1. Case Study: Scope and Purpose This Case Study was developed to demonstrate the use of IMI telemedicine technology in a “real life” ophthalmic clinical situation The scenario presented highlights the major features of the system, and demonstrates portions of the interaction with the system The complete patient care process is depicted, enabling the patient to benefit through application of the technologies

2. Where applicable, each page contains: –A scenario that provides the narrative for the demonstration –A features description, with instructions, describing the steps to follow in operating the system –Note: The pointer ( + ) indicates the primary action Tele-Ophthalmology Case Study

3. Scenario: Mary James is a 68 year-old retiree who visits her Ophthalmologist with complaint of sudden visual loss and pain in her right eye. The symptoms have been present for 72 hours. Features: The technician locates Ms. James’ folder, and opens the folder to review her recent information: Locate Ms. James’ folder by clicking on the “J” in the Rolodex Select the patient folder by double-clicking on the line containing James, Mary in the Grid Tele-Ophthalmology Case Study +

4. Scenario: After the record for Ms. James is double- clicked, the Patient Folder is displayed. The ophthalmic technician would like to review recent exams and her current meds. The technician checks intraocular pressure and finds that the pressure is extremely high. Features: Once the Patient Folder is displayed, the technician is able to click on the Clinical Events button just below the folder to review further information for this patient. The Clinical Events screen is displayed, enabling the technician to review the recent examinations and related information. The technician observes that the patient is diabetic and taking insulin. + +

5. Tele-Ophthalmology Case Study Scenario: The ophthalmic technician then checks the patient’s lab work and notices an elevated blood glucose level, and documents the elevated intraocular pressure. Dr. Ward enters the exam room a few minutes later and greets Ms. James. He begins to discuss her history of visual loss and recent visual changes, and examines both her eyes. He realizes that a glaucoma specialist is needed immediately. Features: The technician sees that the glucose value is highlighted in red, indicating that it is out of normal range. Dr. Ward and the technician then examine and document the patient’s condition in the Progress Notes area of the record. +

6. Tele-Ophthalmology Case Study Scenario: Dr. Ward then decides to use PARADIGM’s Office Visit capability to begin his videoconference with Dr. Logan, a glaucoma specialist. They discuss the patient’s symptoms, and decide to have Ms. James visit Medical Center for emergent PRP and implementation of glaucoma medication. Features: Dr. Ward initiates a videoconference with Dr. Logan by selecting Dr. Logan’s number and calling him on the Office Visit videophone.

7. Tele-Ophthalmology Case Study Scenario: Dr. Ward and Dr. Logan then decide to review one of the images together. They select the image to review, then start the PARADIGM Consult module to share the image. Features: Dr. Ward starts PARADIGM Consult and transfers an image to Dr. Logan. Drs. Ward and Logan then use the Consult shared screen to discuss and annotate the images, while talking over the Office Visit videoconference.

8. Tele-Ophthalmology Case Study Result: Drs. Ward and Logan conclude that Ms. James’ symptoms are a result of neovascular glaucoma, following an old CRAO. Ms. James is very pleased with the speed and efficiency of the care she received. Dr. Ward and Dr. Logan have improved the patient’s time to wellness, and provided care in a very productive and cost-effective manner. +