folders!
This lamentable hybrid mix of paper and up to five ‘online’ programmes, which do not interoperate, is a great hindrance to the practice of efficient ophthalmology in DHB public clinics. Contracting clinics mostly use modern electronic health record (EHR) and practice management systems and, unsurprisingly, don’t have a floating population of un-dedicated follow-up appointments and the, well-publicized, morbidity which results.
