As is well known, diabetic retinopathy is the leading cause of blindness in the USA (mostly for adults 20-74 yrs of age). About 30 million Americans and 414 million people worldwide have diabetic retinopathy. With early detection, vision loss is preventable in up to 95% of the cases.
AAO, NCA and NQF recommend annual retinal exams for diabetic patients – however, only 20-50% really comply. These are assumed to be due to various reasons including, but not limited to:
- Lack of patient awareness and education
- Lack of access to healthcare and even more so, specialists.
- Patient logistics are usually the biggest factor.
Even though retinal exams are to be included in NCQA HEDIS and CMS STAR ratings (and even for CMS ACO diabetes management), despite the fact that DRE compliance increases incentives under HEDIS/STAR ratings, compliance has been poor.
Fort Drum Regional Health planning organization had started a telemedicine based diabetic retinopathy screening program where 95 % of the target population live in a health profession shortage area (HPSA) across various sites (see here). In less than a year after launch, they reported pretty promising results here.
As reported numerous times, the main challenges of patient logistics are due to the current workflow (as below)
- A patient visits their PCP for a check up (not necessarily related to diabetic retinopathy)
- The PCP office knows that they are supposed to do yearly retinal exams (well, many PCP offices are not equipped with this clinical decision support system either).
- The PCP office refers the patient to a specialist office (ophthalmologist). They typically do so by handing the patient a note or a referral pad referral.
- The patient leaves the office – there’s no further follow up.
- A minority of those patients call the ophthalmologist offices (specialty – hence, they are already backed up)
- The patient faces barriers in setting up an appointment with the specialist office
- Finally, and when the patient does get an appointment with the specialist office, they may or may not show up.
- Even when the patient does actually show up for the visit, the encounter/visit notes may or may not be sent back to the PCP office.. Therefore leaving an open care loop.
An ophthalmology group in NYC that deals with a large diabetic population wanted to offer teleretinal screening services to their referring partners.
This not only assisted in medical marketing for them but at the same time extended patient compliance in addition to assisting the primary care providers to meet their yearly CDC screening goals.
How it was executed:
In this particular case, the PCP office was responsible for patient acquisition, identification for retinal screening cases and therefore the ophthalmology group depended on the PCP offices.
The PCP office would create the patient as a new screening case to be diagnosed. They would then upload their images (right and left eye) to the web portal. This would send the alert to the retinal specialists on staff at our ophthalmology group and the specialists would immediately diagnose the images.
More often than not, while the patient was still at the PCP office, the PCP would get a report back. The system would generate a report with all information and notes necessary for billing purposes as well.
For patients that were diagnosed with NPDR, the PCP office could immediately send an electronic referral to the ophthalmology group so the patient compliance was already expected to be higher.
While WelchAllyn and retinalscreenings offer a slew of retina specialists that grade images, this does not help individual ophthalmology practices generate new patient business. Using those existing services is like listing themselves on ZocDoc – you cannot predict the amount of business you can generate, because every retina specialist is already on those networks.
Since the patient referral was generated immediately and the patient got an appointment before leaving the PCP office, the problem of patients forgetting to follow up with the specialist office was entirely eradicated.