Gerald J. Selvin, ODLeonard Goldschmidt MD

Highlights of FY09Much smoother operation with few if any

“burps”.Images are being deletedSoftware is stableVendor is cooperative and a partnerLeads have been working together nearly 4 years.Quality Managers are remarkably efficient and

helpful.Greater than 20% increase in workload vs FY 08Increasing participation and awareness of

dermatology in CCSF Store and Forward (Tony and Junius)

CCSF: Teleretinal Report– September 2009284 cameras deployed nationwide – at

most recent count462,568 patients screened FY06-present

33,766 patients screened in FY2006 168,620 patients screened in FY2007120,883 patients screened in FY 2008139,279 screened in through the 1st 11 months

of FY2009 (projected 152,000 for FY09)

And this has enabled us to…Meet HEDIS 88% target required for retinal

exam for diabetic patients (up from non compliant 86%)

Help teleretinal imaging to become a permanent part of the clinical landscape in facility after facility.

Risk assess and do what we’re paid to do…..preserve vision and triage risk more efficiently

Meet System Redesign and access goals more efficiently

CCS site visits with review by Teleretinal Leads and Quality Management Team FY09V8: October 2008V19: November 2008V1: April 2009V2: June 2009V11: July 2009V23: August 2009V10: September 2009

Perspective of the program from implementation.….RFP (IL-2005-001) dated 1/13/05 and

released to field 1/19/05Spelled out programRequirements and deployment strategy

http://vaww.va.gov/occ/Docs/TeleretinalRFP1-19-05.pdf

Teleretinal kickoff meeting St Pete: January 2006More collaboration

EyeClinical engineeringITCACImplementation teamPCP

Work group agreed on program clinical design and templates

Implementation FY06 and beyond17 VISNs received awards based on response

to RFPFunding was for cameras, imagers, readers,

limited admin.Purpose was to “seed” such that the program

could “sprout” into something permanentFY 06 workload: 33,766

Beyond FY 06…All 21 VISNs implemented over the next 2

yearsFY 07: 168,620 (why so high???)FY 08: 120,883FY 09: projected 152,000

Workload is just that…Quality management:

CCS VISN reviewsCCSF Training Center reader and imager

continued competencyCCSF Training Center Patient Satisfaction

SurveyContinuous monitoring of patient safety issues

Image deletion Guidance for selective use of dilation Any required change on the fly

Reader/imager QACompetence for both imagers are readers is

tested before leaving the training center and is required (passing) before they are certified.

Reader competence is the highest risk:Adjudicated cases used in training centerStrictly proctoredPeriodic competency evaluation of field

readers…

Field competence testing of readers…LMS basedBank of adjudicated casesMany beta versions until we were

satisfied…..slow but carefulAnd if a reader fails?

CCSF Training Center provides remedial plan to VISN QM

Re-testing after appropriate re-learning

CCSF Training Center resultsPatient satisfaction survey

Are our patients happy with the service? Satisfaction is 4.76 on a scale of 5

Are we foisting something on them that they perceive as a barrier or have they bought into what we know is the “right care at the right time in the right place”? No! Patients feel taken care of and correctly

managed.

Reader/Imager QA program100% pass rate

Ongoing projects

Guidance (nationally) on the use of dilation in Teleretinal Imaging

Implementation of strategic plans which includeRegional reading centersInvestigating teleretinal validation for other

diseases such as glaucoma and amd.

Principals to live byTeleretinal belongs in every location that

has diabetic patients (We’re getting there!)

Teleretinal is as much a part of the clinical landscape as any other medical or surgical service

There is a wealth of valuable clinical information obtainable via teleretinal, a process patient friendly, efficient, and cost effective