Eyes On Site
2015 • Penn Medicine Center for Health Care Innovation
Problem + opportunity
Diabetic retinopathy (DR) is the most common cause of vision loss among working-age adults. Treatment of late- stage DR can cost as much as $28,000 per patient, while the cost of early- stage treatment is minimal. DR is a challenging disease, but 90% of cases can be prevented by early screening and treatment.
However, because DR is asymptomatic until later stages, many patients are unaware of the disease and are unmotivated to complete screening. In 2015, only 22% of Penn Medicine patients met recommended screening standards for diabetic eye care. Advances in retinal imaging technology prompted an interdisciplinary team at Scheie Eye Institute to take a fresh look at DR screening.
Action
Patient experience
At the start of the project, I worked to develop an understanding of the patient experience of traditional eye exams using contextual inquiry, interviewing, and secondary research. I learned that traditional exams take half a day to complete, involve painful eye drops, and require patients to arrange to be picked up at the end. We hypothesized that new non-mydriatic cameras (which do not require pupil dilation) would significantly improve the patient experience. These cameras are portable, making mobile screening possible.
Data analysis
I pulled chart data to learn more about Penn’s non-adherent patients and to identify opportunities. Notably, I saw that 8,900 patients had appointments for other services in 2014. Further, these appointments were clustered in settings and clinics related to diabetic care. We wondered, could we design a service which provides mobile, on- demand retinal screenings in these settings?
Piloting
We felt that the best way to learn about this new model was to do it. I led the team through 5 pilots in 3 clinics, with 125 patients screened. These pilots de-risked some of our critical assumptions. For example, we confirmed that patients would be willing to complete impromptu screenings. Importantly, these pilots produced clinical data which gave us an evidentiary foundation for this new screening model.
Impact
We reached patients who don’t normally complete screenings. 47% did not know when their last screening was, or reported never having completed one.
We discovered previously undiagnosed disease. 57% required a referral, either for baseline or detected eye disease and 11.4% presented with evidence of diabetic retinopathy.
EOS helped to avoid costly treatment. If EOS screened 890 patients yearly, we predict 356 cases of undiagnosed disease, amounting to more than $290,000 in cost avoidance.
A better patient experience. EOS screenings are 18x faster than traditional ones. EOS does not require pupil dilation, so patients can drive home alone.
Articles
Pitch Day 2016 presentation
