Hi Kaweh,
You are the founder and medical director of the Artemis Clinic Group, Germany. You are a practicing ophthalmologist and eye surgeon yourself. Recently, you opened the first digital ophthalmology practice in Germany. What were your reasons for doing so?
In a rather rural town the only ophthalmology practice closed due to retirement of the colleague and despite an intensive search for a successor for over 7 years this was not successful. So we decided to try a different approach.
Can you tell us about the typical process in your new practice?
Patients come to premises which we share with a local GP who uses the rooms for educating his diabetic patients. One extra room is equipped with all the ophthalmology devices and the waiting area etc. is shared. Patients need to sign an informed consent form about the fact that no doctor is physically present. After filling in a structured medical history form an experienced technician performs the different examinations such as visual acuity, autorefraction, NCT, non-mydriatic fundus photo, OCT etc. The results are transferred via a special software to an ophthalmologist of our group who sends a written report to the patient (or in urgent cases calls the patient)
So the examinations are performed semi-automatically by a medical assistant, then transferred to a computer system and analyzed centrally. After what time can you then provide patients with your diagnosis and advice?
We try to get back to the patient within 36 to 48 hours depending on the case
In my experience, a thorough patient history is often important, for example, to separate emergencies from less urgently ill patients. How do you solve this problem?
We have a list of triage questions to sort out patients when they call for an appointment in the first place as obviously not all issues can be handled in such a setiing. Patients with no urgent problems do fill an anamnesis form that is also transmitted to the reading doctor.
How are patients taking to the service? Do you miss the personal doctor-patient contact?
Patients so far seem to be very happy about this service as the next ophthalmology practice is at least 45 minutes away. And often they do not have many slots for new patients. Certainly patients (and we) would prefer a personal interaction but this is a lot better than no possibility at all.
In Germany, but also worldwide, we see an increasing shortage of doctors, especially in ophthalmology. What do you think - is this the model of the future to counter long waiting times and especially underuse in rural regions?
Especially for chronic and not very urgent issues I am sure that this is a solution for areas young doctors do not want to work and live in.
In order to be able to meet the growing demand in the light of fewer doctor hours we should reconsider the workflow in traditional practices as well in order to free appointments for new patients.
When you think about the equipment in your digital practice, what's your favorite device? What is absolutely necessary, what can you do without for the time being?
We have to do without equipment that needs invasive steps like mydriasis or even fluorescein angiography. Non-mydriatic funduscameras and OCT are invaluable devices.
Do you rely on established devices or do you also use new technology from start-ups, for example?
For the time being we rely mostly on established devices but we closely monitor new developments.
Let's take a look into the future. What do you think is missing to be able to run a completely automated ophthalmology practice?
In my view the only really missing link is the human factor, the “doctor drug”. It can be mitigated a bit by video calls with the patient in complex cases.
Links:
