Telehealth Practice Recommendations for Diabetic Retinopathy

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Telehealth PracticeRecommendations for Diabetic
Retinopathy

• Editorial and Review Process
• Helen K. Li, MD
• Matt T.S. Tennant, MD

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Document Goals

• Publish ocular telehealth recommendations to
• Increase access to retinopathy evaluation
• Preserve vision
• Serve as a bridge to ocular health providers in
  other countries

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Process

• Started March, 2003
• Completed April, 2004

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Process

• Three workshops with clinical, industry,
  administrative, operational personnel
• Conference calls
• Emails
• Web review

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Web Review

• Licensed medical staff as imaging personnel is
  costly.
• Dropped license requirement
• Added education and skill requirements
• Readers do not have to be licensed.
• Added supervision by licensed personnel
• Added reader quality control mechanisms
• Quality control requirements are too costly.
• Used recommendations instead of standards or
  guidelines

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Editorial Goals

• Be inclusive
• Transparency
• Assure the document is flexible
• Assure the document applies to the global
  community
• Build consensus
• Provide clarity
• Speak as one voice

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Editorial Tasks

• Integrate three documents
• Identify missing elements
• Clarify
• Levels of clinical validation
• Technical recommendations
• Expand references
• Up-to-date and pertinent

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Lessons Learned

• Use line numbers for easy discussion reference
• One person to merge/revise text
• One person to update electronic data base of
  references
• Use a simple version numbering system

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International Bridge

• Cross referenced proposed International
  Classification of DR with ETDRS
• Early Treatment Diabetic Retinopathy Study
• ETDRS Report 12. Ophthalmology 1991
• International classifications
• Ophthalmology 2003 1101677-82
• Consider publishing in multiple languages

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Future

• This is a living document
• Add evidence-based technical specifications,
  education requirements, operational outcomes, etc.