Cost-Savings Analysis of Telemedicine Use for Ophthalmic Screening in a Rural Appalachian Health Clinic

Life in mountainous, rural areas poses unique obstacles for ophthalmic care--notably, a lack of access to ophthalmologists and cost of care. Using telemedicine as a screening tool addresses both issues for diabetic retinopathy (DR) screening, as fundus photography has been determined to be sensitive and specific when screening for DR.1,2 The American Diabetes Association places a Grade E recommendation on fundus photography as a screening tool.3 We analyze the financial impact of ophthalmic telemedicine in a mountainous, rural health clinic in West Virginia over a seven year period from 2003-2009. At-risk patients are screened with a fundus camera during routine clinic visits, and the image is interpreted off-site by an ophthalmologist. Patients are either advised to follow up yearly or receive an immediate opthalmic referral. Considering the number of patients screened, travel costs, work missed, overhead, and billing considerations yields a savings of $153.43 per patient visit

Screening Diabetic and Hypertensive Patients for Ocular Pathology using Telemedicine Technology in Rural West Virginia: A Retrospective Chart Review

Abstract: Purpose: There is a disparity between the number of people who need healthcare and availability of medical services in rural areas. This paper describes the experience of using telemedicine technologies for ophthalmologic evaluation in diabetic and hypertensive patients presenting to a community health center in rural West Virginia. Methods: A registered nurse at a community health center in McDowell County, WV was trained to use a retinal camera to capture high-resolution digital images of the retina. Patients with diabetes or hypertension were screened during their routine primary care visits. Retinal photos were transmitted to an ophthalmologist for review and reports from the screenings were returned with instruction for follow-up care or specialist referral when indicated. Findings: A retrospective chart review of 643 patients with diabetes or hypertension who were screened for ocular problems from October 2003 to December 2009 was completed. 44.8% of patients who were screened in the primary care center were identified as having 1 of 34 types of eye pathology that were previously unknown,of which 33% of patients were recommended to seek prompt attention by a retina consultant or glaucoma specialist for suspected ocular pathology. Conclusions: Our review demonstrates the actual benefits of telemedicine in the effective screening of diabetic and hypertensive patients for eye pathology,and our experience suggests that using distance medicine and telemedicine technologies is valuable for screening rural populations