Improving Diabetic Retinopathy Screening Through a Statewide Telemedicine Program at a Large Federally Qualified Health Center

Journal of Health Care for the Poor and Underserved - Volume 22, Number 3, August 2011, pp. 804-816
 
J.N. Olayiwola, MD, MPH, FAAFP1; D.M. Sobieraj, PharmD2, K. Kulowski, BA3; D. St. Hilaire, BA4; J.J. Huang, MD, FAAO
1. Chief Medical Officer, Community Health Center, Inc., Middletown, CT
2. Research Associate at the University of Connecticut School of Pharmacy, Harford, CT
3. Student researcher at Community Health Center, Inc., Middletown, CT
4. Diabetic Retinopathy Program Coordinator at Community Health Center, Inc., Middletown, CT.
5. Associate Professor, Yale University Department of Ophthalmology

 
Abstract:
 
Background: Diabetic retinopathy (DR) is the leading cause of acquired blindness in U.S. adults. Early detection prevents progression. Screening rates are only 10% in medically underserved populations. Methods: A statewide telemedicine-based program within primary care centers was implemented to improve DR screening, detection and referrals for underserved patients. Study design: Retrospective, descriptive study. Results: A total of 568 adults were screened during a comprehensive nurse visit from July 2009-June 2010 and had complete data available. Nearly 60% were minorities and 24% were uninsured. A total of 145 cases of DR were identified. The majority were recommended to return in one year for follow-up, while 75 were referred to a specialist. Conclusions: Telemedicine using digital imaging technology in the primary care office is a strategy that can be used to screen underserved and at-risk patients for DR, increase compliance with screening, and streamline specialist referrals.

> Download the whitepaper Improving Diabetic Retinopathy Screening Through a Statewide Telemedicine Program at a Large Federally Qualified Health Center


EyePACS: An Adaptable Telemedicine System for Diabetic Retinopathy Screening

Jorge Cuadros, O.D., Ph.D.1 and George Bresnick, M.D., M.P.A.2
1. University of California, Berkeley, Meredith Morgan Optometric Eye Center, Berkeley, California
2. University of California, Berkeley, School of Optometry, Worthington, Massachusetts

 
Abstract:
 
Annual retinal screening of patients with diabetes is the standard clinical practice to prevent visual impairment and blindness from diabetic retinopathy. Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings can effectively detect sight-threatening retinopathy and significantly increase compliance with annual retinal exams. EyePACS is a license-free Web-based DRS system designed to simplify the process of image capture, transmission, and review. The system provides a flexible platform for collaboration among clinicians about diabetic retinopathy.

> Download the whitepaper EyePACS: An Adaptable Telemedicine System for Diabetic Retinopathy Screening


EyePACS: An Open Source Clinical Communication System For Eye Care

Jorge Cuadros, OD, PhD1,2, Ida Sim, MD, PhD2,3
1. University of California, Berkeley, Meredith Morgan Optometric Eye Center
2. Program in Biological and Medical Informatics, University of California, San Francisco
3. University of California, San Francisco, School of Medicine

 
Abstract:
 
Purpose: EyePACS is an application for communicating and archiving eye-related patient information, images, and diagnostic data. We studied how users adopted the system in diverse clinical settings. Methods: 53 clinicians and 142 students uploaded cases over 2.5 years from 6 pilot sites: a university teaching clinic, a university glaucoma clinic, an urban private optometric practice, a rural elderly care facility, a diabetic management program, and an eye hospital in India. Results: EyePACS collected 1122 cases. Users employed it for informal “curbside” consults in 17% of cases. Other uses of the system were: 1) to replace telephone and fax referrals to a retinal specialist (10%), 2) as part of ocular teleconsultations and diabetic retinopathy screening (31%), 3) for education via digital grand rounds and evaluation of students (32%), and 4) for research (10%). Conclusion: EyePACS has been used successfully for consults and education in diverse settings. The resulting database of digital cases serves as a searchable reference for clinicians.