University of California San Diego, 9415 Campus Point Dr MC0946, La Jolla, CA 92093. Email:
Am J Manag Care. 2022 Oct 1;28(10):e355-e362. doi: 10.37765/ajmc.2022.89253.
To improve diabetic retinopathy (DR) screening rates through a primary care-based "teleretina" screening program incorporating clinical informatics tools.
Quality improvement study at an academic institution.
Existing DR screening workflows using in-person eye examinations were analyzed via a needs assessment. We identified gaps, which clarified the need for expanding DR screening to primary care settings. We developed informatics tools and described associated challenges and solutions. We also longitudinally monitored imaging volume and quality.
The needs assessment identified several gaps in baseline DR screening workflows. Health information technology (IT) considerations for the new primary care-based teleretina screening program included integrating the new program with existing information systems, facilitating care coordination, and decreasing barriers to adoption by incorporating automation and other features aimed at decreasing end-user burden. We successfully developed several tools fulfilling these goals, including integration with the ophthalmology picture and archiving communication system, a customized aggregated report in the electronic health record to monitor screenings, automation of billing and health maintenance documentation, and automated results notification to primary care physicians. Of 316 primary care patients screened between October 2020 and July 2021, 73 (23%) were found to have ocular pathology, including DR, glaucoma, age-related macular degeneration, and a range of other eye conditions that were previously undiagnosed.
New models of health care delivery, including telemedicine workflows, have become increasingly important for complex diabetic care coordination and require substantial health IT engagement. This program illustrates how clinical informatics tools can make substantial contributions to improving diabetes care.
通过结合临床信息学工具的基于初级保健的“远程视网膜”筛查计划，提高糖尿病视网膜病变（DR）的筛查率。
在学术机构进行的质量改进研究。
通过需求评估分析现有的基于个人检查的 DR 筛查工作流程。我们发现了一些差距，这明确了将 DR 筛查扩展到初级保健环境的必要性。我们开发了信息学工具，并描述了相关的挑战和解决方案。我们还对成像数量和质量进行了纵向监测。
需求评估确定了 DR 筛查工作流程基线中的几个差距。新的基于初级保健的远程视网膜筛查计划的健康信息技术（IT）考虑因素包括将新计划与现有信息系统集成、促进护理协调以及通过纳入自动化和其他旨在减轻最终用户负担的功能来减少采用障碍。我们成功开发了满足这些目标的几种工具，包括与眼科图片和存档通信系统的集成、在电子健康记录中用于监测筛查的定制聚合报告、计费和健康维护文档的自动化以及向初级保健医生自动通知结果。在 2020 年 10 月至 2021 年 7 月期间筛查的 316 名初级保健患者中，有 73 名（23%）被发现患有眼部病理学，包括 DR、青光眼、年龄相关性黄斑变性和一系列其他以前未确诊的眼部疾病。
包括远程医疗工作流程在内的新医疗保健交付模式对于复杂的糖尿病护理协调变得越来越重要，需要大量的健康信息技术参与。该计划说明了临床信息学工具如何为改善糖尿病护理做出重大贡献。
