Abstract
Purpose :
To determine the clinical and financial impact of a single-center pilot tele-ophthalmology screening program for diabetic retinopathy at the University of California Davis (UCD) Health System.
Methods :
A pilot tele-ophthalmology screening program was implemented at a large UCD ambulatory care center by deployment of a Nidek AFC-230 camera, training of camera operator, engagement of pre-visit planning nurses, education of primary care physicians, creation of an electronic health record (EHR) system order set, and development of an image-grading protocol and work-flow using an on-site reading center under supervision by a retinal specialist, with integrated Picture Archiving and Communications System (PACS) system for store-and-forward image interpretation.
Results :
A total of 352 eyes from 176 patients underwent tele-ophthalmology screening over a 5 month period. At time of inquiry in October 2018, 64% of claims were paid and 15% of charges were denied, based on the use of CPT code 92227. Mean diabetic retinopathy screening rates at the single center increased from 48+/-0.8% in the 4 months before the pilot program, to 58+/-3.8% in the 4 months following tele-ophthalmology screening implementation (P < .009), while the entire UCD health system increased from 37+/-.08% to 41+/-1.4% (P < .003). Among the images collected, 6% were ungradable, 7.95% of gradable images showed referable diabetic retinopathy and 19.9% of gradable images showed other macular or optic nerve pathology resulting in referral to the ophthalmology service.
Conclusions :
Implementation of a tele-ophthalmology program improved screening rates of diabetic retinopathy at a single ambulatory care center at UCD and resulted in increased referral to the ophthalmology service. Significant challenges remain, with limited portion of claims paid and many patients still not adequately screened. Future employment of EHR automation, machine learning-assisted image interpretation, and changes in reimbursement paradigms may help improve penetration of tele-ophthalmology screening programs across other health systems.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.