While this editor has often covered digital health within startups and early-stage projects, telemedicine innovation is not just the purview of small companies and healthcare incubators. Since 1976, Canon, Inc., the same multinational corporation that has been making cameras and other imaging devices since 1937, has also been involved in healthcare. Today, we’re looking at Canon’s efforts to improve the process of teleretinal scanning through their suite of devices and software designed for clinical use.
For the long-time Medgadget readers, you may be familiar with previous posts from back in 2010 and 2011 when the Canon technology we’ll be learning more about in this article was going through its FDA clearance process.
Review of retinal scans, like those captured by Canon’s technology, are important for patients who have, or are at risk for, diabetic retinopathy. Diabetic retinopathy is a condition experienced by patients with diabetes in which damage to the small blood vessels of the eye ultimately leads to loss of vision. Traditionally, patients visit their ophthalmologist or optometrist for a retinal scan to assess the progression or risk of diabetic retinopathy. With Canon’s technology, which does not require dilation of the eye, primary or general care practitioners are able to capture high quality retinal scans, digitally share those images with an eye care specialist, and receive a diagnosis with recommendations for next steps.
Medgadget had a unique opportunity to sit down with Tom Russo, Regional Sales Manager of Canon USA’s Healthcare Solutions Division, to understand Canon’s vision and its technology, as well as Dr. Rajnikant (Raj) Shah, CEO and CMO of SmartCareDoc, to hear first-hand the impact that Canon’s technology can make in the clinic. Dr. Shah is also a cardiologist and associate professor of clinical medicine at Drexel University College of Medicine. SmartCareDoc uses Canon’s technology as part of it’s telemedicine platform.
Mike Batista, Medgadget: Tom, Canon has long been known for its development of imaging and optical products, can you tell us about the opportunity Canon sees in teleretinal scanning?
Mr. Tom Russo (Canon): Beyond the traditional use of retinal imaging systems by ophthalmologists and optometrists, we are noticing a growing trend among a number of primary health care providers to include diabetic retinopathy screenings, a leading cause of blindness among the adult population, as part of their preventive medicine disease prevention programs. The trend is supported by a growing number of health care plans that are starting to offer reimbursement for this screening, including Medicare and 3rd party insurers. The primary purpose is to initiate the early detection of this condition so that medical intervention can begin sooner to help avoid loss of vision.
The high resolution retinal imaging technology solutions that we deliver today to the eye care practitioner can be also be utilized by primary care practitioners within many healthcare provider networks. The Canon Non-Mydriatic retinal camera systems do not require the eye to be dilated and can be strategically placed within the primary care clinics that provide diabetic patient examinations. Historically, Canon Non-Mydriatic retinal cameras have been used for teleretinal programs for about 15 years now beginning in the UK and then in the USA.
Medgadget: Dr. Shah, tell us about your background and how you became involved with Canon’s teleretinal scanning program?
Dr. Raj Shah (SmartCareDoc): This occurred through my affiliation with Temple University Health System. Temple purchased our SmartCareDoc Virtual Clinic System and was exploring new ways to use the system when they asked if there was an easy way to do diabetic retinopathy screening using the SmartCareDoc system. To do this well, I knew we would need to use a device that did not require dilation of the pupil. I recalled seeing the Canon camera at the 2015 American Telehealth Conference and I reached out to them to assess its potential. We found the camera could integrate into our system, and the answer was emphatically yes. We have now served over 300 patients using this platform.
Medgadget: Tom, walk us through a typical scenario of how Canon’s teleretinal technology is used.
Tom (Canon): The Canon Non-Mydriatic teleretinal camera and software solutions can be placed in primary care clinics that take care of patients that have or are at risk of developing diabetic retinopathy. The retinal camera system is used by technicians or nurse practitioners to acquire the retinal images, which are then processed by the system computer to store and forwarded to a central reading location within the healthcare network. The images are reviewed and graded by an ophthalmologist or optometrist who then generates a clinical report, which is entered into the electronic medical record for that patient. The primary care doctor then accesses or receives this report and informs the patient about the clinical findings within a day or two of the screening. Based on the clinical findings, the primary care doctor can assist with scheduling an appointment with the facility’s eye clinic or recommend that the patient seek medical attention with their existing eye care providers.
Medgadget: Dr. Shah, which medical use cases is Canon’s technology used to evaluate?
Dr. Shah (SmartCareDoc): Integrating the Canon camera into the system allows diabetic retina screening in patients at risk for diabetic retinopathy, which causes blindness when unchecked. Additional uses will be defined by our users as they become acclimated to our system and the great benefits utilization will yield.
