title: Timely implementation of a retinopathy of prematurity telemedicine system.
abstract: To examine the feasibility of a retinopathy of prematurity (ROP) telemedicine evaluation system of providing timely feedback to a neonatal intensive care unit (NICU) with at-risk premature infants.
  
  
  
  This was a prospective observational study of premature infants with birth weights of <1251 g in five NICUs in the United States. Infants scheduled for clinically indicated ROP evaluations underwent indirect ophthalmoscopic examinations and digital imaging on the same day. Imaging was performed by nonphysician retinal imagers. Times required were determined from obtaining digital images of both eyes to submission via web-based system to a secure server for grading by trained readers at a central reading center to sending back grading results to the clinical center.
  
  
  
  A total of 1,642 image sets of eyes of 292 infants were obtained, from 823 imaging sessions. The mean turnaround time from submission of image sets of both eyes to return of the grading results to the clinical center was 10.1 ± 11.3 hours (standard deviation), with a median of 12.0 hours (1st quartile, 0.9 hours; 3rd quartile, 16 hours). Overall, 95.5% of gradings (95% CI, 93.9%-96.7%) were returned within 24 hours. Subgroup analyses found, for image sets submitted to the reading center before 2 p.m. Eastern Standard Time, median time to report was 1.7 hours (1st quartile, 0.7 hours; 3rd quartile, 15.5 hours) compared with those submitted after 2pm (median, 14.1 hours; 1st quartile, 11.2, hours; 3rd quartile, 16.3 hours).
  
  
  
  An ROP telemedicine approach can provide timely feedback to the NICU regarding the detection of potentially serious ROP and thus referral to an ophthalmologist for examination and consideration of treatment.
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: quinn@email.chop.edu.
authors.forename: Graham E
authors.initials: GE
authors.lastname: Quinn
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Michael X
authors.initials: MX
authors.lastname: Repka
authors.affiliation: Dean McGee Eye Institute, University of Oklahoma, Oklahoma City.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Siatkowski
authors.affiliation: Department of Ophthalmology, University of Utah, Salt Lake City.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoffman
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Monte D
authors.initials: MD
authors.lastname: Mills
authors.affiliation: Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee.
authors.forename: David
authors.initials: D
authors.lastname: Morrison
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.affiliation: Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Agnieshka
authors.initials: A
authors.lastname: Baumritter
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: P Lloyd
authors.initials: PL
authors.lastname: Hildebrand
authors.affiliation: National Eye Institute, Bethesda, Maryland.
authors.forename: Eleanor B
authors.initials: EB
authors.lastname: Schron
authors.affiliation: Department of Ophthalmology, University of Calgary, Canada.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Ells
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Kelly
authors.initials: K
authors.lastname: Wade
authors.affiliation: Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Kemper
mesh_terms: D000488:Allied Health Personnel; D003952:Diagnostic Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors