Eyeworld

March 2017 • Ophthalmology Business 17 patient into the office—it's not a replacement for good care, it's an ad- junct," Dr. Habash said, adding that telemedicine provides physicians and nursing staff with more infor- mation when they otherwise would only be relying on a patient's verbal description. Dr. Habash also offers telemedi- cine for some follow-up visits. "As patients are leaving the of- fice, my receptionists will have them download the app and we confirm them just like a regular patient and put them on the schedule for 1 week later. At that time they're at home or sitting at their desk at work and we do a quick follow-up. It has been invaluable to me in an outpatient setting," she said. While Dr. Habash might have integrated telemedicine into her practice, she doesn't think it is being fully utilized in the field. "We're so equipment heavy and people might feel like if they don't have their equipment, they're not doing a good exam. But there are many examples where you can triage patients in 30 seconds and tell them what is going on. Those are the types of things that people don't think about doing, but it's so easy," Dr. Habash said. Retinopathy screening and beyond The American Academy of Ophthal- mology and the American Diabetes Association recommend diabetic patients receive a dilated funduscopic exam every year to screen for retinal issues. However, of the millions of Americans who have diabetes, Dr. Weng said only an estimated 50% to 65% receive such screening. communication apps or programs, which seek to make telemedicine more accessible and applicable to physicians. Current state of telemedicine In ophthalmology, Christina Weng, MD, MBA, assistant professor, Baylor College of Medicine, Houston, said telemedicine is currently being used most for diabetic retinopathy and retinopathy of prematurity screen- ing, but more "informal" uses, such as the case Dr. Habash described, are becoming more common. "For instance, part of my clinical effort is spent at the Ben Taub Gen- eral Hospital, one of the country's busiest county hospitals. We recently purchased a device that attaches a tablet to a slit lamp to take pho- tographs and upload them to the patient's electronic medical record. The residents and fellows frequently consult me using a patient's slit lamp or funduscopic photographs. This allows me to teach and contribute to the management plan even when I am unable to be there in person, sparing the patient a delay in care or an extra trip back to the clinic to see me. Even photographs taken on cellular phones are often used today to share data, either patient to provider or provider to provider," Dr. Weng said. Dr. Habash said offering telemed- icine options has been invaluable to her patients and to her practice. "When a patient wakes up in the morning with a swollen eye or conjunctivitis and he or she doesn't know what to do, you're able to triage the patient. If you don't know what's going on, then you bring the R anya Habash, MD, Bascom Palmer Eye Institute, Miami, had more than a dozen patients in her office when she received a call from the emergency room of the local hospi- tal. She was asked to come in imme- diately to evaluate an orbital fracture for surgery. Unable to leave her busy clinic at the drop of a hat, she asked for a texted picture of the patient's CT scan and arranged a video call on her phone to discuss with the ER physi- cian and the patient. "Thirty seconds later we ascer- tained the patient wasn't entrapped and didn't need surgery. [They] sent him home on oral antibiotics, got all the orders started, and that was it. I hung up my cell phone and went about my business," Dr. Habash said. A couple of days later, she got a call from the hospital's compliance officer: This exchange was not HIPAA compliant. "I said, 'I don't understand: I'm happy, the patient was happy, the ER doctor was happy, everyone was happy,'" Dr. Habash said. With that in mind, Dr. Habash, a TopLine MD consultant, soon there- after spoke with her brother, a soft- ware engineer, who told her that he could make her a HIPAA-compliant app that was as easy to use as regular texting and video chatting. So HipaaBridge (originally Hi- paaChat, which was acquired in 2014 by Everbridge, [Burlington, Massa- chusetts], a global software com- pany for which Dr. Habash is now the chief medical officer) was born. HipaaBridge is by no means alone in the market of HIPAA-compliant continued on page 18 Telemedicine services in ophthalmology today and in the future

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