Diabetic retinopathy is the leading cause of adult blindness in the U.S. One of the greatest barriers to prevention is access.
This content is sponsored by Microsoft
All diabetic patients are asked to visit an eye care provider for an annual diabetic retinal exam, but very few patients follow through. Leading healthcare providers are turning to new technology and processes to improve patient compliance and detect eye disease early.
During a Sept. 26 webinar sponsored by Microsoft and hosted by Becker's Hospital Review, leaders from a health system and a medical group described their experiences implementing diabetic retinal exam solutions for primary care that integrated with their organization's unique processes, workflows and EHR.
Panelists included:
- Yousuf Khalifa, MD, chief of service, ophthalmology, Grady Hospital (Atlanta)
- Anas Daghestani, MD, president and CEO, Austin Regional Clinic
- moderated by Jason Crawford, MBA, CEO, Intelligent Retinal Imaging Systems
How Grady Hospital operationalized a scalable diabetic retinal program in primary care
Grady Hospital is the largest hospital in Georgia and the fifth largest public hospital in the U.S. It provides primary care services to more than 175,000 patients, of which are 25,000 are diabetic. Before redesigning their diabetic retinal exam program, approximately 44 percent of diabetic patients did not undergo an annual eye exam.
Grady Hospital was challenged to close the care gap while improving access for diabetic retinal exams. "Really, diabetic retinopathy is a population health problem, and that's how we approached it," Dr. Khalifa said. He explained how Grady implemented IRIS, a diabetic retinal exam solution integrated with their EHR, in their primary care clinics to achieve this goal.
Dr. Khalifa first identified five primary care clinics that served a majority of their diabetic patient population and implemented diabetic retinal exam programs within their workflows. To improve retinal eye exam compliance, Grady built best practice alerts, or a protocol for retinopathy, into their EHR to proactively track and identify noncompliant patients. The protocol looked through the EHR for patients with ICD-10 codes indicating diabetes, then examined at each patient's record for CPT codes designating either an eye exam or retinal photograph. The protocol then pinged PCPs of patients who did not have those CPT codes, alerting them to the patient's need for services.
The program resulted in a 60 percent increase in patients examined. Additionally, retinal pathology was diagnosed in 41 percent of patients as a result of primary care exams.
How Austin Regional Clinic operationalized a scalable diabetic retinal program in primary care
Austin Regional Clinic had a 35 percent screening rate for diabetic patients before redesigning their diabetic retinopathy protocol. They aimed to improve screening rates and follow-up treatment and improve cost of care through early intervention.
To achieve this goal, Dr. Daghestani brought diabetic retinopathy exams to patients in the primary care office by integrating the IRIS solution with their EHR. Austin Regional eventually expanded the IRIS program across nine clinics. DR exams were ordered during routine primary care visits using onsite cameras to capture and export images. If the images indicated pathology, patients were immediately referred to specialists to ensure the patient saw the right physician at the right time to improve health outcomes.
Within two years, the program resulted in a 20 percent improvement in screening rates, 70 percent improvement in follow-up rates on abnormal results and improvement in patient and physician satisfaction.
"Next on our radar, we are planning to expand [IRIS] to other clinics and provide practice-level results to our physicians to give them insight into their practice, and comparing them to other practices," Dr. Daghestani said.
Key findings
Drs. Daghestani and Khalifa noted several keys to success for healthcare organizations considering implementing diabetic retinal exam programs.
- Onsite access in a primary care clinic to appropriate cameras and equipment
- Easy-to-use technology
- EMR integration
- Emphasis on follow-up treatment
- Partnership with IRIS
To watch a recording of the webinar, click here.