Award Title: Dem Dx Triage Support Platform for Ophthalmology Referrals
Funder: Department of Health and Social Care

Abstract: Background   A steady increase in the use of Ophthalmology services over the past 2 decades combined with a forecasted shortfall of trained ophthalmologists, make the optimisation of patient triage vital if delivery of care is to be maintained or improved.  No globally recognised triaging system for Ophthalmic emergencies yet exists and physician-defined risk stratification is currently considered as gold standard care.      Aims and objectives   This project aims to train and test machine learning algorithms on Dem Dx s novel Triage Platform and assess how well it supports allied healthcare professionals (AHPs) to perform triage and improve operational efficiency in the Ophthalmology Emergency Department.      Methods and timeline for delivery   The 24-month project divides broadly in three stages and includes:   Stage 1:  train and test  period for the Triage Platform s ML algorithms using live Electronic Medical Record data from Moorfields Eye Hospital combined with SNOMED CT data input by the triage consultant in Dem Dx.   Stage 2:  assessment of the Triage Platform s ML algorithms performance, safety and usability when applied by inexperienced healthcare providers in simulated scenarios derived from real cases.   Stage 3: multi-centre, prospective, quasi-experimental study to evaluate the accuracy and clinical effectiveness of the triage platform s AI algorithms      Anticipated impact and dissemination   It is expected that the Dem Dx Triage Platform will increase the efficiency and safety of triage performed by nurses and allied healthcare professionals in ophthalmology services and improve the patient experience by reducing wait and consultation times. The product is also likely to reduce the number of inappropriate referrals to Ophthalmology and promote better integration with tertiary care.

Lay Abstract: Ophthalmology (the treatment of eye diseases) is the National Health Service s busiest outpatient service, with 7.5 million attendances each year. Currently, two million people in the United Kingdom live with some form of visual impairment and 250 start to lose their sight each day. Two-thirds of eye appointments are for diseases which only occur in the elderly. The Royal College of Ophthalmologists expects a 22% increase of these conditions by 2025 and their work with The Royal College of General Practitioners has shown that 52% of all referrals to specialist eye services are unnecessary.   Overall, this means that whilst spending on eye health has almost doubled in the last ten years to £2.3 billion, hospital eye services are struggling with 1 in 8 patients waiting longer than 18 weeks to be seen.  Ideally, growing demand for eye care would be met by increasing the number of eye doctors available.  However, a recent survey suggests that, in the short term, medical schools were unlikely to be able to provide sufficient new eye doctors to address the current shortfall.   Another way of meeting the demand for eye care would be to improve what is known as triage.  This is the process by which doctors decide what level of risk a patient s symptoms represent e.g. is this a simple cold or is it a more serious illness like cancer?  It is based on a series of judgements made at the time that a patient arrives at a healthcare facility such as a hospital Accident and Emergency department or a GP practice and the outcome of these judgements affect what diagnosis a patient is given, what treatments they are offered and where that care takes place.  Research suggests that you can improve the accuracy and speed of this triage process by using  computerised Artificial Intelligence software .  This project, bringing together a commercial digital health company, DemDx, and Moorfields Hospital (England s leading eye hospital), will develop and test a new technology called Triage Platform to see if it can gather and process information about patients  symptoms well enough to support less specialist healthcare staff such as nurses make accurate and safe triage decisions and deal with many of the most common eye problems.  This will free-up specialist doctor time for the most urgent or complicated cases.  If successful, the Triage Platform could save the NHS between £38-£42million each year and help 350,000-540,000 (mostly elderly) patients gain better access to eye treatment wherever they live, including shorter waiting times to see an eye specialist when that is what they need.

Research Activity Codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES;7.3 MANAGEMENT AND DECISION MAKING
Health Categories: EYE