1. CHRISTINA SHEPPLER, PHD Devers Eye Institute Telehealth Alliance of Oregon 2013 Implementing a Telemedicine Program for Diabetic Retinopathy Screening at an Internal Medicine Clinic: Benefits, Barriers & Future Directions

2. BACKGROUND Diabetic retinopathy (DR) is the leading cause of blindness in adults aged 20-74. DR usually has no symptoms in its early stages Early diagnosis and treatment can reduce the likelihood of severe vision loss by 90% Approximately 50% of those diagnosed with diabetes obtain annual eye exams.

4. OVERVIEW Program Goals Program in Practice Qualitative Study Objective Findings Future Directions

5. PILOT PROGRAM GOALS Goal 1: Increase the proportion of patients with diabetes that are screened for retinopathy Goal 2: Address common screening barriers with “one stop” diabetic care Goal 3: Determine whether telemedicine service would be reimbursed by insurance We partnered with LMGNW’s Internal Medicine Clinic to pilot the diabetic retinopathy screening telemedicine (DRST) program

6. PROGRAM IN PRACTICE Equipment Non-Mydriatic Camera (NIDEK Model NM-1000) Laptop w/ Software to Transfer Retinal Images Technician Training Clinic medical assistants Ophthalmic imaging manual Two training sessions

7. PROGRAM IN PRACTICE (continued) Patient Screening Charts reviewed to “flag” eligible patients Approaching Patients Telemedicine screening presented by physician Brochures in waiting room

8. PROGRAM IN PRACTICE (continued) Imaging & Transferring Photos Imaging during primary care appointment Photos transferred using the Remote Client software

9. PROGRAM IN PRACTICE (continued) Evaluation Photos evaluated by Dr. Mansberger Report generated and faxed to primary care provider Pilot Program Results 5 doctors referred patients 13 patients imaged Pilot program lasted 5 months

10. CURRENT STUDY OBJECTIVE Obtain feedback from the clinic regarding perceived benefits of the program perceived barriers to implementation possible improvements sustainability potential METHODS Semi-structured interviews with clinic manager clinic physician medical assistants

11. RESULTS BENEFITS Capturing the patients who would not normally see an eye doctor Telemedicine makes screening easy for all patients New skill for medical assistants

12. RESULTS (continued) BARRIERS Program Not Presented to Patients Difficulty with Imaging Medical Assistant Restrictions Time

13. RESULTS (continued) IMPROVEMENTS Equipment Additional staff devoted to imaging Contacting patients in advance Sending evaluation results

14. RESULTS (continued) REIMBURSEMENT Charges submitted for 10 of the 13 patients Amount billed by clinic was $102 8/10 claims were reimbursed Average reimbursement was $65.90 (65%)  Average Medicare Payment = $54.75 (54%)  Average Private Insurance Payment = $77.05 (76%)

15. Summary Program adoption is a process work flow issues need to be addressed “we are willing to try new things, but slow to make changes” Clinic staff viewed the program as important and worthwhile “telehealth is really taking off and this is a neat possibility” Identification of barriers can aid future implementation efforts Program has the potential to be self-sustaining, so future efforts will focus on securing “start up” funds

16. Questions ?