The eHealth readiness of Australia's medical specialists - Final Report

Ophthalmology and dermatology

Page last updated: 30 May 2011

General overview - Ophthalmology

Overview of group

Description of specialtyOphthalmology is the branch of medicine that deals with the anatomy, functions, pathology, and treatment of the eye.

Ophthalmologists practice under the following sub-specialties: cornea and external disease, glaucoma, neuro-ophthalmology, ophthalmic pathology, ocular inflammation, oculo-plastics, orbital surgery, paediatric ophthalmology, vitreoretinal disease, and developing world ophthalmology.

NumberApproximately 800 registered practicing ophthalmologists.26
Gender mix18% female, 82% male.

General overview - Dermatology

Description of specialtyDermatologists are qualified medical specialists who, through additional training, have obtained postgraduate qualifications to specialise in the diagnosis, treatment and prevention of skin, nail and hair diseases and skin cancers. Dermatologists practice under the following sub-specialties: pigmentation disorders, systemic diseases, skin cancer and skin tumours, pupuras and vascular disorders, inflammatory dermatoses, disorders of keratinization, psoriasis, lymphocytic and blood element disorders.
NumberJust under 400 registered practising dermatologists.27
Gender mix35% female, 65% male.

Ophthalmologists/Dermatologists and eHealth

Examples of relevant eHealth applications

Some example uses of eHealth that ophthalmologists and dermatologists currently or possibly could benefit from include:
  • Telehealth applications are growing in acceptance in dermatology due to the urbanised nature of the specialty and the need to prevent unnecessary travel for rural patients – there are a large number of dermatology conditions that can be completely managed using telehealth to communicate with the GP, so long as photos and biopsies are taken correctly at the rural end of the transaction. It is unclear how these processes should best be remunerated under Medicare, and it does not necessarily result in less work for the GP, who now must assume responsibility for the patient rather than simply writing a referral.
  • The introduction of health identifiers could potentially greatly reduce errors in the processing of biopsy specimens
  • Ophthalmologists are interested in the introduction of systems that ease reporting requirements and data entry into registries and that reduce red tape.

Current eHealth ‘position’

  • The ACD generally reports a high level of eHealth readiness in its fellows due to the nature of the specialty easily enabling transfer of records (which consist largely of photos and associated disease categories) into an electronic format. Some of the more senior practitioners are still resistant to computer use, but even this group uses practice management software and the associated tools
  • An Australia-wide teledermatology program is run by the Australian College of Rural and Remote Medicine where rural doctors can email patient histories and a set of photographs to a secure website supported by a dermatologist in South Brisbane who make a diagnosis and send educational materials and a treatment plans back to the GP. Significant savings on patient travel and public-sector wait times, but increases GP workload beyond a simple referral
  • In ophthalmology, many fellows are quite technologically savvy although this does tend to be the younger ones with the older ones still resistant. Almost 100 percent use smartphones in their practice and for personal use
  • Most ophthalmology practices are computerised in terms of practice management, but uptake of clinical records management has been very patchy due to lack of suitable systems for specialist use – almost all are in private practice, still many on their own. There are some evangelists who have gone completely paperless but the majority have yet to follow suit
  • The RACO provides online exams and training, and trainees are required to keep their surgical logbooks online. Numerous online surveys have been undertaken with ophthalmologists previously and the responses have been reasonably good
  • There are varied views amongst the RACO Fellows re eHealth – government initiatives tend to be met with suspicion and a fear of change. There are also fears about privacy and confidentiality in the community to contend with.

Any new system for ophthalmologists will need to start simple and have an easy-to-use interface. An emphasis in quality and safety as occurs in the public hospital system will make adoption easier for them.

Key insights from eHealth readiness survey

  • Ophthalmologists and dermatologists are generally average eHealth users, with the following exceptions:
    • They are more likely to use computerised practice management (78 percent use computers for booking and scheduling and 83 percent use computers for billing and patient rebates)
    • They are above-average users of electronic ordering for pathology tests (30 percent currently use computer to order pathology tests)
    • They are more likely to use computers during consultations. 49 percent use computers to show patients information during a consultation and 47 percent use computers to view or record patient information during consultations
    • They are less likely to view pathology results online (46 percent versus 62 percent of all medical specialists), view diagnostic imaging results online (16 percent versus 53 percent of all specialists), and to complete event summaries/ specialist’s letters on computers (20 percent versus 33 percent of all medical specialists)
  • Relative to other specialists, ophthalmologists and dermatologists are less likely to agree that most practitioners in their network use computers (43 percent strongly agree) and that they are expected to use computers in their specialty (31 percent strongly agree). Just 14 percent like to be early adopters of new computer systems, versus 28 percent of all medical specialists. Ophthalmologists and dermatologists are also less interested in access to a shared patient summary (27 percent strongly agree versus 51 percent of all medical specialists). These specialists typically operate in a more standalone manner as compared with other specialists and perceive less value in accessing past histories for their patients because they are less likely to uncover relevant information
  • Perceptions of eHealth benefits for ophthalmologists and dermatologists range from average to below average as compared with all medical specialists. They are especially less likely to agree that eHealth improves continuity of care (27 percent strongly agree), improves quality of care (20 percent strongly agree), improves the care delivery process (20 percent strongly agree), and increases patient safety (18 percent strongly agree)
  • Compared with other specialists, ophthalmologists and dermatologists are especially concerned about system malfunctions or downtime (47 percent strongly agree this is a barrier to adoption). They are also more likely to agree that it is too difficult to select and implement a new system (26 percent strongly agree, versus 12 percent of all medical specialists). Perceptions of the remaining barriers are relatively consistent with the average across all specialists
  • As compared with other specialists, ophthalmologists and dermatologists are more motivated by financial incentives (34 percent strongly agree and 31 percent somewhat agree that financial incentives will have an influence on their adoption of eHealth solutions). After financial incentives, professional bodies were second most popular adoption driver (13 percent strongly agree, 58 percent somewhat agree).

