Enhancing Care for Retinopathy of Prematurity Patients through Better Logistic Planning, Process Mapping, and Telemedicine-Driven Interventions
Abstract
Retinopathy of Prematurity (ROP) is a serious condition that disrupts the development of retinal blood vessels in premature infants, posing a significant risk of permanent blindness if not promptly diagnosed and treated. A critical component of managing ROP is ensuring the safe, timely, and efficient transport of neonates to specialized care facilities equipped to deliver the necessary interventions. Despite the importance of this process, to the best of our knowledge, no prior studies have explored process mapping within this specific context. This paper aims to evaluate neonatal transfer practices from a process perspective, identify opportunities for quality improvement, and propose targeted telemedicine interventions to enhance the transfer process. To achieve this, we used Business Process Model and Notation (BPMN) to map and analyze the existing workflows systematically. The findings of this study include a detailed examination of current practices. Based on these insights, we developed targeted telemedicine interventions designed to optimize care delivery for this vulnerable population. These interventions aim to improve coordination, reduce delays, and ensure timely access to specialized care. The results of this study have the potential to lay the foundation for the development of necessary laws and regulations governing neonatal transfer services in the country. Furthermore, this paper seeks to foster collaboration among healthcare stakeholders, inform evidence-based policy-making, and promote standardization in clinical workflows. Ultimately, these efforts are expected to lead to improved patient outcomes, enhanced operational efficiency, and a more robust neonatal care system.
Keywords:
Business process model and notation, Telemedicine, Process mapping, Retinopathy of prematurity, Neonatal transferReferences
- [1] Gabryelczyk, R., Sipior, J. C., & Biernikowicz, A. (2024). Motivations to adopt BPM in view of digital transformation. Information systems management, 41(4), 340–356. https://doi.org/10.1080/10580530.2022.2163324
- [2] Marsinyach Ros, I., Sanchez García, L., Sanchez Torres, A., Mosqueda Peña, R., Pérez Grande, M. del C., Rodríguez Castaño, M. J., … ., & Sánchez Luna, M. (2020). Evaluation of specific quality metrics to assess the performance of a specialised newborn transport programme. European journal of pediatrics, 179(6), 919–928. https://doi.org/10.1007/s00431-020-03573-z
- [3] Hong, E. H., Shin, Y. U., Bae, G. H., Choi, Y. J., Ahn, S. J., Kim, I., & Cho, H. (2022). Ophthalmic complications in retinopathy of prematurity in the first decade of life in Korea using the national health insurance database. Scientific reports, 12(1), 911. https://doi.org/10.1038/s41598-021-04616-7
- [4] Dave, H. B., Gordillo, L., Yang, Z., Zhang, M. S., Hubbard, G. B., & Olsen, T. W. (2012). The societal burden of blindness secondary to retinopathy of prematurity in Lima, Peru. American journal of ophthalmology, 154(4), 750–755. https://doi.org/10.1016/j.ajo.2012.04.003
- [5] Bishnoi, K., Prasad, R., Upadhyay, T., & Mathurkar, S. (2024). A narrative review on managing retinopathy of prematurity: Insights into pathogenesis, screening, and treatment strategies. Cureus, 16(3), 1–9. https://doi.org/10.7759/cureus.56168
- [6] Chmielarz-Czarnocińska, A., Pawlak, M., Szpecht, D., Choręziak, A., Szymankiewicz-Bręborowicz, M., & Gotz-Więckowska, A. (2021). Management of retinopathy of prematurity (ROP) in a Polish cohort of infants. Scientific reports, 11(1), 4522. https://doi.org/10.1038/s41598-021-83985-5
- [7] Hartnett, M. E., & Lane, R. H. (2013). Effects of oxygen on the development and severity of retinopathy of prematurity. Journal of American association for pediatric ophthalmology and strabismus, 17(3), 229–234. https://doi.org/10.1016/j.jaapos.2012.12.155
- [8] Kovács, G., Somogyvári, Z., Maka, E., & Nagyjánosi, L. (2017). Bedside ROP screening and telemedicine interpretation integrated to a neonatal transport system: Economic aspects and return on investment analysis. Early human development, 106–107, 1–5. https://doi.org/10.1016/j.earlhumdev.2017.01.007
- [9] Chiang, M. F., Quinn, G. E., Fielder, A. R., Ostmo, S. R., Paul Chan, R. V, Berrocal, A., … ., & Zin, A. (2021). International classification of retinopathy of prematurity, third edition. Ophthalmology, 128(10), e51–e68. https://doi.org/10.1016/j.ophtha.2021.05.031
- [10] Rolón, E., Garcia, F., Ruiz, F., Piattini, M., Calahorra, L., Garcia-Rojo, M., & Martin, R. (2008). Process modeling of the health sector using BPMN: A case study. Proceedings of the first international conference on health informatics (pp. 173-178). https://www.researchgate.net/publication/221334166
- [11] Berrocal, A. M., Fan, K. C., Al-Khersan, H., Negron, C. I., & Murray, T. (2022). Retinopathy of prematurity: Advances in the screening and treatment of retinopathy of prematurity using a single center approach. American journal of ophthalmology, 233, 189–215. https://doi.org/10.1016/j.ajo.2021.07.016
- [12] Somogyvári, Z., Maka, E., Németh, J., & Nagy, Z. Z. (2019). Training hungarian neonatal transport nurses in screening for retinopathy of prematurity with telemedicine. Developments in health sciences, 2(3), 65–71. https://doi.org/10.1556/2066.2.2019.011
- [13] Haynes, S. C., Dharmar, M., Hill, B. C., Hoffman, K. R., Donohue, L. T., Kuhn-Riordon, K. M., … ., & Marcin, J. P. (2020). The impact of telemedicine on transfer rates of newborns at rural community hospitals. Academic pediatrics, 20(5), 636–641. https://doi.org/10.1016/j.acap.2020.02.013
- [14] Hayden, E. M., Boggs, K. M., Espinola, J. A., Camargo, C. A., & Zachrison, K. S. (2020). Telemedicine facilitation of transfer coordination from emergency departments. Annals of emergency medicine, 76(5), 602–608. https://doi.org/10.1016/j.annemergmed.2020.04.027

