One Vision for Telemedicine’s Future

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At present, the ability to deliver medical services remotely is only a modest patchwork of what can be accomplished in a doctor’s office, a clinic or a hospital. As such, telemedicine’s promise is being delivered one solution at a time, with unique technologies being rolled out within specific disciplines.

Getting this right usually involves a detailed vetting process, as can be seen with the recent selection of Montreal’s Retina Labs’ iVision platform by the Ontario Telemedicine Network (OTN) for its provincial Teleophthalmology program.

“The RFP came out in March 2016, and the contract was awarded in December 2016,” says Richard Pridham, President and CEO of Retina Labs RD Inc. “The RFP process was quite exhaustive and there were several vendors competing and multiple stages. A short list of four vendors was selected for the demo stage. Then two vendors were chosen and a detailed products evaluation took place of each proponent’s solution. There was also a financial viability component.”

In the end, Pridham says that Retinal Labs was chosen on the clinical strength of its solution, given that it was designed specifically for diabetic retinopathy screening, which met or exceeded all of the requirements.

“Another important element is that we offer other capabilities as part of our product ecosystem,” says Pridham. “This includes e-referrals and live teleconsultation. We also provide clinically validated interpretation modules for other diseases such as retinopathy of prematurity, age-related macular degeneration and glaucoma.”

To date, the OTN is best known for its Telehomecare initiative, which allows congestive heart failure and chronic obstructive pulmonary disease patients to be monitored and coached at home. There is also Telestroke, wherein consulting stroke specialists can collaborate with doctors at 23 referring hospitals in Ontario. Specific to Retina Labs and the OTN’s Teleophthalmology program, there is an opportunity to deliver optimal service while also saving money.

“From a public health and financial perspective, we save the province millions through early detection and prompt treatment,” says Pridham. “As well, by setting up a more efficient grading process, we allow ophthalmologists to focus on higher value cases—those with actual diabetic retinopathy—and on treatment.”

Pridham notes that it’s important to keep in mind that positive and treatable diabetic retinopathy represents 20% to 30% of all cases.

“This means that a lot of time is spent looking at retinas of otherwise healthy people,” he says. “By setting up a provincial grading centre and using automated retinal analysis software—part of our roadmap is to introduce algorithm-based DR detection—we reduce the burden of cost and improve patient throughput.”

Diabetic retinopathy is on the rise in Ontario. It is estimated that there are 1.2 million people with diabetes in Ontario, with 20% of those expected to experience vision loss. Importantly, an estimated 35% are not getting screened annually. For a Canadian company like Retina Labs, however, it would seem there is even greater opportunity south of the border.

“The problem is far more acute in the U.S., where it is estimated that there are about 30 million diabetics and the non-compliance rate for screening is 40% to 50%,” says Pridham, who can cite numerous studies to support his claim, including one by the American Academy of Ophthalmology.

As it stands, diabetic retinopathy is the most common cause of blindness in people under age 65, and the most common cause of new blindness in North America. The Canadian Diabetes Association estimates that approximately two million individuals in Canada—almost all people with diagnosed diabetes—have some form of diabetic retinopathy.

Yet Canada isn’t doing particularly well when it comes to screening. For example, a multi-province screening program conducted in 2009 found that 38.7% of respondents never had an eye exam, and 30.1%, had not had an exam in the past two years. Though that data is not recent, there is little to suggest things have dramatically improved in Canada. This new approach by the OTN and Retina Labs could bring about dramatic results, in part because it is looking to the example of other successful jurisdictions.

“The gold standard for diabetic retinopathy screening is the U.K., where compliance rates are upwards of 97%,” says Pridham. “They’ve achieved this largely by making screening part of routine primary care. They have public health educational programs to improve awareness, and have implemented a standardized approach and system to manage the entire process. This is what OTN is seeking to accomplish, and our system will enabled them to do it.”

As a cloud-based system, Retina Labs’ iVision platform can scale, while also delivering on all the Canadian regulatory requirements—the solution is hosted on Canadian soil on Tier 2, SSAE 16 certified infrastructure. The added value will come in how the OTN leverages the Retina Labs’ solution to save money while also delivering optimal service.

“The key is how the province manages the screening program and how efficient the process works,” says Pridham. “For example, patients don’t need to see an eye care professional face-to-face. They can go to a community clinic and get their fundus photos (e.g. a photograph of the back of the eye) taken by a technician. These images are automatically uploaded to our platform. Rather than have an ophthalmologist review the images, they can first be graded by people who are trained to detect diabetic retinopathy.”

From here, positive cases are then routed to an ophthalmologist for final interpretation and recommendation. That should save the system money in the long run, while also delivering better care. And isn’t that the gold standard for any new healthcare technology?


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