By Anas Daghestani, MD
ARC CEO, Medical Director Population Health & Clinical Quality
It has been six years since ARC first piloted the Intelligent Retinal Imaging Systems (IRIS) program in three of our clinics. Recognizing the need to make blindness prevention easier for our patients and to raise our quality performance with the diabetic retinopathy exam (DRE), ARC partnered with IRIS and Austin Retina Associates (ARA) to bring the exam in-house. Eighteen ARC clinics now provide easy access to high-quality diabetic eye exams at the time of a visit with the primary care provider or when patients are getting routine diabetic blood tests. What was the driver behind this technological advancement?
Diabetic retinopathy threatens the vision of more than 5 million U.S. adults over age 40. The leading cause of blindness in this country, diabetic retinopathy can affect anyone diagnosed with Type 1 or Type 2 diabetes, so blindness is a real possibility for millions of Americans. Diabetic retinopathy is highly preventable and treatable if caught early. Still, data suggest fewer than half of people living with diabetes keep up with the recommended annual eye screening.
Step one: identify the problem
In the past, our primary care providers relied only on encouraging their diabetic patients to see an eye care specialist to receive the exam. Despite our proactive efforts - using electronic medical record alerts, mailing letters, making phone calls, and delivering in-person reminders - we barely moved the needle from a 45% annual DRE screening rate, which is just above Texas screening rate and right at national average. But average was not our aim.
Several hurdles kept our patients from fulfilling their important preventive screening. Mostly, the obstacles fell under the heading of inconvenience.
Step two: identify a solution
Our physicians and staff members wanted to change this dynamic and convince patients to get screened. It was only because of advancements in technology that we found a way to achieve this goal with IRIS, a young but a very promising startup company at the time. Additional factors that contributed to the selection of IRIS were step-by-step guidance during implementation and training, ongoing client support, proven experience integrating with an EPIC EMR interface and the ability to partner with ARA, a high-quality local retinal specialty group.
The eye screening is ordered by the patient's physician. It is painless, takes less than 10 minutes to complete, and is administered at ARC after your appointment.
Step three: develop a standard, repeatable process
The process begins with a patient identification process through ARC's Epic electronic medical record system, an order can be placed by the patient's primary care provider or by ARC Population Health staff. Once a patient has been flagged as needing a DRE, any trained ARC staff can administer the exam at the end of the appointment. High-quality images are then sent to Austin Retina Associates, who provide almost immediate remote interpretations. Finally, the diagnostic results and recommendations are delivered back to the ordering provider, who works with the patient to develop an ongoing screening schedule and management plan.
The first IRIS exam taken at ARC was on August 18, 2015. In the remaining months of 2015, the three ARC clinics that were live with an IRIS program performed 1,112 diabetic retinopathy screening exams. Of those, 244 patients were diagnosed with diabetic retinopathy. ARC patients like Demetrius and Stella have been able to halt the progression of diabetic retinopathy and even improve their vision with prescribed treatments.
ARC's timeline of success
At the end of 2016, after the first full year of using the IRIS solution, 60% of patients with diabetes had received the exam. This was a noticeable improvement from the 45% compliance rate pre-IRIS.
By 2017, the IRIS solution was expanded to a total of nine of the 21 existing ARC clinics. Placement has been determined by the volume of diabetic patients and the number of physicians at each location.
In 2019, two additional ARC clinics adopted the IRIS solution, bringing the total to eleven tabletop cameras across the organization.
Despite a COVID-19-induced slowdown in the capturing of patient exams, ARC grew IRIS exam volume by 3.8% year over year in 2020 to over 4000 diabetic patients screening for DRE at ARC
ARC added handheld IRIS devices at two clinics and confirmed that it produced equally accurate results as the tabletop solution and required less space. This allowed for rapid expansion to an additional five clinics in September, for a total of 18. The handheld option gives patients in more rural areas the same easy access to blindness prevention technology.
Between 40 to 45% of Americans diagnosed with diabetes have some stage of diabetic retinopathy and the rate of blindness is about 2%. This means for every 1,000 patients screened, we've prevented 20 people from becoming blind. Screening almost 5,000 patients a year, we have so far prevented at least 100 people from becoming blind and assisted many others in the management of other eye conditions. While we celebrate our successes, our aim is to reach a 100% screening rate for our patients with diabetes. Dedicated partners like IRIS and Austin Retina help us stay on that path as we improve the process and technology and inch closer to our goal each year.
Now, instead of, "I don't have time for another appointment, " or, "I'm too young to worry about eye disease, " we hear, "You just made my eye exam so easy, " or as Stella told us, "I feel like I see 20/20 again." Thanks to the commitment of our physicians and staff to solve this challenge, our patients with diabetes now have easier access to effective tools to prevent blindness and achieve better health outcomes.
Dr. Anas Daghestani is CEO of Austin Regional Clinic and the Medical Director of ARC Population Health & Clinical Quality.