- Diabetic Retinopathy is the Leading Cause of Blindness in Adults
- 4.2 million people, or 28.5% of diabetics, have diabetic retinopathy
- National Retinal Screening Rates are less than 40%
- If detected early, medical therapies can reduce the risk of severe vision loss by more than 90%
- Retinal Screening programs in primary care improve access and will drive screening rates to more than 80%
Harris Health System Outcomes:
- Launched in June 2013
- 14,112 patients screened
- 15.8% of those screened had moderate or severe diabetic retinopathy
- This means 2,081 people of Harris County who have been found to have moderate or worse diabetic retinopathy
- Access to treatment with patients who have positive findings has been streamlined with Baylor and UT
Ricci Sanchez, VP of Operations and Associate Administrator Ambulatory Care Services: “We were not meeting standards of care for diabetes for our patients. Even with our optometrists, whose job is to screen, the resources are limited and they were overwhelmed. Refraction work wasn’t getting done, and only 65% of diabetics were receiving a retinal eye exam.”
FULL HARRIS HEALTH SYSTEM CASE STUDY SITUATION
Currently, 28.5% of diabetics, or 4.2 million people, suffer from diabetic retinopathy in the United States. It is the leading cause of blindness among working age adults in the United States. After 15 years, about 2% of diabetics go completely blind, and about 10% of diabetics develop severe vision impairment. After 20 years, more than 75% of patients will have some form of diabetic retinopathy. At this advanced stage of the disease, the cost of pharmaceutical injections and surgeries is far greater than early laser treatments and preventative care.
The good news is that, while blindness from diabetes is irreversible, it is almost completely preventable. Early detection of diabetic retinopathy reduces the risk of severe vision loss by 90%. Still, a high percentage of diabetic patients never get screened.
Harris Health System in Houston, Texas, is proactively working to change that statistic within its population of diabetic patients. Harris Health serves the nation’s third most populous county and is one of the largest Federally Qualified Health Centers (FQHC) in the United States. Fewer than 10% of their patients have health insurance.
Harris Health System in Houston Texas represents a microcosm of the challenges faced by healthcare organizations throughout the country.
Health systems are confronted with growing diabetic populations and an inadequate number of skilled eye care professionals to screen patients. This problem is especially apparent in under- served population centers such as inner cities and rural areas.
The tools necessary to provide proper eye-care and testing services have been historically expensive, which has prevented mass adoption by primary care health professionals. Sophisticated and expensive technical and human resources are vastly stretched and over-utilized, considering the majority of diabetic patients who should be screened annually will turn out to be negative for diabetic retinopathy. Additionally, the current system is challenged by a limited number of eye care professionals matched with an ever-increasing number of cases of diabetic retinopathy. Many ophthalmology clinics limit visits to 30-50 patients a day for normal patients and are often booked three to six months in advance. Additionally, ophthalmologists do not have a quick and efficient way to prioritize patients that come in the door based on pathology.
These logistical barriers are also a major factor preventing most diabetics from getting their recommended annual screening. General practitioners, primary care, and community health clinics have not been equipped to provide eye care and testing services. Referrals to ophthalmologists are common, but it often takes patients months to get an appointment and requires extra effort or expense to get to the appointment. This leaves the majority of diabetics unscreened year after year, which delays detection of the disease.
Harris Health System was facing a significant backlog of timely screenings due to their volume of over 47,000 diabetic patients. Limited funding and a low number of skilled eye care professionals also contributed to the health care system’s inability to meet the demand.
“We needed a way to identify the patients at eminent risk for vision loss,” said Sanchez. “With our huge number of patients who are diabetic, we needed a filtering system to pinpoint those most at risk and tackle those first while putting others on hold and monitoring them along the way.”
Harris Health needed a cost effective solution to providing more comprehensive care to its diabetic population, operated by low level technicians, and interpreted by the highest skill level personnel, while saving significant dollars and identifying those at highest risk.
Harris Health turned to Intelligent Retinal Imaging SystemsTM (IRIS) to increase their patient- screening rate while overcoming barriers to patient access. IRIS is a turnkey technology and service solution that is proven to accurately detect potential pathology with a quick and simple retinal scan.
The solution includes an easy-to-operate, auto-focusing camera, auto-read software, and simple and understandable reporting to determine each patient’s risk level for diabetic retinopathy. The complete system combines.
- Automated imaging system
- Advanced Image Enhancement Technologies
- Real-time data transfer using HIPAA-compliant (Health Insurance Portability and Accountability Act) cloud computing
- Reading by highly-qualified retina specialist
- Tele-medicine grading
- Detailed reporting
- Referral recommendation based on pathology detected
Harris Health installed IRIS cameras in eight of its busiest primary care practices throughout the county. Within one week, Harris Health went live at each location, making a clinical exam previously performed by a specialist as easy as a simple automated exam performed by a patient care technician (PCT). Without any special training to run the equipment the PCT easily performed screenings and produced high-quality images using IRIS.
