Digitised retinopathy screening improves efficiency

By Roibeard O’hÉineacháin

GOTHENBURG — A digitised approach to diagnosis and referral can increase efficiency and reduce the cost of providing optimum health care to patients with diabetic eye disease, a Swedish ophthalmologist told the 7th International Conference on Low Vision
“Blindness in diabetic eye disease can be prevented by early detection, timely treatment and regular follow-up.

“A conventional full-scale healthcare programme however consumes resources. With our digitised model we have achieved greater efficiency, a cost-reduction of consultations and an assurance of quality healthcare for diabetic eye disease,” Helle Kalm MD said.
The new digitised programme is based on the local Gothenburg healthcare model for the diagnosis and management of diabetic eye disease.
It involves having ophthalmic nurses and their assistants perform a range of examinations including digital fundus photography.
“In the Gothenburg model we use fundus topography as a screening method and also at follow-up. In addition, we focus on medical risk factors and try to get an updated risk factor profile at each re-screening.

“We have regular communication between the eye department and patients’ GPs and we have clear-cut guidelines for the information we give the patients,” she said.
By using specially developed software together with retinal images and digitised medical records, the "telemedicine" model greatly simplifies the process of screening, diagnostic evaluation, information and post-laser follow-up, she explained.

In the new digitised programme, initiated in January 1999, ophthalmic nurses and their assistants use two digital fundus cameras each with a digital technician.
One of the cameras is in the eye department and the other is at another hospital. Both are attached to the same computer network used by the healthcare providers.
Component Object Model (COM) technology was used to integrate the digital cameras, a server and the hospital patient administration system. The user manual, Guidelines, Diabetic Retinopathy, Sahlgrenska University Hospital, was used as a guideline for the software development.

The ophthalmologist viewing the retinal images then chooses from pre-selected diagnosis options, such as proliferative or non-proliferative, or clinically significant macular oedema, and makes treatment recommendations accordingly.
The system’s software then incorporates the diagnosis together with other clinical information into the patient’s records, which include the new profile as well as an overview of their initial and follow-up visits.
In addition, certain diagnoses and clinical findings act as automatic triggers to arrange for referral to treatment. For example, a patient who has vision below 20/50 will be referred to a low vision clinic.

“Our system has been tested on more than 4,500 patient visits, covering the whole spectrum of health care from screening to post-treatment follow-up.
“Our health care process has been analysed and fully documented. Images and digitalised recording sheets have been combined and a logistic for workflow established,” she added.
Dr Kalm noted that compared to the conventional appointment model, the telemedicine approach has provided more efficient medical intervention and a reduction in diagnosis procedures. It also allows ophthalmologists to examine more patients in a cost-effective way.

For example, a doctor can see 15 patients on one shift with the conventional approach to screening whereas they can see 50 patients in one hour with the telemedicine model.
When the salaries of all those involved are added up, the telemedicine approach reduced the cost of an eye examination by one third compared to the conventional appointment model.
“Applying telemedicine offers high quality reading of photographs and treatment advice to persons with diabetes and to health care providers,” she said.

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