1. Technology-based Eye Care Services (TECS)
Increasing Access to Specialty Eye
Care for Underserved Patients
April Maa, MD
Clinical Director of TECS
VISN 7 Regional Telehealth Services

3. Critically important to quality of life
VISION IS…
Critically important to quality of life
Keeps people independent and healthy
High priority for patients

4. Barriers to Getting Care
Denial – doesn’t want to know
Lack of access
No Transportation
Mr. C not getting care
Doctor fatigue
Lack of education
Lack of resources

5. Large Catchment Area = Barriers to Care = Poor Access/Healthcare Disparities

6. Rural Patients = Lack of Subspecialty Providers

7. High Demand – Growth Rate >> Existing Clinical Infrastructure
9% per year growth nationally
15% per year growth in Atlanta
Also, Growth Rate >> ability to build new clinics

8. Barriers to Care

9. What is TECS?
Use store and forward telemedicine technology to provide routine or follow up eye care at primary care clinics
Prevent blindness

10. TECS
Dedicated Ophthalmology Technician at CBOC – COLLECTS INFO
Vision/Eyeglasses
Detailed history
EHR
10X12 room
Provider interprets
CPRS Note
Eye Pressure/CCT
Vista Imaging

11. What did we learn?

12. Work Smarter

13. Eye Care Delivery in the VA
CURRENT MODEL: CLINIC VISIT
Medically underserved have no close private providers, poor coordination, unable to check quality of care, high costs
Far drive, decrease patient compliance, barriers to care OR OR VA
Optometry VA
Ophthalmology
Choice?
Can be difficult to coordinate or higher level care may not be available 6

14. Eye Care as a Spectrum of Needs
Reduce outsourcing of ophthalmic surgery and subspecialty care consults e.g. neuro-ophthalmology; bring it back in house
Advanced
Optometry and Comprehensive Ophthalmology
Advanced
Intermediate
Intermediate
Basic
Basic
Increase outsourcing to telemedicine methods of basic Eye Care needs; exams and eyeglass dispensing (TECS)

16. Tools in the Toolbox to Care for Patients
For VA: Cost-effective, appropriate population management for patients needing eye care. Proper direction of resources.
For Providers: Does NOT replace! Enhances eye provider value by bringing patients who need your expertise.
For Veteran: Preventing blindness.
TECS
In-Person Care

17. Current TECS Sites - Atlanta

18. TECS is National!
Future sites
2017 sites
2018 sites

19. TECS: Expansion of Services?
Humphrey Visual Field Machine

20. Tele-Follow ups
COMBINE VISUALS WITH TEXT TO SHARE QUOTES OR OTHER PERTINENT INFORMATION.

21. Quality Assurance and Improvement
(Except we don’t serve hamburgers)
We should be like McDonalds…

22. Standardization Across the Country
Multidisciplinary third party data team: Charleston VAMC through the VA HSR&D Center of Innovation, HEROIC.
Two statisticians, health economist, and epidemiologist. 5

23. Categories of Data Patient Satisfaction Quality of Care Access to Care
Cost
Published data in April 2017:
Early Experience with Technology-Based Eye Care Services (TECS): A Novel Ophthalmologic Telemedicine Initiative. Ophthalmology April 124(4):

24. FY 2018 National TECS Quality Data
Patient Satisfaction:
31.6% survey response rate
99.6% “clinic gave me high quality service” and “excellent” rating.
97.2% “definitely would” refer another patient to the clinic
Quality of Care:
5.7 out of 6 average image quality score
97.6% percent agreement on peer review of images
Statistically insignificant difference in number of eyeglass remakes from TECS vs. Non-TECS site.
Access to Care:
5277 patients seen nationally in total
55% same day appointments
98.5% within 30 days

25. How Could TECS Help You?
Optical sales and services may help cover the cost of screening.
Adding a component of video telehealth would potentially allow for payment.
Partnership with VA?

27. THANK YOU!
Prevent blindness