Expansion of the Northern Ireland Electronic Care Record sees improvement in eye care in Northern Ireland

Orion Health is pleased to announce the successful expansion of the user base of the Northern Ireland Electronic Care Record (NIECR) to include community optometrists. For the first time, optometrists can obtain access to relevant aspects of a patient’s electronic care record, including medications that they have been prescribed, for the benefit of patient care.

This access brings a much more joined up approach to eye care in Northern Ireland with optometrists now having sight of underlying health issues a patient may have which could have an impact and direct relevance for their eye care, for example in diabetes care. In addition an optometrist can access information about attendance at ophthalmology and other eye services in secondary care facilitating continuity of care and ultimately supporting optometrists in their clinical decision making. Similarly, if an optometrist identifies something during an eye examination which they believe requires further investigation, they can make an immediate electronic referral through the Clinical Communications Gateway (CCG) which is visible within the NIECR. CCG enables direct and enhanced referrals to be made and with further planned developments, electronic triage of these referrals through NIECR will increase efficiency in triage and management, ensuring the patient is placed on the correct clinical pathway in a timely manner which should positively affect outcomes.

“The expansion of the NIECR further into the community to include optometrists demonstrates what can be achieved when projects think outside the box to include actors not traditionally included in shared care record projects,” commented Nick Willox, sales director for Orion Health. “We are delighted to have been part of this project in Northern Ireland and are looking forward to welcoming more user cohorts to the NIECR, for example dentists and medical students, in the future.”

Until they were brought into the fold of the NIECR, optometrists had to rely on patients remembering everything about their eye care with the result that important details were often forgotten about. They now have the ability to log on to the secure NIECR portal and view a specific subset of a patient’s electronic care record that is relevant to their eyecare, including any medications they may be taking. This insight is particularly useful when considering medications which could be causing side effects for a patient’s vision. In addition, the optometrist can avoid unknowingly recommending or prescribing medication which could affect another condition which the patient is suffering from. The ability of optometrists and all medical professionals involved in a patient’s care to make more informed decisions based on a holistic view of their electronic care record supports and enables patient-centred care.

Through the Clinical Communications Gateway and NIECR, optometrists are now able to make an electronic patient referral directly to a dedicated clinical pathway whilst the patient is sitting in front of them. This greatly improves the speed of referral for patients and, in addition, because the GP is no longer required to undertake the process of referral this will save valuable GP time. Consultants in secondary care can view the referral through the NIECR with the supporting images and scans which an optometrist can upload with the referral, for example retinal images and OCT scans; this means that ophthalmologists can now access excellent clinical information to assist in triage and management of the referral, a real and meaningful benefit for patients.

“Through access to the NIECR, for the first time optometrists can access all relevant aspects of a patient’s electronic care record”, said Stephen Beattie, BSO, “This insight is already helping to improve the level of care which patients receive and ensure that more informed decisions can be made by all of the health care professionals involved in a patient’s care."

Of course strict protocols are in place, such as two-factor authentication, to avoid unauthorised or unnecessarily detailed access to a patient’s record. Having access to only a filtered view of a patient’s electronic care record via a role-based access model has also been designed to build trust and put patients at ease that their optometrist can only view the appropriate information.

At this point more than 60% of the 271 optometry contractor practices across Northern Ireland have access to the NIECR with more and more being added every day. Usage is strong and growing, with over 1,000 log ins from optometrists in June 2019. Early feedback from users is positive.

Margaret McMullan, Optometric Clinical Adviser at the Health and Social Care Board commented that the policy driver “Health and Wellbeing 2026: Delivering Together” has facilitated work to improve integration primary and secondary care and access to NIECR for community optometrists is a perfect example of the dividend that the work on implementing “Delivering Together” has generated. Margaret has received a wealth of positive feedback about access to NIECR for optometrists with a locum optometrist commenting; “I was working one Saturday in a practice as a locum and met and examined an elderly lady .She mentioned that she had stopped taking her eye drops as she felt she didn’t need them anymore. When I examined her, I found that her eye pressure was very high. With access to NIECR, I was able to quickly and easily see that she was on drops for treatment of Ocular Hypertension and I was also able to quickly follow up with her family, and her GP, so that they could reinstate the drops and track her adherence. Without access, particularly as a locum, this would have been a lengthy undertaking and would not have been a simple process, leaving the elderly lady at risk of damage to her eyes and potential sight loss. Having access to the NIECR made me feel more informed and connected to the HSC system, ultimately benefiting me and my patient in the care provided”.

It is envisaged that the further access to optometrists who have not yet availed of access to NIECR will continue through 2019. There are also plans to enhance the information available to optometrists through the NIECR, including adding an interface with various management systems used by ophthalmology sub-specialties e.g. the macular service and providing access to the diabetes screening report from the Northern Ireland Diabetic Eye Screening Programme (NI DESP). A care pathway for cataracts is also on the roadmap, to enhance multi-disciplinary team working across care settings around patients with the condition.

Gavin Corrigan, optometrist at Corrigan Opticians in Cookstown concluded, “It’s brilliant to have access to patient information through NIECR. I can follow a patient’s journey through the hospital eye service from my initial referral though to any appointments and procedures they have carried out. This allows me a more informed and patient centric approach to my decision making.”

Watch the videos below to learn more about the benefits to both the health and care service and to patient care.

Gavin Corrigan, Optometrist, Corrigan Opticians

Stephen Beattie, eHealth Programme Manager, Business Services Organisation

Margaret McMullan, Clinical Optometric Advisor, Health and Social Care Northern Ireland

Nick Willox, Sales Director, Orion Health