How St. Elizabeth Healthcare’s Retinal Eye Exam Program Boosted Rates and Revealed Sight-Saving Diagnoses

diabetic retinal imaging

St. Elizabeth Healthcare serves as one of the oldest, largest, and most respected medical providers in the Greater Cincinnati Area. With over 10,000 associates,1,200 providers, and 165 multi-specialty and primary care locations, St. Elizabeth serves all of Northern Kentucky, Southern Indiana, and Ohio. They were struggling to find a comprehensive retinal eye exam solution to improve hospital efficiency and increase their capacity to catch retinal pathologies early. Once St. Elizabeth Healthcare implemented IRIS technology, St. Elizabeth Healthcare saw an immense shift in patient compliance and the identification of pathologies. 


Exams Performed to Date


Patients Who Were Identified with Diabetic Retinopathy, Early and Late-Stage AMD, Glaucoma, Cataract, Epiretinal Membrane, or Other Ocular Pathologies


Cases of Diabetic Retinopathy Identified


IRIS Saves


Exam Gradable Rate


St. Elizabeth sites with IRIS technology implemented


1 in 10 Americans are affected by diabetes, and over 40% of these patients are diagnosed with diabetic retinopathy. With their wide-reaching practices, St. Elizabeth wanted to put systems in place to support patients and ensure individuals with diabetes were receiving their annual eye exams.

Before implementing IRIS, St. Elizabeth did not have any tools to provide these retinal eye exams in primary care settings, instead making referrals to external eye care specialists.

“As a primary care provider, one of the most frustrating things is to know what to do with a patient and how to provide care, but not to be able to do it,” explained Dr. Meghan Markovich, Physician Director, Value-Based Care, St. Elizabeth Health Care.

Without the ability to complete retinal eye exams in-office, St. Elizabeth Healthcare found patient compliance with these exams was low— problems would arise either due to patients living in areas with limited access to eye care, or due to trying to integrate results to patients’ charts after receiving an external screening. 

Lack of compliance and integration resulted in poor performance and low screening rates for St. Elizabeth’s diabetic patients. In March and April of 2018, St. Elizabeth’s screening rates dropped to nearly 30%.

Eager to make a change and support their at-risk patients, St. Elizabeth began looking for an in-house retinal eye exam system that could easily integrate into their extensive healthcare network.


After a long evaluation process with multiple retinal eye exam providers, St. Elizabeth Healthcare decided to partner with IRIS to build a consistent standard of care for their at-risk patients and increase exam compliance.

IRIS is an FDA Class II retinal telehealth platform developed to help end preventable, permanent blindness caused by diabetic retinopathy. After partnering with IRIS, St. Elizabeth Healthcare and the IRIS team worked to implement the retinal screening solution across more than 20 locations. 

IRIS’s history of successful integration with Epic, St. Elizabeth’s EMR system, made for a streamlined implementation process. The success was immediately apparent, and soon requests came in from St. Elizabeth locations without an IRIS system in place hoping to integrate it for their own patients.

“It felt like a true partnership in how we worked together, more so than a vendor-client relationship.” – Hank Kerschen, AVP Primary Care & Clinical Transformation, St. Elizabeth Physicians 

By 2021, IRIS has implemented its sight-saving technology in 31 total sites across the St. Elizabeth Healthcare system, with plans to add 10 additional locations by midyear.

Instead of having to refer patients to outside eye care providers and hope for the best, IRIS provided St. Elizabeth with a fully integrated, end-to-end solution. Better yet, the exam process could be carried out with little interference in the practitioners’ standard workflow. 

The retinal eye exam process at St. Elizabeth now follows this structure:

1. Point-of-care image capture: 

When patients with diabetes come into St. Elizabeth for a routine appointment, the retinal eye exam is now built into their visit. After an appointment is complete, trained staff will enter the room to capture patient images with a portable retinal imaging camera. This exam itself takes less than 2 minutes. Capturing a retinal eye exam with IRIS does not require licensure or advanced training, so St. Elizabeth Health Care enabled medical assistant staff to lead the tests.

2. Image Upload and Enhancement: 

The retinal image taken during the exam is then uploaded to the cloud-based platform. IRIS’s software enhances the image, in turn increasing gradeability and decreasing the chances of false results or repeated images. After the image is enhanced, it is sent out to a qualified, external ophthalmologist at the IRIS Reading Center for review.

