EyeWorld Korea September 2020 Issue

22 EWAP SEPTEMBER 2020 SECONDARY FEATURE 표 1. 안과 진료 및 그 이상의 디지털 보건을 위한 운영 모델 * Consultation alludes to provision of medical advice and/or clinical care (e.g. diagnosis, prescription of medications, recommended surgical management). ** Tele-support alludes to the provision of medical information not amounting to clinical care (e.g. illness coping support, generic information about drug interactions, tackling misinformation) # Operational impact is presented as it relates to the need to re-orient in-person clinical services to cater to the new digital service. Digital Operational models Description of model and clinical context. Clinical applications Health system impact Operational impact # Descriptions of illustrative examples and existing research reports Triage/ Risk stratify Consultation* Telesupport**  Availability of clinical expertise  Access to care  Capacity of care & efficiency Low Middle High Out of Hospital (“Pre-Hospital”) Sorting conveyor Optimise patient flow to minimise unnecessary physical touchpoints. + + + + + + + + + – AI-based eye screening (eg IDx-DR 17 , SELENA 17,31 ) – AI-based chatbots (eg ZOC digital hospital 32 ) Hub-and-Spoke Project expertise across geographies including provider- provider support + + + + + + + + + + + + – Telehealth outreach Services (eg TECS 10 , ETHAN 34 ) – Online health community (OHC eg WebMD 35 , AskDr 36 ) Front-line settings (Outpatient clinics/ Emergency departments) Stream fishing In-person providers with spare capacity help cross-cover digital care. + + + + + + + – Single patient channel (eg ER) – Support from providers on an adhoc basis 2 (e.g. Surgeons with cancelled electives) Inflow funnel Digital care provider augmenting in-person care for overflow patients. + + + + + + + –Multiple patient channels (eg multiple primary care clinics) – Support from dedicated digital provider (eg telehealth) 37 Pyramid Single service with stacked technology such as hybrid telehealth (Synchronous- Asynchronous). + + + + + + + + + + + – “Digital first” service before in-person care (eg SAVED 41 ) – AI chat bot with referrals 40 to online/offline clinic (eg Babylon) Shuffling cards Mixed service with digital appointment- based care overlaid with on-demand. + + + + + + + + + + + + + – “Digital only” healthcare services with scheduled chronic cases & adhoc acute cases (eg SNEC VidCON 41 ) Monitoring solutions (In-/Outpatient) Catchment net Passive monitoring that is ambient or patient-led. + + + + + + + –Wearables (eg ViSi Mobile) 2 –Mobile/IoT applications (eg Alleye 43 ) Lighthouse Active monitoring that is provider- supported and/or state-led + + + + + + + + – Chronic disease apps with provider support (eg Diabeo 47 ) – State-led contact tracing 49 and Surveillance (eg travel/ exposure) 요청으로 인한 기존 진료의 중단에 대처하기가 어렵다고 생각한다. 18 업무흐름과 우선순위가 정해지지 않는다면, 이러한 중단의 연쇄적인 영향은 의료 서비스의 전반적인 지연으로 이어질 수 있다. 그러므로, 임상의, 관리자, 그리고 연구진들은 의도된 모든 혁신에 위한 이해당사자, 업무흐름, 자원 및 상황 별 요소를 포함한 운영 고려사항을 평가하는 것이 유익하다. 이는 여러 환경에서 예측하지 못한 장애물을 확인하는 데 도움이 되고, 대규모에서 채택되기 전에 이러한 장애물들을 해결할 수 있는 기회가 될 것이다. Conclusions 디지털 안과진료 모델은 안과환자의 관리에서 점점 핵심적인 역할을 하게 될 것이다. COVID-19은 더 빠르고 넒은 디지털 솔루션 채택의 필요성을 심화시켰다. 안과