Implementation, Characteristics, and Effectiveness of an Ophthalmic Hospital-Based Virtual Clinical Service in China During COVID-19

Background: The COVID-19 pandemic crisis is posing challenges for clinical practice worldwide. We describe the characteristics and effectiveness of a virtual clinical service run by a tertiary ophthalmic center in China with an aim to provide practical guidance for such services during and beyond the pandemic. Methods: We conducted a longitudinal observational study. To provide the diagnosis and treatment of eye diseases under stringent epidemic control measures, the Zhongshan Ophthalmic Center (ZOC) established a virtual clinical service (virtual 2020) by harnessing several digital technologies (5G telecommunication networks, big data analytics, artificial intelligence (AI) and blockchain technology). Multiple interrelated services were offered online, including AI prescreening, virtual live consultation, and online pharmacy. We extracted data from the online clinical service records, along with on-site face-to-face (F2F) clinical records obtained from February 1 to March 13 in 2020 (F2F 2020) as well as a similar period in 2019 (F2F 2019) for analysis. We analyzed the clinical service pattern by day and time; indication of visit and demographics of age, gender, and geographical origin between three groups: virtual 2020, F2F 2020, and F2F 2019. Findings: A total of 38,038 visits to the ZOC were conducted online and F2F from February 1 to March 13, 2020, including 10,641 visits from an AI chatbot, 9,850 virtual live consultations by 127 doctors, and 17,547 on-site F2F consultations in the clinics. With the gradual opening of on-site outpatient and emergency services, online service numbers steadily increased. The AI chatbot services after office hours (8 pm to 8 am) accounted for 26.9% of the total visits, which was significantly higher than the proportions of virtual live consultations (10.9%) and on-site F2F consultations (3.5%) in 2020. Among the indications for virtual live consultation, specific disease consultation was the most common across all ages (64.7–70.7%); younger patients tended to have visual symptoms (18–34 years old, 60.4%), whereas seniors were more likely to require prescription renewal (>55 years old, 63.5%). Virtual live consultation in 2020 was more common in younger (median age 32 years) and female patients (53.3%) than in the F2F 2020 or F2F 2019 groups. Ocular surface diseases were the most frequent diagnosis in the virtual live consultations, which differed from the top diagnosis in F2F 2020 (retinopathy) and F2F 2019 (refraction) groups (P<0.05 comparisons between groups). Interpretation: The management of many ophthalmic diseases online in a virtual hospital setting can be implemented and is complementary to those of physical on-site F2F clinics. Virtual clinical service may be a useful model of care in the post-COVID19 pandemic “new normal”. Funding Statement: The study was supported by the National Key RD Guangzhou Key Laboratory Project (202002010006); Guangdong Science and Technology Innovation Leading Talents (2017TX04R031); the National Natural Science Foundation of China-General Programs (81770967, 81873675); National Natural Science Fund for Distinguished Young Scholars (81822010); the National Natural Science Foundation -Young Scientists Fund (81800810) and the Science and Technology Planning Projects of Guangdong Province (2018B010109008). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study followed the principles outlined in the Declaration of Helsinki. The study protocol was approved by the ethical board committee of the Zhongshan Ophthalmic Center, Sun Yat-sen University (2020KYPJ012).