Characteristics and practice attributes

General workforce trends

Both ophthalmology and dermatology are specialties dominated by private practice and where undertaking multiple minor procedures is the norm. As such they can be highly lucrative and create far fewer lifestyle pressures than some other medical specialties. This means that entry into these professions can be very competitive leading to perceptions of a shortage in training positions. Like other specialties, they are highly concentrated in urban areas, although in ophthalmology, ‘fly-in, fly-out’ services to indigenous communities are commonly provided by State Governments and the charitable sector.

A high-level practice profile of survey respondents suggests:
  • These are procedural specialties characterised by high patient throughput (>60 percent see more than 25 patients/day), with most activity occurring in the private sector – approximately 90 percent derive more than 75 percent of their income from private practice
  • These specialties involve highly repetitive examinations and minor procedures, with fewer patients requiring overnight admissions to hospital.
EXHIBIT 35
(D)

Education, registration and accreditation – dermatology

The Australasian College of Dermatologists (ACD) is the medical college responsible for training dermatologists and maintaining standards in Australia.

The Australasian College of Dermatologists
PO Box 3785, Rhodes NSW 2138
T: +61 (02) 8765 0242
F: 61 (02) 9736 2194
www.dermcoll.asn.au

The training pathway is outlined as follows:28

Post-university Medical Experience
After the completion of university medical studies, at least two years (PGY 1 and PGY 2 accredited positions) acceptable training in a teaching hospital or equivalent recognised by the ACD must be completed

Australasian College of Dermatologists Training Program
The Australasian College of Dermatologists is the only organisation accredited to train and assess dermatologists in Australia. Entry to the program is highly competitive – the current class has only 12 members and there is usually a wait for training positions. Once accepted to the program, trainees must complete four to five years of defined clinical and educational experience in accredited training programs and pass a series of assessments.

Education, registration and accreditation – ophthalmology

The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) is the medical college responsible for training ophthalmologists and maintaining standards in Australia.

The Royal Australian and New Zealand College of Ophthalmologists
94-98 Chalmers Street, Surry Hills 2010
T: 61 2 9690 1001
F: 61 2 9690 1321
www.ranzco.edu

The training pathway is outlined as follows – selection is very competitive: 29

Selection
Complete medical degree and intern year
Obtain an appointment to a first year accredited hospital post.

Basic Training
Pass the induction assessment on commencement (within three months)
Pass all Ophthalmic Science (OS) assessments, and the Ophthalmic Basic Competencies and Knowledge (OBCK), and satisfy all term requirements, within the first 18 months, to be eligible to apply for advanced training.

Advanced Training
Obtain an appointment to an advanced training post from Year three
Meet all requirements to be eligible to sit basic and advanced pathology from Year three
Sit and pass basic and advanced pathology, usually in Year three
Demonstrate fitness to sit the RANZCO Advanced Clinical Exam (RACE) in Year four
Sit and pass the RACE
Pass all rotation requirements for Year four.

Final Year
Meet the pre-requisites and all requirements for the final year, by obtaining prior approval from the Censor-in-Chief of the final year program and supervisor, and approval also of final year reports from both the trainee and the supervisor.

Sources of financial reimbursement/role in the healthcare ecosystem

Both dermatology and ophthalmology are specialties heavily weighted towards private practice. Those who do work in the public sector usually have academic positions and are providing highly specialised services for one or two sessions per week. Most of these specialists join group practices early in their career, which then fragment as they go out on their own. Rebates for private sector consultations and procedures are provided under the Medicare Benefits Schedule at normally 85 percent of the Schedule fee for out patients, and at 75 percent of the Schedule fee for in patients as previously outlined. Procedures in these specialties tend to be small, rapid throughput and repetitive, such as biopsies in dermatology, and cataract eye surgery.


26AIHW Medical Labour Force Survey 2008, published in 2010.
27IBID.
28Australasian College of Dermatologists website 2011.
29Royal Australian and New Zealand College of Ophthalmologists website 2011.