Preventative medicine is more than a phrase. For those at risk of losing their sight, it can be the difference between light and darkness.

Diabetic retinopathy is the most common cause of vision loss among people with diabetes as well as the leading cause of blindness in working-age people in the United States. According to the U.S. Centers for Disease Control and Prevention’s Vision Health Initiative, 5.3 million people (about 2.5% of the populations), ages 18 years and older, suffer from the disease.

But “common” doesn’t mean “inevitable,” and blindness is preventable for the majority of diabetic patients with retinopathy. Today, early detection can reduce the risk of severe vision loss by 90% and significantly reduce long-term healthcare costs.

As physicians seek to make the teleretinal screening sustainable, it’s clear its successful integration into everyday workflow is paramount.

Diabetic patients navigating the complex healthcare system as well as physicians struggling to obtain and enter their results are bogged down by inefficiencies in manual processes. True success for diabetic teleretinal exams will only be realized by successful integration with the electronic health record (EHR).


Need for exams

Diabetes is one of the largest crises for our nation’s health system. By 2050, it’s projected that one in three Americans will have the disease. Retinopathy, or damage to the retina, is a major concern for these patients. While 40% to 45% of diabetics have the condition, only about half of them are even aware of it. Furthermore, while the American Diabetes Association recommends annual retinal screens, only about 40% of diabetic patients comply.

There are no warning signs or symptoms to this eye disease, which can lead to serious damage if undetected. Worse yet, diabetic retinopathy has been projected to double in incidence over the next four decades.

Since most patients won’t seek out physician care unless they are symptomatic, it’s critical that preventative retinal exams are integrated into their standard care. Right now, when diabetic patients are referred to eye care specialists for screening, the majority do not follow through for a number of socioeconomic reasons.

For physicians, a new solution to help patients is about more than just the technology. The process, workflow, and efficiency for staff as well physicians is vital to driving change, especially in today’s mandated and financially constrained market. When the stars align and the right technology is met with the right process, the sky’s the limit in terms of driving compliance and improving care. Case in point, diabetic retinopathy.


Harris Health System: Transition to success

Traditional cloud-based diabetic retinopathy solutions consist of a non-dilated fundus camera, cloud-based reading center, and secure Internet-based transfer portal. This provides step 1—the critical means to get patients screened and increase compliance for the exam by bringing them into the physician practice. However, like with any new technology, there are also the challenges with process and workflow for the many primary care physicians (PCP), specialists, and patients involved.

To overcome these obstacles, in October of 2015, Houston-based Harris Health System worked with Intelligent Retinal Imaging Systems (IRIS) to integrate their stand-alone teleretinal examination program with their current EHR, Epic. Harris and IRIS collaborated to streamline transmission of patient data and results to enhance quality outcomes.

Their outcomes benefited both patients and physicians significantly, making the exams better utilized, with 86% of PCP respondents reporting that IRIS-EHR integration increased access for their patients receiving diabetic retinal exams. Respondents also noted a 69% decrease in the time it took to obtain results of a patient scan after the test. Technicians also reaped benefits of IRIS-EHR integration: 75% reported a four-fold decrease in the amount of time spent manually uploading results after integration.

Regarding reporting, 83% of PCPs found IRIS reports to be helpful for managing diabetic patients and over 77% were generally satisfied with how efficient the integrated product was. It changed everything.

Integration with the EHR increased patient access to this vital exam in the diabetic population. With more streamlined workflow and minimal manual requirements, physician and technician engagement has been strong. The potential of technology is truly realized when the most vulnerable populations reap its benefits and that has happened here.


CoxHealth: Symbiotic from the start

While perhaps the frequent use—and, it could be argued, misuse—of the terms “integration,” “efficiency,” and “interoperability” may cause many eyes to glaze over, when used and put to use effectively, these terms can bring tremendous, positive results to healthcare. Just take the case of CoxHealth.

Included on Missouri’s “Best Hospitals” list by U.S. News & World Report, CoxHealth is the state’s only locally owned, not-for-profit health system. Similar to Harris Health, CoxHealth implemented a cloud-based diabetic retinopathy system, but, in their case, tackled the EHR integration simultaneously with their IRIS DR system installation.

CoxHealth identified 14 primary care and endocrinology clinics that care for the majority of the patients. Along with the DR system, standardized workflows were implemented and exam results were immediately made available on their EHR, Cerner.

In the first six weeks of the program, 1,040 diabetic patients received the teleretinal exam, and 150 patients—or 18% of them—were found to have diabetic retinopathy. The significance of this outcome cannot be overstated: Their degenerative eye condition would have otherwise gone undiagnosed and untreated. For CoxHealth, their HEDIS scores improved significantly.

In total, the exam identified 328 eye pathologies, including 54 cases of macular edema. PCPs were able to view discrete data often demonstrating organ damage directly in the patient chart, leading to more aggressive care plans to control disease progression—in many instances—in the primary care setting.

Diabetic patients are reaping the benefit of convenience—having their hemoglobin A1C test and eye screening all done in the same place.


The future

Teleretinal exam integration with EHRs is changing the face of diabetic eye care.  Telemedicine optimized with automation and integration is a powerful tool in the mission to detect early eye disease. Everyone deserves a lifetime of sight and we must make every effort to facilitate access, efficiency, and engagement of technology to ensure it.


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