1. Gerald J. Selvin, OD Leonard Goldschmidt MD

2. Highlights of FY09 Much smoother operation with few if any “burps”. Images are being deleted Software is stable Vendor is cooperative and a partner Leads have been working together nearly 4 years. Quality Managers are remarkably efficient and helpful. Greater than 20% increase in workload vs FY 08 Increasing participation and awareness of dermatology in CCSF Store and Forward (Tony and Junius)

3. CCSF: Teleretinal Report– September 2009 284 cameras deployed nationwide – at most recent count 462,568 patients screened FY06-present 33,766 patients screened in FY2006 168,620 patients screened in FY2007 120,883 patients screened in FY 2008 139,279 screened in through the 1 st 11 months of FY2009 (projected 152,000 for FY09)

4. And this has enabled us to… Meet HEDIS 88% target required for retinal exam for diabetic patients (up from non compliant 86%) Help teleretinal imaging to become a permanent part of the clinical landscape in facility after facility. Risk assess and do what we’re paid to do…..preserve vision and triage risk more efficiently Meet System Redesign and access goals more efficiently

6. CCS site visits with review by Teleretinal Leads and Quality Management Team FY09 V8: October 2008 V19: November 2008 V1: April 2009 V2: June 2009 V11: July 2009 V23: August 2009 V10: September 2009

7. Perspective of the program from implementation.…. RFP (IL-2005-001) dated 1/13/05 and released to field 1/19/05 Spelled out program Requirements and deployment strategy http://vaww.va.gov/occ/Docs/TeleretinalRFP1-19- 05.pdf http://vaww.va.gov/occ/Docs/TeleretinalRFP1-19- 05.pdf

8. Teleretinal kickoff meeting St Pete: January 2006 More collaboration Eye Clinical engineering IT CAC Implementation team PCP Work group agreed on program clinical design and templates

9. Implementation FY06 and beyond 17 VISNs received awards based on response to RFP Funding was for cameras, imagers, readers, limited admin. Purpose was to “seed” such that the program could “sprout” into something permanent FY 06 workload: 33,766

10. Beyond FY 06… All 21 VISNs implemented over the next 2 years FY 07: 168,620 (why so high???) FY 08: 120,883 FY 09: projected 152,000

11. Workload is just that… Quality management: CCS VISN reviews CCSF Training Center reader and imager continued competency CCSF Training Center Patient Satisfaction Survey Continuous monitoring of patient safety issues Image deletion Guidance for selective use of dilation Any required change on the fly

12. Reader/imager QA Competence for both imagers are readers is tested before leaving the training center and is required (passing) before they are certified. Reader competence is the highest risk: Adjudicated cases used in training center Strictly proctored Periodic competency evaluation of field readers…

13. Field competence testing of readers… LMS based Bank of adjudicated cases Many beta versions until we were satisfied…..slow but careful And if a reader fails? CCSF Training Center provides remedial plan to VISN QM Re-testing after appropriate re-learning

14. CCSF Training Center results Patient satisfaction survey Are our patients happy with the service? Satisfaction is 4.76 on a scale of 5 Are we foisting something on them that they perceive as a barrier or have they bought into what we know is the “right care at the right time in the right place”? No! Patients feel taken care of and correctly managed. Reader/Imager QA program 100% pass rate

15. Ongoing projects Guidance (nationally) on the use of dilation in Teleretinal Imaging Implementation of strategic plans which include Regional reading centers Investigating teleretinal validation for other diseases such as glaucoma and amd.

16. Principals to live by Teleretinal belongs in every location that has diabetic patients (We’re getting there!) Teleretinal is as much a part of the clinical landscape as any other medical or surgical service There is a wealth of valuable clinical information obtainable via teleretinal, a process patient friendly, efficient, and cost effective