Table 1 Alignment between the ERIC framework [24] with NIATx Model and Implementation for Sustained Impact in Teleophthalmology (I-SITE)

1. Understand and involve the customer

Engage patients and clinical stakeholders (e.g. primary care providers, staff, and administrators) to understand and develop strategies to overcome barriers to teleophthalmology use

2. Fix the key problems

Increase teleophthalmology use and diabetic eye screening rates in primary care clinics

3. Pick a powerful Change Leader

Empower a clinic staff member who can be effective in obtaining buy-in from providers, staff and administrators at all levels

4. Get ideas from outside the organization/field

Borrow strategies from other areas of health maintenance (e.g. immunizations and dental appointment reminders)

5. Use rapid cycle testing to establish effective changes

Test strategies cyclically with modifications made as needed to effectively increase teleophthalmology use and screening rates

1. Identify a key problem

Explain the urgent need to increase teleophthalmology use and diabetic eye screening

2. Do a walk-through

Walk-through the current teleophthalmology workflow

3. Assemble the change team

Assemble an implementation team composed of clinical stakeholders (e.g. primary care providers, staff, and administrators) and a patient stakeholder team

4. Flowchart

Flowchart the current teleophthalmology workflow with the implementation team to identify barriers to teleophthalmology use

5. Plan the Change

Discuss potential strategies to increase teleophthalmology use and provide technical assistance

6. Nominal Group Technique

Use this voting technique to reach a consensus on top barriers and top strategies to implement

7. Assign Roles and Tasks

Assign roles and tasks to implementation team members to implement the selected strategies

8. Rapid Cycle Testing

Test strategies, review data and feedback with the implementation team to decide whether to adopt, abandon, or adapt the changes across multiple short cycles

9. Develop a Sustainability Plan

Select strategies that are highly likely to be sustainable or adapt strategies to improve sustainability

10. Completion- Celebrate and Share Results

Share results with the primary care clinic, health system, and community at the end of the implementation period