Case Study
Case Study
Expanding Diabetic Retinopathy Screening for Indian Health Service (IHS)
Improving Access to Eye Care Through Long-Term Operational and Technical Support
COMPANY
Joslin Diabetes Center



Executive Summary
About the Client
The Challenge
Problem
Many American Indian and Alaska Native communities face limited access to ophthalmology services, especially for diabetic retinopathy, a major cause of preventable vision loss.
Solution
Estenda has partnered with Joslin Diabetes Center and IHS to provide daily operational support, software development, and data integration for the IHS JVN Teleophthalmology Program.
Impact
Estenda has supported the expansion of the program to over 100 sites nationwide, improving access to retinal screening for underserved diabetes patients and enabling ongoing research efforts.
Executive Summary
About the Client
The Challenge
Problem
Many American Indian and Alaska Native communities face limited access to ophthalmology services, especially for diabetic retinopathy, a major cause of preventable vision loss.
Solution
Estenda has partnered with Joslin Diabetes Center and IHS to provide daily operational support, software development, and data integration for the IHS JVN Teleophthalmology Program.
Impact
Estenda has supported the expansion of the program to over 100 sites nationwide, improving access to retinal screening for underserved diabetes patients and enabling ongoing research efforts.
Executive Summary
About the Client
The Challenge
Problem
Many American Indian and Alaska Native communities face limited access to ophthalmology services, especially for diabetic retinopathy, a major cause of preventable vision loss.
Solution
Estenda has partnered with Joslin Diabetes Center and IHS to provide daily operational support, software development, and data integration for the IHS JVN Teleophthalmology Program.
Impact
Estenda has supported the expansion of the program to over 100 sites nationwide, improving access to retinal screening for underserved diabetes patients and enabling ongoing research efforts.
Our Engagement
01
How We Started
Estenda began supporting the Joslin Vision Network (JVN) Teleophthalmology Program in the early 2000s through an ongoing partnership with Joslin Diabetes Center and Indian Health Services.

01
How We Started
Estenda began supporting the Joslin Vision Network (JVN) Teleophthalmology Program in the early 2000s through an ongoing partnership with Joslin Diabetes Center and Indian Health Services.

01
How We Started
Estenda began supporting the Joslin Vision Network (JVN) Teleophthalmology Program in the early 2000s through an ongoing partnership with Joslin Diabetes Center and Indian Health Services.

02
Project Goals
Provide daily operational support across all active program sites.
Develop and enhance teleophthalmology software systems.
Assist with data integration across systems.
Support research initiatives that aim to improve patient outcomes.

02
Project Goals
Provide daily operational support across all active program sites.
Develop and enhance teleophthalmology software systems.
Assist with data integration across systems.
Support research initiatives that aim to improve patient outcomes.

02
Project Goals
Provide daily operational support across all active program sites.
Develop and enhance teleophthalmology software systems.
Assist with data integration across systems.
Support research initiatives that aim to improve patient outcomes.

03
Collaboration Model
Estenda operates as a long-term technical and operational partner, delivering a comprehensive suite of services including custom software development, system integration, daily operational support, and research infrastructure. Our team works closely with both clinical and administrative stakeholders to ensure that the teleophthalmology platform remains reliable, scalable, and responsive to evolving program requirements. By aligning technology with the unique needs of the Joslin Vision Network and Indian Health Services, Estenda plays a key role in maintaining program continuity, enhancing data-driven insights, and supporting strategic growth across over 100 service sites nationwide.

03
Collaboration Model
Estenda operates as a long-term technical and operational partner, delivering a comprehensive suite of services including custom software development, system integration, daily operational support, and research infrastructure. Our team works closely with both clinical and administrative stakeholders to ensure that the teleophthalmology platform remains reliable, scalable, and responsive to evolving program requirements. By aligning technology with the unique needs of the Joslin Vision Network and Indian Health Services, Estenda plays a key role in maintaining program continuity, enhancing data-driven insights, and supporting strategic growth across over 100 service sites nationwide.

03
Collaboration Model
Estenda operates as a long-term technical and operational partner, delivering a comprehensive suite of services including custom software development, system integration, daily operational support, and research infrastructure. Our team works closely with both clinical and administrative stakeholders to ensure that the teleophthalmology platform remains reliable, scalable, and responsive to evolving program requirements. By aligning technology with the unique needs of the Joslin Vision Network and Indian Health Services, Estenda plays a key role in maintaining program continuity, enhancing data-driven insights, and supporting strategic growth across over 100 service sites nationwide.

