By Sunil Gupta, MD | April 16, 2019 | Medical Economics
Between 40 and 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy (DR)—but only about half are aware of it, according to the National Eye Institute. In addition, although annual retinal exams are recommended for all patients with diabetes, research has found that over 60 percent skip these potentially sight-saving exams.
Primary care physicians typically do not perform DR exams but rather refer patients to eye care specialists for the testing. However, if primary care physicians embrace in-office retinal imaging technology to screen patients with diabetes for vision issues, they can not only improve the standard of care but also achieve managed care quality measures associated with annual DR exams.
DR testing in primary care
St. Vincent Medical Center of Evansville, Ind., operates a busy diabetes practice that provides a high standard of care, but had struggled with early identification of DR. “We had tools and resources to diagnose most vascular complications, but retinal involvement in diabetics was a challenge to diagnose at an early stage due to the need for a separate visit to an eye doctor’s office,” says Vishal Bhatia, MD, an endocrinologist at St. Vincent Medical Center. That challenge prompted St. Vincent’s leadership to adopt a retinal-imaging telemedicine solution.
Retinal imaging technology is straightforward, allowing nearly any clinical or administrative employee to perform a DR exam. The screening typically takes fewer than five minutes and doesn’t require patients’ eyes to be dilated.
A camera is used to take retinal images that are sent via a HIPAA-compliant telemedicine platform to eye specialists in a remote reading center for interpretation. Some advanced retinal imaging systems may use artificial intelligence to enhance ocular images, highlighting potential areas of pathology to help specialists make diagnoses. After a remote provider performs a diagnosis, the results are returned to patients’ charts via an EHR integration, within one business day although usually faster, along with referral recommendations if needed. Then, data is generated to launch the referral and billing cycle. The leading retinal imaging systems are supported by a bidirectional EHR interface to capture all diagnostic information, document outcomes, and ensure results are delivered as discrete, structured data to the medical record.
At St. Vincent Medical Center, the implementation of this technology found that 31 percent of patients examined have shown some form of pathology, while 24 percent had previously undiagnosed DR.
“This timely diagnosis of retinal conditions may have prevented potential catastrophic vision loss in addition to closing the quality care delivery gaps in these patients,” Bhatia says.
Greater convenience equals greater compliance
A number of potential barriers can prevent people with diabetes from obtaining DR exams—including insurance, misunderstanding the exam’s purpose, lack of access to an eye care provider, and general hardships related to an appointment, such as transportation and time off work.
Virtually all of these difficulties are eliminated by bringing retinal imaging into the primary care setting.
“Patients really enjoy having the convenience of being able to see their physician and have an eye exam at the same time all in one location,” says James Bonucchi, DO, ECNU, FACE, an endocrine consultant at Missouri-based CoxHealth, which implemented the technology in 2016. “It is saving our patients time away from work by being able to have a screening exam in the office.”
It also helps health systems improve diabetes management quality scores. Houston Methodist, a health system that piloted a DR-testing platform at three clinics beginning in 2016, experienced a three- to five-fold increase in patient compliance with annual diabetic eye exams, according to Archana Sadhu, MD, an endocrinologist at Houston Methodist. Forty-five percent of patients examined with the technology tested positive for some type of pathology, while 29 percent had DR.
“Based on these results, as well as a financial analysis that showed cost-effectiveness of the procedure, we have integrated the process into our EHR and are currently expanding the program to additional clinics,” Sadhu says.
Sunil Gupta, MD, is founder and chief medical officer of IRIS, the leading cloud-based diagnostic imaging solution and retinal telemedicine platform.