3. Diagnosis: 

After receiving the enhanced image through the cloud, the ophthalmologist then provides a remote diagnosis. The physician can provide nuanced diagnostic results for different stages of diabetic retinopathy, as well as make note of additional suspected pathologies present in the eye.

4. Integration and Referral: 

Diagnoses are returned and integrated directly into St. Elizabeth’s EMR and the patient’s chart. St. Elizabeth staff will then reach out to patients, notifying them of their results and prescribing further care if necessary.

By creating a simplified exam process built-in to existing patient visits, St. Elizabeth saw compliance and sight-saving diagnoses skyrocket.



Exams Performed To Date


Patients With Identified Pathology — Diabetic Retinopathy or Otherwise. Other suspected diseases include early and late-stage AMD, glaucoma, cataract, epiretinal membrane, and other ocular pathologies


Patients with Identified Diabetic Retinopathy


IRIS Saves — Patients identified with sight-threatening pathology who presumably did not know they had the condition because of a lack of historical testing


Average Exam Gradable Rate


After implementing IRIS technology, physicians at St. Elizabeth Healthcare were thrilled to see diabetic patients who hadn’t received an eye exam in years finally receive sight-saving diagnoses.

Patients appreciated the new exam offering, as it didn’t require them booking an additional appointment or paying for specialty care. Providers also found the process extremely hands-off, and saw huge payoffs from the adjustment in workflow.

Once testing began to ramp up, St. Elizabeth Healthcare found that 1 in 10 patients with diabetes were having issues related to diabetic retinopathy without knowing.

A lot of patients who received the exam initially were “non-compliant patients,” or diabetic patients who had not visited an ophthalmologist in a long time for their annual retinal eye exams.

IRIS enabled St. Elizabeth physicians to finally capture these patients at the point of care, close care gaps, and ensure future care. 

“[IRIS] gives us back a lot of power to take care of patients in the moment.” — – Dr. Meghan Markovich, Physician Director, Value-Based Care, St. Elizabeth Health Care

After struggling to surpass a 60% screening rate of eligible patients completing their diabetic eye exams in 2018, St. Elizabeth finished off 2019 with a screening rate above 80% only one year into their partnership with IRIS. In 2021, they expect to surpass these numbers.


Clinical impact is the clear driving force behind why St. Elizabeth and other health providers partner with IRIS to provide DR exams at the primary level. However, diabetic retinopathy screenings and exams have an inherent financial impact as well.

Of course, there are costs associated with running a retinal eye exam program and acquiring the proper equipment, including cameras. However, by adding in-house retinal eye exam programs to your healthcare system and increasing patient compliance, you can receive financial bonuses and incentives.

The performance metrics that accompany a successful telehealth program like St. Elizabeth’s lead to financial incentives, including:

  • Value-based contracts
  • Payer uptake
  • HEDIS/quality bonuses
  • HCC and RAF adjustments

In the end, primary care DRE programs can result in better patient care as well as financial success.

Alternatively, the downstream repercussions of late diabetic retinopathy detection are expensive, and importantly, preventable. By removing all barriers to early DR detection, patients and healthcare systems can save sight and cut costs.  

“If I had known we were going to get the outcomes that we’ve seen, I would’ve pushed a lot harder to get it implemented a lot sooner.” – Hank Kerschen, AVP Primary Care & Clinical Transformation, St. Elizabeth Physicians 


An effective telehealth program for diabetic retinopathy requires buy-in from patients, providers, and staff alike.

For St. Elizabeth, they were able to empower staff and clinics by helping people understand the “why” behind a primary care retinal eye exam program. Upon implementation, St. Elizabeth emphasized that a retinal eye exam was not just a checkbox on a patient’s chart, but a valuable tool that can impact people’s lives and save their sight.

Once implemented, physicians could easily communicate with patients not only the importance of the exam, but the benefits that came with receiving it through primary care. These range from financial coverage, lessening the number of patient visits, increased ease of exam, and the reduced necessity for dilation.

As rollout increased, St. Elizabeth found it essential to be transparent about retinal eye exam results. This meant utilizing IRIS’s customized analytics dashboard to share clinical successes and track goals across the healthcare system. 

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