Faced with the increasing burden that medico-legal and privacy issues place on practitioners, it is important to make sure the systems you have in place meet or exceed the standards of care. Oculo, an Australian designed secure communications platform for eye health professionals backed by the Centre for Eye Research Australia, greatly enhances this process.
Oculo is the result of a collaboration between Professor Jonathan Crowston and Dr. Kate Taylor, two like-minded Australian eye health professionals who are equally passionate about enhancing collaborative, patient care.
At a meeting in November 2014, they had a discussion concerning referrals and the many issues surrounding this complex area of eye care and had determined to make a difference.
Just two years on Oculo is on the market, a safe, secure, encrypted cloud-based clinical communications platform that provides integrated privacy of patient information with shared history, referrals and a library of images. Oculo is already connecting over 900 optometrists and 360 ophthalmologists in Australia and with Dr. Taylor at the helm, it continues to develop and evolve offering greater integration with existing systems as needs grow and technology allows.
Today it provides integrated privacy of patient information with shared history, referrals and a library of images
The Challenge of Referrals
One of the challenges Prof. Crowston and Dr. Taylor wanted to overcome was the challenge of overseeing referrals. On the face of it, it seems that banging out a referral letter is a relatively easy process. However, once actioned it is often forgotten.
Prof. Crowston had noted that referral letters were often not acted on which meant patients did not see a specialist. With no systems in place to track these occurrences, the consequences were potentially vision threatening. He also noted issues with continuity of care and the inability to access previous referral letters, recommended treatments and outcomes. This was especially so with patients who had moved or been seen by multiple practitioners, in a variety of settings.
Almost half of all the people with glaucoma are not diagnosed. Additionally, half of those who have been diagnosed and prescribed therapy, are not using it appropriately. Furthermore, around 40 per cent of patients referred between eye care professionals are lost to follow up.
Privacy issues in Australia (and many other countries) were another challenge. Transmission of patient data (e.g. referral letters) via unencrypted email is forbidden, although paradoxically a simple letter or fax transmission, although not exactly secure, is approved. This is really a legacy issue and most agree it needs to change. That said, the law is the law and as health care professionals we need to abide by the laws, best practice and clinical and ethical guidelines.
Considering the gap in the continuity of care and the explosion of technologies for the diagnosis and management of eye care, Prof. Crowston wanted to find a better way for ophthalmology and optometry to communicate.
Dr. Kate Taylor helped him think it through. She had learned the importance of eye care through observing the work of her father Prof. Hugh Taylor and Prof. Fred Hollows as they crisscrossed Australia on the National Trachoma and Eye Health Programme in the 1970s. She followed in his footsteps, training as an ophthalmologist. Alas she developed a life-threatening allergy to latex surgical gloves and had to leave clinical medicine.
Gaining invaluable experience with the internationally renowned group McKinsey and Company, as a business management consultant, she then moved overseas to work in global health, specifically looking at the intersection between business and health. Galvanised and motivated by the Bill and Melinda Gates Foundation, Dr. Taylor worked on many of the innovative public-private partnerships financing and delivering programmes on HIV, TB, malaria and vaccine-preventable diseases.
Together, she and Prof. Crowston discussed the challenges of delivering effective eye health in Australia, came up with some conclusions and formulated their ideas. Then they decided to create an online platform that would radically improve the referral process and clinical communication between optometrists and ophthalmologists. Oculo was founded.
Much More Than a Letter
Oculo’s initial mandate sounded simple enough: Dr. Crowston sought to create a communication system that was ‘better than a letter.’ The organisation proceeded to grow out of the Centre for Eye Research Australia (CERA) with an aim to promote the efficiency and quality of clinical communications by supporting collaboration. The ultimate goal was, and continues to be, to help deliver the best possible care so that patients may enjoy the best possible sight.
Like any successful venture, beyond the need for passionate people with big ideas, is having the wherewithal to make it happen. Although Oculo had the backing of CERA as its major investor, the company needed additional seed capital.
Peter Gunn, a logistics entrepreneur and angel investor, has been instrumental in this regard.