The Solution
Technologies Used
Custom software platforms supporting the JVN program.
Integration of imaging and clinical data systems.
Tools for image review and workflow management.
Custom software platforms supporting the JVN program.
Integration of imaging and clinical data systems.
Tools for image review and workflow management.
Custom software platforms supporting the JVN program.
Integration of imaging and clinical data systems.
Tools for image review and workflow management.
Processes implemented
Ongoing system development and maintenance.
Support for site operations across over 100 locations.
Data infrastructure to enable clinical research.
Ongoing system development and maintenance.
Support for site operations across over 100 locations.
Data infrastructure to enable clinical research.
Ongoing system development and maintenance.
Support for site operations across over 100 locations.
Data infrastructure to enable clinical research.
Customization
Solutions are tailored to the infrastructure, workflows, and reporting needs of IHS program sites to ensure consistent service delivery and data capture across the national network.
All software platforms and data systems are developed and maintained in compliance with federal information security and privacy regulations, including FISMA (Federal Information Security Management Act) and NIST 800-53 standards.
Solutions are tailored to the infrastructure, workflows, and reporting needs of IHS program sites to ensure consistent service delivery and data capture across the national network.
All software platforms and data systems are developed and maintained in compliance with federal information security and privacy regulations, including FISMA (Federal Information Security Management Act) and NIST 800-53 standards.
Solutions are tailored to the infrastructure, workflows, and reporting needs of IHS program sites to ensure consistent service delivery and data capture across the national network.
All software platforms and data systems are developed and maintained in compliance with federal information security and privacy regulations, including FISMA (Federal Information Security Management Act) and NIST 800-53 standards.
Challenges Along the Way
Obstacle
Supporting a growing number of sites with varying technical capabilities.
Solution
Estenda delivered adaptive software solutions and scalable support models.
Obstacle
Supporting a growing number of sites with varying technical capabilities.
Solution
Estenda delivered adaptive software solutions and scalable support models.
Obstacle
Supporting a growing number of sites with varying technical capabilities.
Solution
Estenda delivered adaptive software solutions and scalable support models.
Obstacle
Integrating software and data systems in a wide range of environments.
Solution
Facilitated data interoperability and research data capture.
Obstacle
Integrating software and data systems in a wide range of environments.
Solution
Facilitated data interoperability and research data capture.
Obstacle
Integrating software and data systems in a wide range of environments.
Solution
Facilitated data interoperability and research data capture.
Obstacle
Ensuring reliable and standardized image review processes.
Solution
Worked closely with Joslin and IHS stakeholders to evolve the program’s tools and processes.
Obstacle
Ensuring reliable and standardized image review processes.
Solution
Worked closely with Joslin and IHS stakeholders to evolve the program’s tools and processes.
Obstacle
Ensuring reliable and standardized image review processes.
Solution
Worked closely with Joslin and IHS stakeholders to evolve the program’s tools and processes.
Results & Success Metrics
Quantifiable Outcomes
Quantifiable Outcomes
Operational and software support extended to over 100 individual sites across the U.S.
Enabled over 250,000 retinal screenings for diabetes patients in underserved communities across more than 100 sites nationwide, through 20+ years of continuous operation.
Recognized for outstanding service with the 2023 Distinguished Service Award by the American Academy of Ophthalmology.
Operational and software support extended to over 100 individual sites across the U.S.
Enabled over 250,000 retinal screenings for diabetes patients in underserved communities across more than 100 sites nationwide, through 20+ years of continuous operation.
Recognized for outstanding service with the 2023 Distinguished Service Award by the American Academy of Ophthalmology.
Operational and software support extended to over 100 individual sites across the U.S.
Enabled over 250,000 retinal screenings for diabetes patients in underserved communities across more than 100 sites nationwide, through 20+ years of continuous operation.
Recognized for outstanding service with the 2023 Distinguished Service Award by the American Academy of Ophthalmology.
Qualitative Benefits
Qualitative Benefits
Expanded access to screening services that help prevent diabetic-related vision loss.
Supported research efforts focused on disease prevalence, treatment adherence, and image review quality.
Expanded access to screening services that help prevent diabetic-related vision loss.
Supported research efforts focused on disease prevalence, treatment adherence, and image review quality.
Expanded access to screening services that help prevent diabetic-related vision loss.
Supported research efforts focused on disease prevalence, treatment adherence, and image review quality.
Current Status
Where We Are Now
Where We Are Now
Estenda continues to support the IHS Teleophthalmology Program with operational services, system enhancements, and research infrastructure.
Estenda continues to support the IHS Teleophthalmology Program with operational services, system enhancements, and research infrastructure.
Estenda continues to support the IHS Teleophthalmology Program with operational services, system enhancements, and research infrastructure.
Ongoing Relationship
Ongoing Relationship
The collaboration with Joslin Diabetes Center and Indian Health Services is ongoing, with continued efforts to scale and improve the program.
The collaboration with Joslin Diabetes Center and Indian Health Services is ongoing, with continued efforts to scale and improve the program.
The collaboration with Joslin Diabetes Center and Indian Health Services is ongoing, with continued efforts to scale and improve the program.
Key Takeaways
Why It Matters:
Why It Matters:
The IHS Teleophthalmology Program addresses a critical gap in diabetic care for Native American communities. Estenda’s long-term technical and operational support has helped expand access to sight-saving screenings for high-risk patients.
The IHS Teleophthalmology Program addresses a critical gap in diabetic care for Native American communities. Estenda’s long-term technical and operational support has helped expand access to sight-saving screenings for high-risk patients.
The IHS Teleophthalmology Program addresses a critical gap in diabetic care for Native American communities. Estenda’s long-term technical and operational support has helped expand access to sight-saving screenings for high-risk patients.
Why Estenda:
Why Estenda:
Estenda brings deep experience in healthcare software, long-term partnership models, and research-oriented data systems, making it a valuable collaborator in public health initiatives like this one.
Estenda brings deep experience in healthcare software, long-term partnership models, and research-oriented data systems, making it a valuable collaborator in public health initiatives like this one.
Estenda brings deep experience in healthcare software, long-term partnership models, and research-oriented data systems, making it a valuable collaborator in public health initiatives like this one.
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