Barriers to Implementation of Teleretinal Diabetic Retinopathy Screening Programs Across the University of California

Chen, Jimmy; Lin, Mark; Yiu, Glenn; Thorne, Christine; Kulasa, Kristen; Stewart, Jay M.; Nudleman, Eric; Freeby, Matthew; Han, Maria; Baxter, Sally L.

doi:10.1089/tmj.2022.0489

Telemedicine and e-Health

2023

DOI: 10.1089/tmj.2022.0489

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Barriers to Implementation of Teleretinal Diabetic Retinopathy Screening Programs Across the University of California

Jimmy Chen

Mark Lin

Glenn Yiu

et al.

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2024

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Cited by 3 publications

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“… 7 However, some barriers for wide-scale implementation of telemedicine DR screening are still present; some examples are the lack of adherence and operational challenges such as poor network access in rural areas. 8 , 9 Hence, further work is necessary to continually optimize practices and improve long-term patient outcomes. In that sense, simplifying the imaging protocol holds the potential to increase adherence and improve the effectiveness of screening programs.…”

mentioning

confidence: 99%

Automated Identification of Different Severity Levels of Diabetic Retinopathy Using a Handheld Fundus Camera and Single-Image Protocol

Malerbi,

Nakayama,

Melo

et al. 2024

Ophthalmology Science

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mentioning

confidence: 99%

Automated Identification of Different Severity Levels of Diabetic Retinopathy Using a Handheld Fundus Camera and Single-Image Protocol

Malerbi,

Nakayama,

Melo

et al. 2024

Ophthalmology Science

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Novel Technologies in Artificial Intelligence and Telemedicine for Glaucoma Screening

Christopher,

Hallaj,

Jiravarnsirikul

et al. 2024

Journal of Glaucoma

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Purpose: To provide an overview of novel technologies in telemedicine and artificial intelligence (AI) approaches for cost-effective glaucoma screening. Methods/Results: A narrative review was performed by summarizing research results, recent developments in glaucoma detection and care, and considerations related to telemedicine and AI in glaucoma screening. Telemedicine and AI approaches provide the opportunity for novel glaucoma screening programs in primary care, optometry, portable, and home-based settings. These approaches offer several advantages for glaucoma screening, including increasing access to care, lowering costs, identifying patients in need of urgent treatment, and enabling timely diagnosis and early intervention. However, challenges remain in implementing these systems, including integration into existing clinical workflows, ensuring equity for patients, and meeting ethical and regulatory requirements. Leveraging recent work towards standardized data acquisition as well as tools and techniques developed for automated diabetic retinopathy screening programs may provide a model for a cost-effective approach to glaucoma screening. Conclusion: Leveraging novel technologies and advances in telemedicine and AI-based approaches to glaucoma detection show promise for improving our ability to detect moderate and advanced glaucoma in primary care settings and target higher individuals at high risk for having the disease.

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Implementation Mapping of the Collaborative University of California Teleophthalmology Initiative (CUTI): A Qualitative Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework

Radgoudarzi,

Gregg,

Quackenbush

et al. 2024

Cureus

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Background This study aimed to investigate the rationale, barriers, and facilitators of teleretinal camera implementation in primary care and endocrinology clinics for diabetic retinopathy (DR) screening across University of California (UC) health systems utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Methodology Institutional representatives from UC Los Angeles, San Diego, San Francisco, and Davis participated in a series of focus group meetings to elicit implementation facilitators and barriers for teleophthalmology programs within their campuses. Site representatives also completed a survey regarding their program’s performance over the calendar year 2022 in the following areas: DR screening camera sites, payment sources and coding, screening workflows including clinical, information technology (IT), reading, results, pathologic findings, and follow-up, including patient outreach for abnormal results. Focus group and survey results were mapped to the EPIS framework to gain insights into the implementation process of these programs and identify areas for optimization. Results Four UC campuses with 20 active camera sites screened 7,450 patients in the calendar year 2022. The average DR screening rate across the four campuses was 55%. Variations between sources of payment, turn-around time, image-grading structure, image-report characteristics, IT infrastructure, and patient outreach strategies were identified between sites. Closing gaps in IT integration between data systems, ensuring the financial sustainability of the program, and optimizing patient outreach remain primary challenges across sites and serve as good opportunities for cross-institutional learning. Conclusions Despite the potential for long-term cost savings and improving access to care, numerous obstacles continue to hinder the widespread implementation of teleretinal DR screening. Implementation science approaches can identify strategies for addressing these challenges and optimizing implementation.

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Barriers to Implementation of Teleretinal Diabetic Retinopathy Screening Programs Across the University of California

Cited by 3 publications

References 31 publications

Automated Identification of Different Severity Levels of Diabetic Retinopathy Using a Handheld Fundus Camera and Single-Image Protocol

Automated Identification of Different Severity Levels of Diabetic Retinopathy Using a Handheld Fundus Camera and Single-Image Protocol

Novel Technologies in Artificial Intelligence and Telemedicine for Glaucoma Screening

Implementation Mapping of the Collaborative University of California Teleophthalmology Initiative (CUTI): A Qualitative Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework

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