Introduction to OPERAi

OPERAi is an Electronic Eyecare Referral System introduced across NHS Wales to support the modernisation and improvement of eyecare referral services.

The application provides a digital platform through which Primary Care optometrists and Secondary Care ophthalmology services can manage clinical referrals, share relevant patient information and communicate throughout the referral process.

By replacing traditional paper-based and fragmented referral processes with a more structured electronic approach, OPERAi aims to improve communication, reduce administrative delays and support patients in accessing appropriate eyecare services.

The system supports clinical teams in making informed decisions by ensuring that relevant referral information, clinical documentation and supporting images can be made available to authorised users.

1. The Digital Eyecare Programme

The implementation of OPERAi forms part of the wider Digital Eyecare Programme across NHS Wales.

The programme is funded by Digital Health and Care Wales and supports the transformation of eyecare services across all seven Health Boards in Wales.

The programme recognises the increasing demand being placed on hospital ophthalmology services and the importance of developing more efficient ways of delivering patient care.

Why is digital transformation important?

Demand for hospital eyecare services has increased significantly in recent years and is expected to continue growing as the population ages.

Many patients require ongoing monitoring, specialist assessment or treatment for ophthalmic conditions.

At the same time, Primary Care optometrists have an increasingly important role in providing enhanced clinical services within community settings.

Supporting closer collaboration between community optometrists and hospital ophthalmology services can help ensure patients are directed to appropriate care settings.

The role of OPERAi

OPERAi supports this approach by providing a digital referral mechanism between Primary Care (optical practice) and Secondary Care (hospital setting).

The application allows clinical information to be transferred electronically, reviewed by the receiving service and progressed through an appropriate referral pathway.

This supports the wider objective of delivering more coordinated eyecare services across Wales.

2. How Does OPERAi Work?

OPERAi supports the referral journey from the point at which an optometrist identifies a clinical concern through to the assessment and management of that referral by Secondary Care services.

The application enables relevant information to be shared between healthcare professionals and provides mechanisms for communicating the outcome of clinical triage.

The referral process can be divided into five main stages.

Stage 1: Primary Care Clinical Assessment

The referral journey begins within a Primary Care optical practice.

An optometrist undertakes a clinical assessment of the patient and identifies a condition, concern or clinical finding that may require further investigation, specialist advice or treatment.

The optometrist determines whether a referral is appropriate based on the patient's clinical presentation and the relevant referral pathway.

Where a referral is required, the optometrist can use OPERAi to prepare and submit the relevant clinical information.

Stage 2: Creating and Submitting a Referral

Once the optometrist has determined that a referral is required, the relevant clinical information is entered into OPERAi.

The application uses structured referral templates developed to support the Welsh General Ophthalmic Services (WGOS) clinical pathways.

These templates help ensure that relevant information is captured in a consistent format.

Information included in a referral

Depending on the clinical pathway, the referral may contain:

• Patient demographic information.
• Patient contact details.
• Referring Optical Practice information.
• Details of the referring clinician.
• Relevant clinical history.
• Presenting symptoms and clinical concerns.
• Examination findings.
• Clinical measurements and observations.
• Referral priority.
• Supporting clinical documentation.
• Relevant diagnostic images.
• The selected receiving hospital or service.

The information required may vary depending on the referral pathway and the clinical circumstances.

Supporting clinical images

Where relevant, clinical images can form an important part of the referral information.

These may assist the receiving clinician in understanding the patient's presentation and making an informed triage decision.

The availability and method of accessing images depend on the configured imaging workflow and integrations.

Submitting the referral

Before submission, the referring clinician should review the information entered and confirm that it accurately reflects the clinical assessment.

Once submitted, the referral is made available to the appropriate receiving service through the configured OPERAi referral workflow.

Stage 3: Secondary Care Clinical Triage

Following submission, the referral is made available to the receiving Secondary Care ophthalmology service.

Authorised hospital users can access OPERAi to review referrals awaiting triage.

Clinical triage is the process through which the receiving clinician reviews the referral information and determines the most appropriate next action.

What happens during triage?

The reviewing clinician may:

• Access the referral documentation.
• Review the patient's clinical history.
• Examine the reason for referral.
• Review relevant clinical findings.
• Access available supporting images.
• Consider the clinical priority.
• Determine the appropriate referral outcome.

This process allows the receiving service to assess the information provided and decide how the referral should progress.

Where the available information is insufficient to make a decision, the clinician may request clarification or additional information.

Where further clinical review is required, the referral may be escalated through the applicable secondary triage process.

Stage 4: Determining the Triage Outcome

Once the referral has been reviewed, the Secondary Care clinician records the appropriate triage outcome.

The available outcomes support different clinical and operational requirements.

Stage 5: Referral Progression and Communication

Following the clinical triage decision, the referral progresses according to the selected outcome.

Where the referral is accepted, the relevant booking arrangements can be progressed by the Secondary Care booking team.

Where additional information is required or a referral has been returned, OPERAi supports communication with the referring Optical Practice.

How are Optical Practices notified?

Where action is required from the referring clinician, the application provides notification through the OPERAi clinical dashboard.

An email notification is also sent to indicate that action is required.

The clinician can then sign into OPERAi, locate the relevant referral and review the requested action.

3. Key Features of the OPERAi Application

OPERAi provides a range of functions designed to support clinical referral management and communication.

Electronic Referral Management

The application supports the creation, submission, review and progression of eyecare referrals through electronic clinical workflows.

This reduces reliance on manual referral processes and provides a more structured method of sharing clinical information.

Centralised Referral Records

OPERAi provides a centralised record of referral information and relevant interactions within the application.

