A Guide to Implementation for Sustained Impact in Teleophthalmology (I-SITE)

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Diabetic eye disease is the leading cause of blindness among working-age U.S. adults. Early detection and treatment can reduce the risk of blindness by over 90%, but fewer than half of adults with diabetes obtain yearly recommended eye screening. Teleophthalmology makes it easier for patients to obtain diabetic eye screening by providing convenient access to high-quality, vision saving eye care at low cost. As the number of people with diabetes continues to increase, the prevalence of diabetic eye disease is also expected to nearly double. Teleophthalmology can help meet the growing demand for eye screening.

What is Teleophthalmology?

Teleophthalmology increases patient access to high-quality eye care using technology, such as eye cameras in primary care clinics. This evidence-based method for providing diabetic eye screening has been proven to increase diabetic eye screening rates and prevent blindness.

While teleophthalmology can significantly increase diabetic eye screening rates, initial increases in screening rates may not be sustained over time. We identified multiple barriers to teleophthalmology use through interviews with patients and Primary Care Providers.

The authors of this toolkit created I-SITE, an implementation program to sustain increased diabetic eye screening rates using teleophthalmology. Implementation strategies are selected by primary care providers and staff to enhance integration into the primary care workflow and increase teleophthalmology use.

Who should use this toolkit?

This toolkit is intended for primary care clinics seeking to achieve and sustain increased diabetic eye screening rates using teleophthalmology.

What does the toolkit contain?

There are 4 Modules within this toolkit. In Module 1: Assessing Organizational Readiness, you identify key resources for your teleophthalmology program and develop program goals. In Module 2: Planning & Training, you build a Change Team to develop and test implementation strategies, as well as perform staff training and testing. In Module 3: Implementation, you gather data and obtain feedback to systematically refine the clinic workflow to achieve and sustain increased diabetic eye screening. In Module 4: Community Outreach, you may choose to share the results of your program to improve public awareness and patient education about teleophthalmology in your community. Each of these modules contains worksheets and examples to enhance the learning experience.

How should this toolkit be used?

This “how-to guide” leads you through implementing teleophthalmology and complements the American Telemedicine Association Telehealth Practice Recommendations for Diabetic Retinopathy. This toolkit is designed as an interactive workbook. You may choose to print it and write in your responses.

Development of this toolkit

A Guide to Implementation for Sustained Impact in Teleophthalmology (I-SITE) was adapted from the NIATx healthcare process improvement framework by researchers (Principal Investigator (PI) : Yao Liu, MD MS) at the University of Wisconsin-Madison in partnership with Primary Care Providers, staff, administrators, and patients at Mile Bluff Medical Center in Mauston, Wisconsin.

This project was supported by NIH/NEI K23 EY026518 (PI: Liu). Additional support was provided by the University of Wisconsin Health Innovation Program (HIP), the Wisconsin Partnership Program New Investigator Award, an institutional grant from Research to Prevent Blindness to the University of Wisconsin Dept. of Ophthalmology and Visual Sciences, and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 9 U54 TR000021 from the National Center for Advancing Translational Sciences (previously grant 1 UL1RR025011 from the National Center for Research Resources). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders.

Please send questions, comments, and suggestions to HIPxChange@hip.wisc.edu.

To learn more about the UW Teleophthalmology Program, please visit: eyephoto.wisc.edu.

Toolkit Citation

Liu Y, Benkert R. A Guide to Implementation for Sustained Impact in Teleophthalmology (I-SITE). University of Wisconsin Department of Ophthalmology and Visual Sciences. Madison, WI; 2019. http://www.hipxchange.org/I-SITE

About the Authors

Yao Liu, MD, MS is the Founder and Director of the UW-Madison Department of Ophthalmology and Visual Sciences’ Teleophthalmology Program. The goal of this program is to develop implementation strategies to increase diabetic eye screening rates and reduce preventable blindness. As a clinical glaucoma specialist, Dr. Liu seeks to enhance our understanding and management of vision-threatening eye diseases through novel imaging techniques, interdisciplinary telemedicine collaborations, and clinical trials of new medications and surgical devices.

Ramsey Benkert, BS was a Research Specialist within UW-Madison Department of Ophthalmology and Visual Sciences’ Teleophthalmology Program. She assists with implementing and disseminating I-SITE to increase diabetic eye screening in primary care through the use of teleophthalmology.