Lecture 26: Telemedicine in Eye Care - Challenges and Innovations

Telemedicine

delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education all in the interest of advancing the health of all individuals and their communities

American Telemedicine Association

develops guidelines and accreditation standards for health care providers and agencies engaged in telemedicine

Common conditions in ocular telemedicine

Diabetic Retinopathy, Glaucoma, AMD, Retinopathy of Prematurity, Maybe cataracts and Refractive Error

OD with ATA

Jerry Cavallerano

Telemedicine vs. Telehealth

Telemedicine-services delivered by physician only

Telehealth- more broadly defined as services delivered by health professionals ing eneral

4 elements of telemedicine

1. Provide clinical support

2. Overcome geographical barriers, connecting users who are not in same physical location

3. Involves the use of information and communication technologies

4. Improve health outcomes

Highest need for vision care providers

rural areas

County in Ohio without any eye providers

Morgan county

Telescreening

screenings are provided in a community setting, such as FQHC, and the results are forwarded electronically to a diagnostic referral center for interpretation by an eye care provider

Benefits of telescreenings

early detection of the eye diseases

Distant/Hub Site

The site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunication.

Originating/Spoke Site

Location of the patient at the time the service being furnished via a telecommunications system occurs.

Screening Model

large numbers of patients undergo testing in environment where they are only seeking to identify diseases, results are all or none, those with disease are referred, used by service organizations or lend itself well to a site outside of health care community

Evaluative/Diagnostic Model

more information is obtained by reviewing the screening and provides a more specific diagnosis of the patient; patients are then prioritized into a health care program based on severity; Used in VAs

Consultative/Second Opinion Model

clinicians collect data and send it to a consultant or a tertiary care provider; sending images, etc.

Synchronous approach

both parties at the same time and communication link between them that allows a real-time interaction to take place

Asynchronous/Store-and-forward

communication in which messages are sent and received at different times; used commonly in optometry

Medicare and Medicaid Reimbursement for Telemedicine

Prefers synchronous to asynchronous and tends to not recognize asynchronous as care

Project Muse

telemedicine approach in FQHC

Number of US Veterans that live in rural communities

4.5 million

Technology-based Eye Care Services (TECS)

VA system; trained ophthalmology technicians see patients at their PCP, gather medical history, take vision measurements, conducts a manifest refraction, checks IOP and takes retinal photographs; shared with remote specialist

Agreement for TECS screening protocol and face-to-face exam

84%-98%; really good for diabetic retinopathy, moderate for glaucoma and ARMD

American Indians and Alaska Natives and diabetes

highest prevalence rate of diabetes; twice the rate of general population; only have receive there annual eye exam

Joslin Vision Network

in VA and IHS; imaging done in primary care and endocrinology clinics; certified imagers takes non-mydiatic retinal images

Joslin Vision Network evaluation of images

10% are ungradable (cataracts, etc.)

Challenges to telescreening programs

Equipment, Facility cost, Contracting eye care providers, training local caregivers to preform telescreenings, imaging technology may lack sufficient diagnostic sensitivity and specificity, methods to encrypt patient data may not meet security needs

Idx-DR

software program that uses AI algorithm to analyze images of the eye taken with a retinal camera; first FDA approved (Topcon) abovee 90% sensitivity and specificity