Enabling teleophthalmology during the COVID-19 pandemic in the Province of Trento, Italy: Design and implementation of a mHealth solution

Abstract

Background Due to the many restrictions imposed during the COVID-19 emergency, the normal clinical activities have been stopped abruptly in view of limiting the circulation of the virus. The extraordinary containment measures have had a dramatic impact on the undertaking and follow-up of ophthalmic outpatients. Objective In order to guarantee proper monitoring and routine care, the Pediatric Ophthalmology equipe of Rovereto Hospital (North-East of Italy) supported by the Competence Center on Digital Health TrentinoSalute4.0, designed and implemented a digital platform, TreC Oculistica, enabling teleophthalmology. We report our innovative—albeit restricted—experience aiming at testing and maximizing the efficacy of remote ophthalmic and orthoptic visits. Methods A multidisciplinary team created the TreC Oculistica platform and defined a teleophthalmology protocol. The system consists of a clinician web interface and a patient mobile application. Clinicians can prescribe outpatients with the App and some preliminary measurements to be self-collected before the televisit. The App conveys the clinician’s requests (i.e. measurements) and eases the share of the collected information in a secure digital environment, promoting a new health care workflow. Results Four clinicians took part in the testing phase (2 ophthalmologists and 2 orthoptists) and recruited 37 patients (mostly pediatric) in 3 months. Thanks to a continuous feedback between the testing and the technical implementation, it has been possible to identify pros and cons of the implemented functionalities, considering possible improvements. Digital solutions such as TreC Oculistica advance the digitalization of the Italian health care system, promoting a structured and effective reorganization of the workload supported by digital systems. Conclusions The study tested an innovative digital solution in the teleophthalmology context and represented the first experience within the Italian healthcare system. This solution opens up new possibilities and scenarios that can be effective not only during the pandemic, but also in the traditional management of public health services.

The Prevalence of Teleophthalmology in the Piedmont Region of Italy: Current Situation and Future Perspectives

“…In the ophthalmology department of Rovereto (Trento), one program began during the pandemic, aimed mainly at the pediatric area, using a smartphone application called “TreC Oculistica”. The program focuses on screening and follow-up, while first visits accounted for about 3% of the total number of services provided [ 11 ].…”

Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care

“…In many places, the need to minimize the risk of exposure to infection transformed the usual clinical practices. Eye visits were split into two encounters: patients had pre-ordered tests performed onsite followed by an online encounter with specialists, giving rise to the name “hybrid visit” or “split visit” [ 35 ]. This new visit type allowed fewer touch points for the patient and provider and had additional benefits in educating the patient through easy sharing of test results and informational resources in the virtual wrap-up as depicted in Fig.…”

“…Using a hybrid model, a patient-centered app coupled with the provider’s EMR allowed for time management during the pandemic. [ 35 ]. In India, multiple video communication platforms were used to reach patients and transfer clinical data from their eyeSmart EMR to their phones.…”

Effect of COVID-19 Lockdowns on Eye Emergency Department, Increasing Prevalence of Uveitis and Optic Neuritis in the COVID-19 Era

“…Prior to COVID-19 pandemic retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration were the mainstay of remotely controlled disorders in ophthalmology [ 13 , 14 , 15 ]. However, both the range of telemedicine tools (programs, devices) and the number of centers and doctors engaged in tele-visits, contributed to its development and providing care to patients with a broader spectrum of ocular disorders [ 16 , 17 , 18 ]. Nevertheless, some of the ocular disorders might not be properly diagnosed virtually, retina and choroid inflammations being the typical examples [ 12 , 17 , 19 ].…”