“Our mission is to eliminate preventable blindness,” says Dr. Sunil Gupta, founder and CMO of IRIS (Intelligent Retinal Screening Systems) of Pensacola, Fla.
Imagine making a decision to go to an eye doctor’s office that can mean the difference between having a satisfying life, or one fraught with loss of vision. That’s the potentially dramatic situation of patients with diabetic retinopathy, the leading cause of blindness in working-age adults.
For many of these patients, they wait too long to get their eyes checked by a specialist, and by then their vision has been severely disrupted or gone entirely. They may need significant surgery and expensive medications to maintain their eyesight. Even with intervention, therapies don’t always work.
Diabetic retinopathy is the most common cause of vision loss among people with diabetes. It involves changes to retinal blood vessels that can cause them to bleed or leak fluid, severely distorting vision.
Dr. Sunil Gupta, a physician and an engineer, says that 60% of diabetic retinopathy patients often avoid going to an eye doctor. This negligence can cause devastating consequences for the patients and their families, and impact on healthcare expenses.
Because diabetic retinopathy shows no symptoms is until the disease is in advanced stages, experts say that people with diabetes need a diabetic eye exam at least once a year. That hasn’t been happening as much as it should be, says Gupta, founder and chief medical officer of IRIS.
“When patients do show up for an eye exam, they have been losing vision, and now it’s a problem, and there is damage to the tissue,” he says. “At this stage, it’s an uphill battle. The patient can’t drive. The patient can’t watch TV. The patient can’t focus. And glasses can’t fix the problem. The key is to get to these people for an examination before that happens. If a doctor had gotten to (examine) the patient sometimes years earlier, this would have been all preventable.”
In practice, it is each primary care physician’s (PCP) responsibility for getting patients to this eye exam. However, the PCPs rely on ophthalmologists for these services. Physicians were left to trust that their patients would follow through in seeing an eye doctor, but less than 40% actually would. The idea of a telemedicine solution is to “remove the silos,” Gupta says. By having a team approach, Gupta says primary care and eye specialists can make it easier for patients to be compliant with their necessary care plans.
Gupta is working to drastically improve eye care. “We decided, ‘why not automate the process for the primary care doc’’ he recalls, “and bring the exam to the patient?” He and his IRIS team have developed an FDA-cleared Class II telemedicine platform that securely sends images from primary care to ophthalmology through a cloud-based Grading Platform. The retina specialists are then able to diagnose the image with pathology, and a final, graded report is returned to the PCP to include in the patient’s electronic medical record.
So far, IRIS is a success, Gupta says. Through partnerships with independent physicians, insurers and others, at least 110,000 otherwise unexamined patients have gotten this necessary exam. Ophthalmologists and retina specialists have diagnosed over 40,000 instances of diabetic retinopathy. Gupta says.
About 15,000 patients have been referred for moderate to proliferative diabetic retinopathy. “We think those patients would have gone blind if we had not picked up the disease,” he says. “It [the diagnosis] is a ‘shot across the bow’ for these patients and prompts them to manage their disease better.”
Keeping with the theme of making it easy and automated for primary care practices, Gupta’s team has developed bidirectional integrations with multiple EHRs (electronic health records) – including Epic. When the ophthalmologist signs the patient report, the data is integrated directly back into the EHR. Gupta notes that overall, IRIS’s integration with EHR systems has led to significantly more patient usage and more physician engagement.
In 2013, the Harris Health System in Houston, Texas, partnered with IRIS to improve their evaluation of diabetic patients. “It’s important all patients are evaluated, especially inner-city populations of African-Americans, Latino and Southeast Asia population, all of whom have a high-rate of diabetes,” Gupta says. Harris Health, considered a “safety net” for all residents of Harris County, is the largest county health system in Texas, and the 3rd largest in the country.
“We were able to drive home improved outcomes,” Gupta says. “Right now, Harris Healt actually does better than most private groups in the country.” He adds that Harris’s diabetic exam rate is consistently near or near 80% compliance.
Growing Diabetic Population
Nationally, the diabetic population in the United States is growing. Over the last 4 years, Harris’s diabetic population has gone from 47,000 to 58,000. To maintain and improve exam access, Harris added the bidirectional integration to their already successful IRIS platform in late 2015. To measure the effectiveness of this integration, Harris Health conducted a study of its providers and patient care technicians in the programs. The analysis evaluated efficiency, engagement and patient access.
Among the findings:
- 86% of primary care physicians (PCPs) said that the IRIS-EHR integration increased access for patients receiving diabetic retinal exams.
- 83% of PCP respondents considered the IRIS reports to be helpful for managing diabetic patients.
- After implementing the system, patient exam volume increased 49.4% compared to the same period in the prior year.
Gupta is happy with those numbers, but is always looking for improvement.
Grady Health System in Atlanta, Ga. got a glimpse of the success at Harris Health. Looking for similar results, Grady entered their own relationship with IRIS, Gupta explains. Grady has an estimated 45,000 diabetic patients who are not compliant with their eye exam every year. At least 12,000 of these patients will have pathology that otherwise until now has gone undiagnosed.
“We want to give access to everybody out there who needs a diabetic evaluation. I’d be the happiest guy in the world if we can get all these people and help them see,” Gupta says. As he sees healthcare, the importance is “taking care of the patient in front of me, not just patients at large.”
Ultimately “our mission,” Gupta concludes, “is to eliminate preventable blindness.”