Care within sight: How Azure is making healthcare more accessible
Introduction
You don't need to be a country music fan to appreciate John Denver's tender hymn that captures the soul and beauty of West Virginia. Its rolling hills, winding roads, and vast green forests are both its charm and challenge. In the early 20th century, West Virginia experienced significant growth as workers moved to small towns for jobs in the coal industry, which was crucial for steel and energy production. However, by 1940, the state's coal mining industry reached its peak, prompting many individuals to leave in search of new economic opportunities. This migration left those who remained in small towns with dwindling populations, reduced access to resources, and the loss of economic opportunity and essential services.
One of those services is access to healthcare. The average travel time for an American to reach a doctor is approximately 15 minutes. However, individuals living in the most rural areas of West Virginia often face challenges with reliable transportation access. Unreliable transportation services can significantly hinder individuals from reaching essential destinations like workplaces, healthcare facilities, and educational institutions, leading to economic and social disadvantages. This issue is further compounded by limited availability, fewer routes, longer wait times, and reduced service hours for public transportation options such as trains and buses, making it difficult for people to depend on these services for their daily needs.
This barrier to access is particularly dangerous to the more than 250,000 West Virginians currently diagnosed with diabetes. When left untreated, one of the outcomes is the potential for long-term vision loss, called Diabetic Retinopathy (DR). For these patients, managing multiple doctors' appointments is even more complex and requires finding someone to drive you, getting your eyes dilated, and missing a day of work; follow-up visits with specialists who could be hours away are even more difficult. Being diagnosed with diabetes is one thing; managing the condition daily is something entirely different.
There are more people living with diabetes in West Virginia, than there are ophthalmologists in the world. The number of people with diabetes has risen from 100,000 people to 250,000 people in 22 year.
DiabetesAtlas-West-Virginia-number-by-age available for download.
Innovations in science and technology have a long history in helping us understand diabetes and the treatments used to reduce its impact on people, but the pace of discovery has been slow. The invention of the ophthalmoscope in the mid-1800s allowed doctors to better detect changes in the eye, but it was another half century before ophthalmologists linked diabetes to retinal damage. After the discovery of insulin in the 1920s, diabetic patients began to live long enough to develop such complications. Today, doctors have effective treatments for DR, but early detection is key to prevention and better outcomes.
Fortunately, the pace of technological innovation in recent years is making a real impact on improving the lives of people with chronic health conditions like diabetes. AI integration with telemedicine is a valuable tool with substantial impact on underserved communities not only in West Virginia, but across the United States and throughout the world. In 2011, Dr. Sunil Gupta, an eye surgeon in Pensacola, Florida, established Intelligent Retinal Imaging Systems (IRIS), a company with a mission to end preventable blindness in the United States through technological solutions. IRIS developed a method to capture digital images of the eye and retina, without requiring expensive equipment or a specialist.
(left) Illustration of an optics diagram published in 1894. (center) Dr. Sunil Gupta holds a mobile retinal scan device powered by IRIS software, standing next to a projection showing the results of a recent exam. (right) Ophthalmic vision test showing letters and numbers at varying sizes to determine a patient’s strength of vision.
Innovating with Azure
In 2020, IRIS was selected as a recipient of the Microsoft AI for Health Initiative grant. This collaboration provides IRIS with access to advanced AI tools and Azure computing resources, further enhancing their diagnostic solutions. Deep learning has presented significant opportunities for the automated detection of retinal diseases, including DR. This approach allows for rapid and accurate detection of potential diseases, often within seconds, and facilitating immediate follow-up and treatment decisions. Research suggests that retinal screening using digital photography and telemedicine can lead to early detection, potentially preventing over 90% of DR cases.
The IRIS software allows healthcare providers at various levels of training to conduct retinal scans and return a diagnosis quickly. After capturing the images, they are securely uploaded to the IRIS platform, enhanced for clarity, and reviewed remotely by a licensed eyecare professional at the IRIS Reading Center. Diagnosis results, including images and reports, are then added to the patient's health record, enabling referrals to specialists if needed.
Advancements in telemedicine now enable remote consultations, offering care without the need to visit an eye doctor in person. This is notable given that there are approximately 200,000 ophthalmologists worldwide, and roughly 20,000 currently practicing in the United States, with some states lacking any. IRIS software is part of that solution by creating a new model where skilled health workers can travel to a person’s home to capture the retinal scans and submit them for a timely diagnosis, reducing the strain on patients to make special trips to the closest doctor. Consequently, nearly 30 million individuals in the United States with diabetes may receive more timely diagnosis and treatment.
In West Virginia, a small community hospital achieved notable success by integrating IRIS technology. Within 13 months, they conducted over 1,500 exams, detecting diabetic retinopathy in 16.17% of patients and other eye conditions in 24.4%. This program improved patient outcomes and satisfaction by making screenings more accessible and convenient, significantly impacting patients.
(left) A retinal image enhanced with the AI software. (center) A trained healthcare worker takes a retinal image of a patient using a mobile imaging device. (right) A detailed view of the retina for analysis and diagnosis.
Improving access to care
It's not just West Virginia that benefits from the IRIS software. The company has rapidly scaled operations to meet growing demand and are now processing 40,000 exams per month. This significant increase in exams has played a crucial role in reaching approximately 1.5 million patients, identifying around 150,000 at risk of severe blindness, and referring them for treatment. In 2024 alone, IRIS identified more than 60,000 patients with some form of visually threatening pathology and accomplished more than 37,000 'saves,' a metric the company uses to specify the number of patients who would have gone blind without intervention.
One of the most valuable outcomes of this program is that individuals appreciate being able to visit a single location for comprehensive care, not only because it reduces the time and financial burden associated with multiple visits, but also because it provides a holistic care experience where they can communicate their entire diabetic and healthcare concerns, particularly in regions with limited access to care.
West Virginia is just one example of how we can learn and improve access to care, which will ultimately help us enhance patient care across the country and around the world. This is especially crucial in areas where people lack access not only to hospital care but also to essential resources like electricity and the internet. In Latin America, Microsoft is collaborating with ophthalmologists to develop detection tools for children born prematurely. It is essential for babies to undergo a retinal scan promptly to detect, treat, and prevent underdeveloped eyes, which could result in long-term vision loss or blindness from a very early age. By applying similar technology, community health workers can identify retinopathy in infants born in under-resourced regions.
Building trust within small communities is vital, and IRIS is a testament to how technology can bridge these gaps. While IRIS is a software application, its impact extends far beyond technology—it opens lines of communication between doctors and patients. Our healthcare providers should be among those we trust the most, and with the help of AI, we can ensure that even the world's most vulnerable populations receive the care they need.
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