Ingrid E. Zimmer-Galler, MD (Baltimore, MD)*


When implemented appropriately, programs combining digital retinal imaging and telecommunications technology have the potential to increase assessment rates for diabetic retinopathy. The purpose of this study was to evaluate the utilization of an Internetbased diabetic retinopathy assessment program in the primary care environment and to assess factors which influence use of the system.


The DigiScope system is a validated telemedicine retinal imaging system designed for diabetic retinopathy assessment in the primary care physician’s office. It is based on a semiautomated fundus camera and transmission of data via the Internet to a reading center for interpretation of images and determination of the need for referral to an ophthalmologist. Only diabetic patients who have not had a comprehensive eye examination in the previous twelve months are imaged with this system. The number of patients imaged over a 6 month period in offices that have implemented this technology was assessed. Factors influencing utilization of the system were evaluated.


Between July 1, 2005 and December 31, 2005, the DigiScope system was in place continuously at 88 primary care physician sites. A total of 5,044 patients with diabetes were imaged. Over this 6 month period, the number of patients imaged at each site ranged from 9 to 177 (range of 2 to 30 patients per site per month). Factors associated with increased utilization at individual sites included large diabetic patient population, clinic involvement in quality health care initiatives, positive economic return, and integrated patient workflow. Factors associated with poor utilization included poor ancillary staff acceptance, poor office integration, and perceived poor economic return.


Utilization of the DigiScope diabetic retinopathy assessment program in the primary health care arena varies significantly between sites. Identification of factors associated with both high and low utilization may allow for more appropriate implementation of the system with a goal of achieving a positive impact on overall diabetic retinopathy assessment rates.
* Financial interest disclosed