Medgadget: Tom, what is the historical standard of care for teleretinal imaging programs and how has Canon improved upon it?
Tom (Canon): The historical standard of care for teleretinal imaging programs that have been deployed in the USA has involved the use of a tabletop non-mydriatic retinal camera to acquire one or more 45-degree photos of the central area of the retina. Screening programs began in the USA more than 15 years ago with the use of low resolution CCD cameras at around 1 or 2 Megapixels (MP). Fast forward to today, the Canon technology can provide very high resolution 18 MP or 20 MP digital camera resolutions, which improves the ability to locate early pathology.
By combining the Canon EOS digital camera, Canon camera lens optics technology and automated camera acquisition features, we believe we can deliver one of the highest quality easy to use retinal imaging systems to the marketplace. The Canon retinal imaging solution is used by the practitioner to identify all stages of diabetic retinopathy, macular degeneration, glaucoma, ocular hypertension and other conditions. In addition, the Canon imageSPECTRUM Image Management software can be used to manage the image data so that practitioners can record and share their findings across a computer network in order to make a diagnosis.
Medgadget: Tom, building on that, how does Canon’s technology compare to mobile retinal imaging technology such as that available from Welch Allyn?
Tom (Canon): The Canon 18MP or 20 MP retinal camera systems provide far greater imaging resolution when compared to a 3 MP hand-held instrument. The image resolution is very important when zooming in or enlarging the image to find early disease and conditions. The variability of image quality between imagers when using a hand-held instrument also varies considerably when compared to using a traditional table-top retinal camera system. Should the customer require mobility, the Canon retinal camera and laptop system can be made transportable using the custom transport travel case.
Additionally, the Canon retinal camera does not come in contact with the patient’s head or eye as compared to using a hand-held instrument that requires hand or instrument contact with the patient or patient’s face.
Medgadget: Dr. Shah, how do clinicians benefit from teleretinal scanning programs? How do patients benefit?
Dr. Shah (SmartCareDoc): Clinicians benefit by being able to see patients that they have not been able to see in the past. Expanding patient access to their services makes the physician more effective and competitive. Patients benefit by greater access to physician services, either general practitioner or specialist services, that would otherwise be unavailable to them in a timely or cost effective fashion.
Medgadget: Dr. Shah, how was the process of working with Canon’s teleretinal scanning technology?
Dr. Shah (SmartCareDoc): The process to obtain the camera and integrate it to our system was made very easy by the support group at Canon. They also supported our training and installation at Temple University Health System very well. Today the program has succeeded in improving the HEDIS scores for Temple and we anticipate additional applications of the program based on this great success.
Medgadget: Besides teleretinal scanning, what other healthcare products does Canon offer and what can you tell us about what we can expect to see from Canon down the road in this space?
Tom (Canon): In addition to the CR-2 AF and CR-2 PLUS AF Canon Non-Mydriatic retinal camera systems that can be used for teleretinal screenings, we also offer the CF-1 mydriatic retinal camera that is used by ophthalmologists for fluorescein angiography retinal imaging and the CX-1 Myd/Non-Myd combination camera that combines both technologies. We also provide the Canon TX-20 Auto Non-Contact Tonometer [previous Medgadget article] that acquires the pressure reading of the eye. This is one of the tests for glaucoma in which the Canon RK-F2 automatically measures the refraction of the eye and can be used as an estimate for your eye glass or contact lens prescription. Down the road we expect to release the Canon OCT, which can provide detailed views and measurements of the ten layers of the retina. This product is pending 510(k) clearance from the FDA. The product is already for sale outside of the USA in the European and Asian markets.
The growing needs and opportunities in the healthcare market are recognized by Canon and our commitment to continue to invest in the future is evident not only in our healthcare division, which includes eye care and digital radiology solutions, but also in the establishment of Canon BioMedical, Inc., a wholly owned subsidiary announced on March 2, 2015 that will serve as a worldwide headquarters for its biomedical business.
The new company will look for long-term future growth opportunities in previously untapped markets for Canon such as life science, healthcare, and medical analysis through the use of existing and emerging Canon technology, as well as strategic partnerships. In the future, Canon Inc, wants to open a research center on Long Island to support its entry into genetic testing for the diagnosis and treatment of disease.
Medgadget: Dr. Shah, are there other use cases where you see an opportunity for telemedicine to make a meaningful impact?
Dr. Shah (SmartCareDoc): I would turn the question around and ask if there are any clinical areas of support that telemedicine will not add value. When considering the system wide imperative of better access, higher quality and lower cost – better known as the CMS Triple Aim – there is no better tool to assist in this auspicious goal than a telemedicine program.