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Annual Report: CCSF Teleretinal FY09

Annual Report: CCSF Teleretinal FY09. Gerald J. Selvin, OD Leonard Goldschmidt MD. Highlights of FY09 . Much smoother operation with few if any “burps”. Images are being deleted Software is stable Vendor is cooperative and a partner Leads have been working together nearly 4 years.

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Annual Report: CCSF Teleretinal FY09

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  1. Annual Report: CCSF Teleretinal FY09 Gerald J. Selvin, OD Leonard Goldschmidt MD

  2. Highlights of FY09 • Much smoother operation with few if any “burps”. • Images are being deleted • Software is stable • Vendor is cooperative and a partner • Leads have been working together nearly 4 years. • Quality Managers are remarkably efficient and helpful. • Greater than 20% increase in workload vs FY 08 • Increasing participation and awareness of dermatology in CCSF Store and Forward (Tony and Junius)

  3. CCSF: Teleretinal Report– September 2009 • 284 cameras deployed nationwide – at most recent count • 462,568 patients screened FY06-present • 33,766 patients screened in FY2006 • 168,620 patients screened in FY2007 • 120,883 patients screened in FY 2008 • 139,279 screened in through the 1st 11 months of FY2009 (projected 152,000 for FY09)

  4. 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

  5. CCS site visits with review by Teleretinal Leads and Quality Management Team FY09 • V8: October 2008 • V19: November 2008 • V1: April 2009 • V2: June 2009 • V11: July 2009 • V23: August 2009 • V10: September 2009

  6. Perspective of the program from implementation.…. • RFP (IL-2005-001) dated 1/13/05 and released to field 1/19/05 • Spelled out program • Requirements and deployment strategy • http://vaww.va.gov/occ/Docs/TeleretinalRFP1-19-05.pdf

  7. Teleretinal kickoff meeting St Pete: January 2006 • More collaboration • Eye • Clinical engineering • IT • CAC • Implementation team • PCP • Work group agreed on program clinical design and templates

  8. Implementation FY06 and beyond • 17 VISNs received awards based on response to RFP • Funding was for cameras, imagers, readers, limited admin. • Purpose was to “seed” such that the program could “sprout” into something permanent • FY 06 workload: 33,766

  9. Beyond FY 06… • All 21 VISNs implemented over the next 2 years • FY 07: 168,620 (why so high???) • FY 08: 120,883 • FY 09: projected 152,000

  10. Workload is just that… • Quality management: • CCS VISN reviews • CCSF Training Center reader and imager continued competency • CCSF Training Center Patient Satisfaction Survey • Continuous monitoring of patient safety issues • Image deletion • Guidance for selective use of dilation • Any required change on the fly

  11. Reader/imager QA • Competence 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 center • Strictly proctored • Periodic competency evaluation of field readers…

  12. Field competence testing of readers… • LMS based • Bank of adjudicated cases • Many beta versions until we were satisfied…..slow but careful • And if a reader fails? • CCSF Training Center provides remedial plan to VISN QM • Re-testing after appropriate re-learning

  13. CCSF Training Center results • Patient 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 program • 100% pass rate

  14. Ongoing projects • Guidance (nationally) on the use of dilation in Teleretinal Imaging • Implementation of strategic plans which include • Regional reading centers • Investigating teleretinal validation for other diseases such as glaucoma and amd.

  15. Principals to live by • Teleretinal 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

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