Patients were screened in their primary care doctor’s office during regularly scheduled visits.
- The vast majority of patients did not have to have their eyes dilated.
- Patients didn’t have to take additional time off work for an additional eye appointment.
- Patients didn’t have to arrange for additional transportation.
- Patients were screened in an average of only five minutes.
- Preliminary results were provided immediately and complete results within 72 hours.
Improved Access To Patients
Within the first 60 days, Harris Health screened 5,200 of its 41,000 diabetic patients, which is over 12.5% of its diabetic population. Many of these patients screened were long-time diabetics who had never had access to a retinal exam. After each screening, the patients received a printed copy of their eye findings to help them understand their specific risk of losing their sight. Those patients most at risk for vision loss were triaged into the eye care center for more immediate care. Many of them were asymptomatic but living with a disease about to threaten their vision.
At the same time, patients who did not require an immediate follow-up with an ophthalmologist were simply scheduled for a regular screening at their primary care facility 12 months later. Cases of mild disease were considered observable and able to be screened in the future at the primary care level.
Meaningful Health Outcomes
If screening had not occurred, these patients would be progressing closer to blindness from the disease. Harris Health identified these high-risk cases before vision loss ensued and triaged them to the eye care center. Out of the 5,200 patients screened, 27% had diabetic retinopathy: 850 had a mild case, 311 moderate, 181 severe, and 86 proliferative. More than 7% were identified at risk of glaucoma and referred to the appropriate clinic. Using the IRIS solution, Harris Health eliminated negative cases at the point of care and increased the number of referrals for high-risk patients who required actual treatment from a specialist.
This approach moved screened patients not at risk of vision loss off of the specialist schedule and increased the acuity level of their clinic appointments.
“Most retina specialists would love for more patients to come their way with a known pathology,” said Dr. Yvonne Chu, Associate Professor of Ophthalmology at Baylor College of Medicine. “It’s a better use of their time than seeing normal patients all day and less expensive to the health care system.”
Lower Costs Through Quality Improvement
According to Sanchez, using IRIS is a no brainer in a system like Harris Health where there are not enough resources to care for people. Getting people screened and having a good, high- quality image to work from has added tremendous value to the quality of care they offer diabetics. In fact, Harris Health reduced their cost by 70% while now screening up to 74% of their diabetic population. The payer cost is now $75 per exam, which is a $150 savings per exam over the previous method.
The downstream savings of early detection leads to lower-cost preventative care such as laser- treatment, while reducing the need for expensive injections and surgeries.
Reducing the Gap Between Identified and Accepted HEDIS Goals
The screening capabilities available with IRIS also impact HEDIS measures in primary care offices. Diabetic retinopathy exams are line-item listed as part of the HEDIS comprehensive diabetic care quality measure. All HEDIS measures except diabetic retinopathy and glaucoma screening could be historically achieved in the primary care setting. IRIS allows doctors to meet these HEDIS screening measures in the primary care setting.
The Harris Health primary care clinics that implemented IRIS and their payors are in the process of receiving their HEDIS outcomes. In another case, IRIS drove HEDIS outcomes for Cigna- HealthSpring MA plan in the Florida panhandle from 3 to 5 stars by screening its beneficiaries. Harris Health is anticipating similar positive results as well.
IRIS is properly diagnosing the diabetic population at Harris Health and enabling the system to allocate limited resources toward its higher risk patients. Harris Health is now able to leverage its screening measures to increase the chances of finding patients with pathology and moving them into triage more quickly. The number of screenings has increased from 65% to 74% of patients with diabetes within a 3-month time frame.
“We’re trying to move the needle in terms of impact of vision loss of diabetes. We can end blindness in diabetics,” said Dr. Sunil Gupta, Founder and CMO of IRIS.
Harris Health demonstrates that IRIS is a valuable solution that impacts the way health care providers and payors approach treatment for patients at risk of vision loss associated with diabetes.
“We can install the camera and software, train primary care technicians without any prior experience with ophthalmology and go live within 48 hours,” said Gupta.
The software included in IRIS enhances the pathology to make it more clearly visible, improving grading speed and reducing fatigue for the reader. “We’re working toward creating an automated system to filter out the abnormal vs. normal images so PCT’s can read the reports and easily decide next steps. For example, if there is a 95% probability that the scan is normal, then we can schedule the patient for a screening in a year.”
IRIS is not a substitute for a complete eye exam. It is a way to identify patients at eminent risk for vision loss who are not getting regular screenings. The revolutionary new IRIS service is now the easiest way for patients to be screened for indicators of diabetic eye disease. IRIS is the most advanced turnkey solution available, benefiting patients, providers and payors and potentially saving eyesight for millions of diabetic patients in the United States.
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