This supports authorised users in reviewing referral history and understanding the actions recorded during the referral process.

A centralised record can also support service monitoring, audit activities and quality improvement.

Clinical Documentation

Structured referral templates support the collection of relevant clinical information.

This allows Secondary Care clinicians to review the information provided by the referring practitioner and make informed triage decisions.

Clinical Image Sharing

OPERAi supports the availability of clinical images within relevant referral workflows.

Images may provide additional clinical context and support the assessment of certain ophthalmic conditions.

Where image-sharing integrations are available, authorised clinicians can access the relevant images through the configured process.

Two-Way Communication

A key feature of OPERAi is its ability to support communication between Primary and Secondary Care.

Rather than relying solely on separate communication methods, the application provides mechanisms for recording referral outcomes and requesting further information.

This helps referring clinicians understand what action is required and supports a more coordinated referral process.

Clinical Dashboards

OPERAi provides role-appropriate dashboard functionality to help users access and manage relevant referrals.

Primary Care users can review referrals and actions relevant to their practice.

Secondary Care users can access referrals requiring clinical triage and review relevant referral information.

The information displayed depends on the user's access permissions and the configured application workflow.

4. Benefits of OPERAi

The implementation of OPERAi is intended to provide benefits for patients, clinicians and healthcare services.

Benefits for Patients

• More coordinated care: Relevant referral information can be shared between Primary and Secondary Care services.
• Reduced administrative delays: Electronic referral processes can reduce the time associated with manual handling and transferring referral documentation.
• Appropriate clinical pathways: Clinical triage helps ensure referrals are directed towards the appropriate service or next action.
• Improved communication: Referring clinicians can receive information about referral outcomes and requests for additional information.
• Support for community care: The wider Digital Eyecare Programme supports the provision of appropriate eyecare services closer to patients' homes.

Benefits for Primary Care Clinicians

• Structured electronic referral templates.
• Improved consistency of referral information.
• Ability to include relevant supporting documentation.
• Access to referral status and relevant actions.
• Communication of clinical triage outcomes.
• Requests for further information through the application.
• Reduced reliance on paper-based processes.
• Improved visibility of referral activity.

Benefits for Secondary Care Clinicians

• Electronic access to referral information.
• Ability to review supporting clinical documentation.
• Access to relevant clinical images where available.
• Structured clinical triage processes.
• Ability to request further information from referrers.
• Ability to return referrals with clinical advice.
• Support for secondary clinical review.
• Improved coordination of referral management.

Benefits for Healthcare Organisations

• More consistent referral management processes.
• Improved visibility of referral activity.
• Reduced administrative duplication.
• Support for clinical governance and audit.
• Opportunities for service monitoring and quality improvement.
• Better information to support operational planning.
• More coordinated communication across healthcare settings.

5. Understanding User Responsibilities

OPERAi is used by different healthcare professionals throughout the referral journey.

Each user group has responsibilities relevant to its role within the clinical pathway.

Primary Care Optical Practitioners

Primary Care clinicians are responsible for undertaking appropriate clinical assessments and determining when a referral is required.

When creating a referral, users should ensure that the information provided is accurate, relevant and sufficiently detailed to support clinical triage.

Users should also review notifications and complete any actions requested following Secondary Care review.

Secondary Care Clinical Users

Secondary Care clinicians are responsible for reviewing referrals within their authorised clinical responsibilities.

This includes assessing the clinical information, reviewing relevant supporting documentation and recording an appropriate triage outcome.

Where further information or clinical review is required, the appropriate workflow should be followed.

Secondary Care Booking Teams

Following acceptance of a referral, the relevant hospital booking team manages appointment arrangements through the established booking process.

The OPERAi referral workflow supports the transfer of accepted referrals to the appropriate booking process.

6. Good Practice When Using OPERAi

Following good practice helps support accurate referral management and effective communication.

7. Frequently Asked Questions

What is OPERAi used for?

OPERAi is used to support electronic eyecare referrals between Primary Care optometrists and Secondary Care ophthalmology services.

The application supports referral creation, clinical review, triage and communication of referral outcomes.

Who can access OPERAi?

Access is provided to authorised users in accordance with their organisation, role and configured permissions.

Can supporting clinical images be included?

Yes. Relevant clinical images can be made available through supported referral and imaging workflows.

The availability of specific image functions depends on the configured integration and clinical pathway.

What happens after a referral is submitted?

The referral progresses to the appropriate receiving service where it can be reviewed and clinically triaged.

The subsequent action depends on the clinical triage outcome.

Can Secondary Care request more information?

Yes. Where additional clinical information is required, the receiving clinician can request further information through the referral workflow.

The referring Optical Practice is notified that action is required.

How will I know if action is required?

Where action is required from a Primary Care clinician, a notification is provided through the OPERAi dashboard.

An email notification is also sent indicating that action is required.

Does OPERAi replace clinical judgement?

No. OPERAi supports the management and communication of clinical referrals.

Clinical decisions remain the responsibility of appropriately qualified and authorised healthcare professionals.

8. Further Training and Support

Additional training guides are available within the OPERAi Help Centre.

These provide more detailed instructions covering individual application functions and referral workflows.

9. Summary

OPERAi provides an electronic platform for managing eyecare referrals across Primary and Secondary Care settings within NHS Wales.

The application supports the creation and submission of clinical referrals, the review of supporting information, clinical triage and communication between healthcare professionals.

By supporting a structured digital referral process, OPERAi aims to improve coordination, reduce unnecessary administrative delays and help patients access appropriate eyecare services.