scholarly journals EyePACS: An Adaptable Telemedicine System for Diabetic Retinopathy Screening

2009 ◽  
Vol 3 (3) ◽  
pp. 509-516 ◽  
Author(s):  
Jorge Cuadros ◽  
George Bresnick
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Primary Care Providers ◽  
Retinal Images ◽  
Care Providers ◽  
Telemedicine System ◽  
Web Based ◽  
Diabetic Retinopathy Screening ◽  
Standard Clinical Practice ◽  
Retinopathy Screening

Background: 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. Methods: Primary clinic personnel (i.e., nursing, technical, or administrative staff) are trained and certified by the EyePACS program to acquire retinal images from standard digital retinal cameras. Relevant clinical data and eight high-resolution images per patient (two external and six retinal images) are encrypted and transmitted to a secure Internet server, using a standard computer and Web browser. Images are then interpreted by certified EyePACS reviewers or local eye care providers who are certified through the EyePACS Retinopathy Grading System. Reports indicating retinopathy level and referral recommendations are transmitted back to primary care providers through the EyePACS Web site or through interfaces between EyePACS and Health Level 7-compliant electronic medical records or chronic disease registries. Results: The pilot phase of the EyePACS DRS program in California (2005–2006) recorded 3562 encounters. Since 2006, EyePACS has been expanded to over 120 primary care sites throughout California and elsewhere recording over 34,000 DRSs. The overall rate of referral is 8.21% for sight-threatening retinopathy and 7.83% for other conditions (e.g., cataract and glaucoma). Conclusion: The use of license-free Web-based software, standard interfaces, and flexible protocols has allowed primary care providers to adopt retinopathy screening with minimal effort and resources.

scholarly journals Improving Patient Access to Diabetic Retinopathy Screening Through Telemedicine

Iproceedings ◽  
10.2196/15193 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15193
Author(s):  
Tiffany Wandy ◽  
Michael Kiritsy ◽  
Daniel Durand
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Primary Care Practice ◽  
Primary Care Providers ◽  
Care Practice ◽  
Type I ◽  
Screening Measure ◽  
Diabetic Retinopathy Screening ◽  
Patients With Diabetes ◽  
Retinopathy Screening

Background The LifeBridge Health (LBH) Accountable Care Organization (ACO) serves approximately 20,000 Medicare beneficiaries, many of whom have type I or type II diabetes. Diabetic retinopathy (DR) screening is extremely important in helping to preserve patient’s eyesight and overall functional status. However, like many other organizations, LBH has struggled with low compliance rates for DR screening. As result, LBH searched for a solution to improve DR screening care and improve ACO quality and financial performance. Objective LifeBridge sought a telemedicine diagnostic solution that was easy for our physicians and clinic teams to use that would enable improved management of patients with diabetes. A pilot was initiated at three large primary care practice locations in the last quarter of 2017. Two of the locations received table top cameras, while the other location received a more mobile, hand held unit. Working with a dedicated LBH IRIS team, the practices created and implemented workflows, documented processes, and instilled best practices. Methods We used a pre-post test design to measure whether implementation of this tool enabled providers to better meet the diabetic retinopathy screening measure. We included the final months of 2017 in the preperiod to account for any operational changes required to implement the new workflow. Manual chart abstraction of patients seen in the previous 4/6 weeks who were eligible to determine the proportion of patients who met the measure. This was done quarterly in every primary care practice throughout the organization. One of the three practice sites was changed halfway through 2018 and switched to another; however, both practices were included in the analysis. We also compared the number of diabetes patients in the populations of each of the four practices. A two sample z test with a P value of .05 was used to test for statistical significance. Results As of April 2019, 810 patients were screened for diabetic retinopathy. Of these, 33.1% (282 patients) were diagnosed with pathology. Approximately 15.6% (n=133) were diagnosed with DR. We also identified 87 patients who are considered “IRIS saves” patients who had pathology identified that was serious enough to put them at imminent risk of losing their sight. For all patients requiring follow up, direct referrals were made to our in-network ophthalmologists at Krieger Eye Institute for treatment that these patients would not have otherwise received. Statistical comparison of DR screening performance of practices pre and post implementation showed mean screening rates of 38.5% and 47.2%, respectively, with P=.01. Conclusions IRIS screenings allowed our primary care providers to provide more comprehensive care to patients with diabetes, eliminating the need for additional office visits. Having IRIS available in the practice was able to demonstrably improve performance in the diabetic retinopathy screening measure. As a result, primary care providerss with IRIS helped facilitate access to care, thus making it easier for patients make better choices related to their health outcomes. We hope to further use the data to study HbA1c control, medication adherence, and cost/utilization in those diagnosed with retinopathy compared to those with a negative screening.

scholarly journals Five regions, five retinopathy screening programmes: a systematic review of how Portugal addresses the challenge

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andreia Marisa Penso Pereira ◽  
Raul Manuel da Silva Laureano ◽  
Fernando Buarque de Lima Neto
Keyword(s):  
Diabetic Retinopathy ◽  
Web Sites ◽  
National Health System ◽  
Health Department ◽  
Population Based ◽  
Care Providers ◽  
Levels Of Care ◽  
Diabetic Retinopathy Screening ◽  
Relevant Role ◽  
Retinopathy Screening

Abstract Background The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes, and difficulties. However, factors such as the existence of regional programmes, specificities of each country’s health systems, organisational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. Methods Web of Science and PubMed platforms were searched using appropriate key words. The review process resulted in 423 articles adherent to the search criteria, 28 of which were accepted and analysed. Web sites of all Portuguese governmental and non-governmental organisations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed. Results Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading, and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening. Conclusion Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes, especially if each other highlights are considered. The findings of this research could be very useful for the other countries with similar socio-political characteristics. Trial registration PROSPERO registration ID CRD42020200115.

