Grady Eye Center had a backlog of 14,000 patients to see, and most of these were diabetic screenings.
THE PROBLEM
The center did some research and realized it had more than 20,000 diabetics in Grady Health System and only 20 to 25 percent were being adequately screened for retinopathy. In addition, the burden of acute onset blindness from diabetes – vitreous hemorrhage, neovascular glaucoma, tractional retinal detachment – presenting to the emergency room was extremely high.
PROPOSAL
Grady Eye Center looked at many technologies to solve the problem, including building its own screening program, but it found great difficulty in creating an in-house IT system that integrated into its EHR, notified primary care when patients were due for an exam, placed photos into an organized work queue, allowed for reading of the photos and generation of a report, returned a report into the EHR with codes and billing, and allowed for quality control and analytics.
In its technology search, it discovered that IRIS Telemedicine could do all those things for the center.
MARKETPLACE
There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.
MEETING THE CHALLENGE
“Cameras were deployed into endocrinology, primary care clinics and our satellite neighborhood health clinics,” said Dr. Yousuf Khalifa, chief of ophthalmology at Atlanta’s Grady Health System, which is affiliated with Emory University.
“The EHR integration allowed for best practice alerts to fire when a diabetic patient was due for an exam, thus notifying the primary care doctor while the patient was in their clinic to go ahead and capture the photos," he added. "Medical assistants operate the cameras."
"The EHR integration allowed for best practice alerts to fire when a diabetic patient was due for an exam, thus notifying the primary care doctor while the patient was in their clinic to go ahead and capture the photos."
Dr. Yousuf Khalifa, Grady Health System
The telemedicine system is integrated with the center’s Epic EHR and Zeiss Forum PACS.
“The IRIS solution overcame all the hurdles we faced in creating a robust tele-retina platform,” Khalifa said. “There are many challenges one does not consider at the beginning, but through our partnership with IRIS our primary care doctors are able to identify the patients needing screening and capture photos of their retinas right there in clinic, the photos go up into a cloud where we contracted the IRIS Reading Center to perform the readings for us, the reports get populated into the chart with ICD 10 and CPT codes, patients are automatically flagged for abnormal results, which helps us schedule them for follow-up in the eye center.”
RESULTS
In the end, the work queue dropped from 14,000 to 3,000 within a year of implementation. The number of preventative lasers and injections went up in the clinics and the outcomes for the patients have been much better, according to Khalifa.
ADVICE FOR OTHERS
“Diabetic retinopathy is a huge public health problem that is the leading cause of blindness in working age adults in the U.S.,” said Khalifa. “Blindness in this age group has a huge social and economic impact that cannot be ignored.
“Healthcare organizations must acknowledge this problem and find solutions quickly,” he added. “The number of diabetics continues to grow and the number of blind will continue to grow if we don’t find effective screening tools. IRIS Telemedicine has helped us bend the curve and save vision.”
Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com