His involvement with the evolution of Oculo did not come via your typical business introduction. Rather, it came about as the result of a New Year’s Day wander past The Royal Victorian Eye and Ear Hospital in Melbourne. Having observed his failing hearing, Mr. Gunn decided to pop in to the hospital to find out what was going on. A member of staff examined him and, to his surprise, detected a brain tumour. Mr. Gunn was subsequently operated on and emerged with a newfound recognition and appreciation of how important one’s senses are and a desire to ‘give back’ for the help he’d received.
When approached about the idea of creating a way to improve continuity of care, Mr. Gunn said he “immediately got it”.
“I was already aware of work done by the Eye and Ear Hospital and my experience made me really appreciate just how important sight and sound are to us. Several years ago I worked with Kate and accordingly, she presented the idea of Oculo to me. It appealed to me as a chance to give back,” he explained.
“Investing in innovation fundamentally appeals to me. While most of my working life has been spent in ‘old economy’ industries like trucking, I believe that much of the future for Australia lies in specialising in what I would call ‘Smart Australia’. We have so much talent. We should invest to help talented people build better, smarter ways of doing things. I like that about Oculo and the Oculo team.”
Oculo has evolved from a concept initiated by Prof. Crowston and Dr. Taylor into a strong team of 10. Alex Young was Dr. Taylor’s first recruit. He came from Medibank Private’s internal technology incubator and brought deep, start-up experience, correctly emphasising that software needs to be client-focused.
Consultant James Wolstenholme wrote Oculo’s first line of code. Having considered a career as a doctor, he recognised the value of the process and fell in love with the vision that a software platform could so enhance patient outcomes. He joined the company and now leads Oculo’s software team.
Leeza Williams was next to join, bringing with her decades of optometry industry experience. As the General Manager of ProVision in the mid-1990s, she established the first refractive-laser collaborative clinic between optometrists and ophthalmologists. Ms. Williams has also held the role of marketing manager for the largest independent group of optometrists in New Zealand and, more recently, worked with Essilor on marketing and education and with France Medical on dry eye laser therapy.
Oculo initially reached out to create an optometry working group that included OPSM, Specsavers and Bupa Optical, with input from ophthalmologists affiliated with CERA and the Royal Victorian Eye and Ear Hospital. Oculo also commissioned multiple independent legal and data security reviews to inform software development.
A trial began in June 2015 in Melbourne and was later extended to Sydney and the ACT. By early 2017, Oculo has attracted around 1,260 eye care professionals to the platform in Australia and has plans in place to roll out in New Zealand during the year.
Additionally, Oculo is working on integrating its platform with existing practice management platforms – a factor that is critical from a practitioners’ point of view. Oculo’s first optometry integration, with Optomate Touch went live in March 2017.
Other features are forthcoming, including professional profiles to provide practitioners with the ability to promote their practice and specialties to their colleagues and the public.
Dr. Taylor and Professor Crowston are excited by their rapid progress and success… and why wouldn’t they be, from what we’re seeing, this is a real collaboration between ophthalmology and optometry, and it’s here for the long term.
Oculo at the Coalface
I downloaded and trialled the Oculo platform to provide an evaluation for readers.
It was an effortless, seamless and near instantaneous download and install, unlike so many company websites, loyalty schemes and the like that seem fraught with bugs and issues (there’s nothing that puts you off a company more than poor initial and ongoing experiences necessitating endless emails and calls to helplines).
The experience with Oculo was transparent and a pleasant surprise. After the easy install we tested a simulated referrer and created a mock up referral letter. Finding or creating the patient file was easy, as was selecting the desired referee. Viewing previous letters attached to a specific patient was also a doddle.
Critically, one is able to confirm delivery of the referral letter and in the event that the referral is not actioned the Oculo system lets you know that further action and follow up is required, potentially avoiding life or sight threatening consequences.
Overall the web interface was clean and tidy with plenty of white space. Intuitive menus, drop down selections and options make life easy for busy practitioners. Even a novice can be up and running in a matter of minutes.
I look forward to seeing how Oculo evolves in time.
The opinions expressed here are those of Alan Saks, optometrist, and not necessarily those of