JMIR Publications

ABSTRACT

Background:

Annual retinal exams for patients with diabetes are critical as diabetic retinopathy is the number one cause of preventable blindness is working age adults in the United States. Currently, most patients with diabetes in the United States receive a referral from their primary care provider to see an ophthalmologist for their annual dilated eye exam, which can be an added inconvenience and expense. As such, there is a need for alternative screening strategies within an outpatient network. The use of a telemedicine platform in a primary care setting serves as a novel strategy to increase diabetic retinopathy screening rates. In order to provide better access to diabetic retinopathy screening for our patients, cameras were placed in three primary care practices in October 2017 as part of an eight-month pilot program. Specialized cameras from Intelligent Retinal Imaging Systems (IRIS) were used to acquire images that could be interpreted remotely by ophthalmologists within the LifeBridge Health network for the diagnosis of diabetic retinopathy and the detection of other types of pathology (e.g. macular edema).

Objective:

The aim of this retrospective descriptive study was to examine whether a telemedicine platform can be used as a cost-effective way to increase diabetic retinopathy screening rates in the primary care setting.

Methods:

Aggregate screening volume and diagnostic data were collected for each of the three practice locations for the eight-month pilot period, October 30, 2017, through June 30, 2018. Additionally, payor reimbursement data and equipment cost data were used to determine the pay off period for each of the three practice locations.

Results:

The pilot program proved the business case that implementation of the IRIS camera in three practice locations could result in enough patients being screened to pay for the cost of the camera within a maximum of two years. The three practices showed increased diabetic retinopathy screening rates of 1%, 6%, and 24%, respectively and were all able to screen enough patients to be on track to pay off the cost of the camera within two years of implementation. Aggregate data from the pilot period showed that of the 1,213 patients who were screened, approximately 17.1% (n=207 patients) were diagnosed with diabetic retinopathy and an additional 17.7% (n=215 patients) were suspected of having some form of other pathology. Of note, 10.1% (n=123 patients) were also identified as being “IRIS saves”, defined as having pathology identified that was severe enough to be considered an imminent threat to their vision.

Conclusions:

This retrospective descriptive study suggests that a telemedicine platform can be used to improve diabetic retinopathy screening rates in the primary care setting within a large healthcare system in a cost effective way that allows for the cost of the equipment to be recouped through billing within a maximum of two years.