Fish A, George S, Terrien E, et al. "Workflow concerns and workarounds of readers in an urban safety net teleretinal screening study."

Fish A, George S, Terrien E, et al. Workflow concerns and workarounds of readers in an urban safety net teleretinal screening study. AMIA Annu Symp Proc 2011;2011:417-26.
Telemedicine holds great promise for increased access to specialty care services for safety net clinic patients. However, the adoption of these technologies is not a seamless transition for clinicians working in resource-poor settings. Previous research has analyzed workflow issues that arise in primary care settings when adopting telehealth tools but has not examined the unique workflow challenges facing specialists who provide assessments to safety net clinics. Findings are presented from a case study that employed qualitative methodologies as part of an assessment of a teleretinal screening program in Los Angeles urban safety net clinics. The program utilizes external ophthalmologists to perform retinal readings. The case study provides insights into how difficulties that arise in reader workflow are resolved and identifies unique factors requiring consideration when highly trained specialists perform teleretinal readings. The discussion outlines important issues to address when developing telehealth workflow protocols for the safety net, specifically, and their broader applicability in telemedicine.

To document how reader workflow issues are resolved when using teleretinal screening in a safety net clinic environment.

Tools Used
Type Clinic
Primary care
Type Specific
Diabetes care
not applicable
Other Information
Safety net clinics in South Los Angeles serving primarily immigrant Latino and African American patient population. Four of six clinics have teleretinal screening program in place, two clinics have no previous experience.
Type of Health IT
Type of Health IT Functions
Clinic staff upload patient's images and basic health information into EyePACS, external ophthalmologists read and review case and describe findings in an EyePACS report, clinic staff read the EyePACS report, share and explain results with patients and arrange for referral to specialty care if recommended.
Workflow-Related Findings
Quality of images and lack of biometric data required further exploration of the reader workflow process, readers developed their own workarounds to compensate for image quality.
Clinic staff who had worst images ratings received retraining on the use of the digital fundus camera.
Study Design
Only postintervention (no control group)
Study Participants
Focus of the study was on the three ophthalmologists participating in the study as readers.