Our results show that organization of ophthalmology care in Tuzla canton does not use IT sufficiently. IT and computers provide faster communication, easy access to medical information, and patient satisfaction. Ophthalmology like any other part of medicine has its unique features that need to be taken into count when creating an information system. Basic ophthalmologic examinations such as slit lamp examination, keratometry, ultrasonography, fundus camera, ocular coherent tomography can be digitalized. The quality of the images captured, and hence the diagnosis, are influenced by the skills of the clinician viewing the eye and the technology used (12
). Currently in Tuzla canton none of numerous advantages of image digitalization are used. IT and computers have several other applications in clinical practice as shown in Table ).
Table 1 Computer applications in clinical practice (Adopted from Rayev (6))
Table . shows that computers and computer software can be used in front office management for providing appointment lists and planning of patient waiting time, easy cancellation and rescheduling and enables follow-up of patients who do not show up for appointments. All data can be collected and have information’s about the number and type of performed procedures, number of patients and frequency of follow-up. This information’s can be used for reorganization and improvement of work process. Ophthalmology health care in Tuzla canton does not use any of mentioned advantages and benefits, all appointments are made manually and follow up is often compromised by absence of medical documents.
Back office management includes accounts, price of materials, inventory and payroll. Most of these functions are not integrated in ophthalmologic practice and belong to the system of medical institution and Ministry of health. This system provides the funding by capitation with no practical use of Diagnosis related group systems (DRG) in accounting and payment for medical services.
Clinical data management includes collection, storage, and retrieval of clinical data including patient details and the entire medical record. The field of ophthalmology has a number of unique features compared with other medical and surgical specialties regarding clinical workflow and data management (14
). This has important implications for the design of EHR systems that can be used intuitively and efficiently by ophthalmologists and that can promote improved quality of care (14
). Computer technology has matured to a point at which the graphical demands of the ophthalmology electronic medical record can be satisfied (15
). University clinic does not possess system for storage and digitalization of images. All records are saved in paper form in patient histories and protocols.
A computerized record system provides simple access to patient information and images. Data can be retrieved and reported faster and these data take up less space and increase patient satisfaction (6
). Advantages found over paper record systems include savings in staff, time, paper storage and the ability to access records and clinical images from multiple locations, including mobile devices (16
). Electronic medical (health) records should be standardized to provide more thorough analysis of patients’ diagnosis, therapy, diagnostic procedures, complication rate (20
). This can improve the quality of service and provide important data for the management that can be used in planning and management. The use of an electronic patient record system in ophthalmology is already possible, but still needs further tuning and improvement (23
). In Tuzla canton some steps are made for implementation of EHR but no funding and education is provided by the competent authorities of the government (11
Electronic health record can be used with mathematical algorithm based on epidemiological data on risk factors for screening of several ophthalmic diseases such as diabetic retinopathy. Information technology based on epidemiological data may facilitate individualized determination of screening intervals for diabetic eye disease and reduce number of visits up to 60% (24
). Similar efforts are being made with set-up of glaucoma electronic patient record which proved to be successful in distinguishing highrisk glaucoma referrals (25
). These possibilities have not been used in our practice yet.
IT technologies provide vast possibilities for creating patient information brochures and academic presentations. In countries where EHR is already implemented and available online on the Internet, most patients found the computer technology acceptable. The majority found viewing their electronic health record useful and understood most of the content, although medical terms and abbreviations required explanation (26
). Some efforts have been made in order to achieve better patient awareness but there is still long way to go. For patient education and information brochures that explain common ophthalmic problems such as cataract and retinal detachment are created and distributed to local communities.
One of biggest advantages of IT is use of email and Internet. E-mail represents one of basic application of Internet which allows user to exchange information’s with other users anywhere in the world. There are many discussion groups that can be found on the Internet which communicate through e-mail and can allow exchange text and multimedia messages. Ophthalmologists from around the world can consult each other by subscribing to a mailing list (6
). Using the Internet there can be found many web sites that can include case discussions, grand rounds, news, activities, abstracts of meetings and journals, full articles of journals that are already in print (paid access), outcomes data, clinical alerts, patient handouts, slides of interesting cases and public information material about eye care (6
Telemedicine is the assessment and review of patient information (history, examination, or investigations) by a health professional who is separated temporally and/or spatially from the patient (27
). Teleconferencing (videoconferencing) and telemedicine will be increasingly used in the coming years. Ophthalmologists can sit at computers in their own clinic and conduct discussions by exchanging messages/images through the local network, Internet, or telephone lines (6
). Clinical images can be electronically transferred over long distances for expert or second opinion saving money, time and energy (29
Information technology can be used as support in the area of education (31
). Development of modern technology and the Internet has enabled the explosive growth of distance learning (32
). IT and tele-ophthalmology applications comprise both clinical and educational processes between the send and receive sites (6
). These can include: screening of a disease, formulation of a diagnosis and clinical management plan, secondary advice and support in clinical management plan, peer supervision and support, professional development through group discussion, lectures, and tutorials and, research and administration activities (6
Special part of IT application in ophthalmology is use of smartphones in ophthalmology. Today’s smartphones are multifunctional electronic devices that can be used to perform photography, video, Internet browsing, data sharing, listening to music, and watching movies. There is applicability in virtually every part of the ophthalmologic examination (34