Mailed letter versus phone call to increase diabetic retinopathy screening engagement by patients in a team-based primary care practice: a prospective, single-masked, randomized trial.

2021 ◽  
Author(s):  
Vess Stamenova ◽  
Megan Nguyen ◽  
Nike Onabajo ◽  
Rebecca Merritt ◽  
Olivera Sutakovic ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Usual Care ◽  
Patient Engagement ◽  
Primary Care Practice ◽  
Phone Call ◽  
Care Practice ◽  
Diabetic Retinopathy Screening ◽  
Engagement Strategies ◽  
Retinopathy Screening

Abstract Background: Diabetic retinopathy is the leading cause of blindness among adults, but vision loss is preventable through regular screening. Urban areas in Canada have large numbers of unscreened individuals and teleophthalmology programs have been used to improve access and uptake of screening. The purpose of this study was to test different patient engagement approaches to expand teleophthalmology program to team-based primary care clinic in the city of Toronto, Canada.Methods: A teleophthalmology program was set up in a large urban academic team-based primary care practice. Patients over 18 years of age, with type 1 or type 2 diabetes were randomized to one of four engagement strategies: a phone call, a letter, a letter plus phone call, or usual care. Outreach was conducted by administrative staff within the clinic. The primary outcome was booking an appointment for diabetic retinopathy screening through a teleophthalmology program at the time of the call or within one week for the mail intervention. Results: A total of 23 patients in the phone, 28 in the mail, 32 in the mail and phone, and 27 in the control (usual care) were included in the analysis. After the intervention, 88% of patients in the phone intervention, 11% of patients in the mail group, and 100% in the mail and phone group booked an appointment with the teleophthalmology program compared to 0% in the control group. Phoning patients positively predicted patients booking a teleophthalmology appointment (p< .0001), while sending a letter had no effect. Conclusions: Patient engagement to book diabetic retinopathy screening via teleophthalmology in an urban academic team-based primary care practice using telephone calls was much more effective than letters or usual care. Practices that have access to a local DR screening programs and have the required resources to undertake such engagement strategies should consider using them as a means in improving their DR screening rates.

scholarly journals A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study

10.2196/14525 ◽  
2020 ◽  
Vol 9 (1) ◽  
pp. e14525
Author(s):  
Amber K Brooks ◽  
David P Miller Jr ◽  
Jason T Fanning ◽  
Erin L Suftin ◽  
M Carrington Reid ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Primary Care Providers ◽  
Patient Portal ◽  
Low Back ◽  
Care Providers ◽  
Web Based

Background Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. Objective The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. Methods Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. Results Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. Conclusions The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. International Registered Report Identifier (IRRID) DERR1-10.2196/14525

scholarly journals A Pain eHealth Platform for Engaging Obese, Older Adults with Chronic Low Back Pain in Nonpharmacological Pain Treatments: Protocol for a Pilot Feasibility Study (Preprint)

2019 ◽  
Author(s):  
Amber K Brooks ◽  
David P Miller Jr ◽  
Jason T Fanning ◽  
Erin L Suftin ◽  
M Carrington Reid ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Primary Care Providers ◽  
Patient Portal ◽  
Low Back ◽  
Care Providers ◽  
Web Based

BACKGROUND Low back pain is a costly healthcare problem and the leading cause of disability among adults in the United States. Primary care providers urgently need effective ways to deliver evidence-based, nonpharmacological therapies for chronic low back pain. Guidelines published by several government and national organizations have recommended nonpharmacological and nonopioid pharmacological therapies for low back pain. OBJECTIVE The Pain eHealth Platform (PEP) pilot trial aims to test the feasibility of a highly innovative intervention that (1) uses an electronic health record (EHR) query to systematically identify a phenotype of obese, older adults with chronic low back pain who may benefit from Web-based behavioral treatments; (2) delivers highly tailored messages to eligible older adults with chronic low back pain via the patient portal; (3) links affected patients to a Web app that provides education on the efficacy of evidence-based, nonpharmacological, behavioral pain treatments; and (4) directs patients to existing Web-based health treatment tools. METHODS Using a three-step modified Delphi method, an expert panel of primary care providers will define a low back pain phenotype for an EHR query. Using the defined low back pain phenotype, an EHR query will be created to identify patients who may benefit from the PEP. Up to 15 patients with low back pain will be interviewed to refine the tailored messaging, esthetics, and content of the patient-facing Web app within the PEP. Up to 10 primary care providers will be interviewed to better understand the facilitators and barriers to implementing the PEP, given their clinic workflow. We will assess the feasibility of the PEP in a single-arm pragmatic pilot study in which secure patient portal invitations containing a hyperlink to the PEP Web app are sent to 1000 patients. The primary outcome of the study is usability as measured by the System Usability Scale. RESULTS Qualitative interviews with primary care providers were completed in April 2019. Qualitative interviews with patients will begin in December 2019. CONCLUSIONS The PEP will leverage informatics and the patient portal to deliver evidence-based nonpharmacological treatment information to adults with chronic low back pain. Results from this study may help inform the development of Web-based health platforms for other pain and chronic health conditions. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/14525

scholarly journals Correction to: Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

2020 ◽  
Author(s):  
Márcia Silva Queiroz ◽  
Jacira Xavier de Carvalho ◽  
Silvia Ferreira Bortoto ◽  
Mozania Reis de Matos ◽  
Cristiane das Graças Dias Cavalcante ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening
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