title: Autonomy versus automation: perceptions of nonmydriatic camera choice for teleretinal screening in an urban safety net clinic.
abstract: OBJECTIVE
  Teleretinal screening with nonmydriatic cameras has been presented as a means of increasing the number of patients assessed for diabetic retinopathy in urban safety net clinics. It has been hypothesized that automated nonmydriatic cameras may improve screening rates by reducing the learning curve for camera use. In this article, we examine the impact of introducing automated nonmydriatic cameras to urban safety net clinics whose photographers had previously used manual cameras.
  
  
  METHODS
  We evaluated the impact of manual and automated digital nonmydriatic cameras on teleretinal screening using a quantitative analysis of readers' image quality ratings as well as a qualitative analysis, through in-depth interviews, of photographers' experiences.
  
  
  RESULTS
  With the manual camera, 68% of images were rated "adequate" or better, including 24% rated "good" and 20% rated "excellent." With the automated camera, 61% were rated "adequate" or better, including 9% rated "good" and 0% rated "excellent." Photographers expressed frustration with their inability to control image-taking settings with the automated camera, which led to unexpected delays.
  
  
  CONCLUSIONS
  For safety net clinics in which medical assistants are already trained to take photographs for diabetic retinopathy screening with a manual camera, the introduction of automated cameras may lead to frustration and paradoxically contribute to increased patient wait times. When photographers have achieved a high degree of aptitude with manual cameras and value the control they have over camera features, the introduction of automated cameras should be approached with caution and may require extensive training to increase user acceptability.
authors.affiliation: Center for Biomedical Informatics, Charles Drew University of Medicine and Science, Lynwood, CA 90262, USA. lolaogunyemi@cdrewu.edu
authors.forename: Omolola
authors.initials: O
authors.lastname: Ogunyemi
authors.forename: Erin
authors.initials: E
authors.lastname: Moran
authors.forename: Lauren
authors.initials: L
authors.lastname: Patty Daskivich
authors.forename: Sheba
authors.initials: S
authors.lastname: George
authors.forename: Senait
authors.initials: S
authors.lastname: Teklehaimanot
authors.forename: Ramarao
authors.initials: R
authors.lastname: Ilapakurthi
authors.forename: Kevin
authors.initials: K
authors.lastname: Lopez
authors.forename: Keith
authors.initials: K
authors.lastname: Norris
mesh_terms: D002140:California; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000592:standards*; D006801:Humans; D010781:Photography / Q000295:instrumentation*; D011204:Poverty Areas; D036301:Qualitative Research; D011873:Radiology Information Systems; D064876:Safety-net Providers; D017216:Telemedicine; D019037:Urban Health Services