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Ingrid E Zimmer-Galler, Muge R Kesen, Richard Watson; Improving health care delivery and quality assurance by integration of a telemedicine diabetic retinopathy assessment program with an electronic health record. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1437.
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Appropriate screening and timely treatment of vision-threatening diabetic eye disease has been demonstrated to significantly impact vision outcomes in patients with diabetes. Telemedicine technology has been shown to be an effective adjunct method to increase adherence to guidelines for assessment of diabetic retinopathy in patients with diabetes. With the advent of electronic health records, an opportunity exists to dramatically enhance and measure the performance of telemedicine systems to ensure delivery of quality medical care. The purpose of this project is to describe the novel integration of such systems and review the benefits in health care delivery achieved with this innovative approach.
A telemedicine diabetic retinopathy assessment system which features highly automated, non-mydriatic fundus cameras and a cloud-based telemedicine platform with a remote reading center was deployed in a university-based health care system. The telemedicine platform was integrated into the electronic medical record allowing seamless ordering, capturing of retinal images and reporting of test results.
Health care delivery benefits demonstrated with system integration include optimizing program efficiency by simplifying ordering of the screening test in the primary care setting, reducing time to perform the point-of-care retinal imaging, facilitating referral processes for screen-positive patients and streamlining billing and capturing reimbursement for the imaging.<br /> Enhancement of quality assurance measures achieved with consolidation of telemedicine and electronic health record systems include reporting the time between screening events and review of results by the primary care physician, ensuring annual screening intervals and confirming inclusion of reports in the permanent medical record.
The integration of a diabetic retinopathy telemedicine system with an electronic medical record holds significant promise for advancing health care delivery, assessing quality measures and meeting key performance indicators. Future directions with this approach may include measuring discreet data points related to eye disease, severity, treatment and time to treatment. Additionally, integration with a patient database will allow a fail-safe method to identify all eligible patients due for diabetic retinopathy assessment.
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