Objective: Systems engineering theory, hand-hold fundus camera(FC) and internet cooperative platform were applied to help community staff, long distance specialists' organizations and teams to cooperate on the screening for diabetic fundus pathological change(or diabetic retinopathy, DR) in regional residents. It aims at promoting the ability to prevent and control (PC) the important non-infectious chronic diseases (NCD) to design a proper value-chain for mutually beneficial mode of interactions among regional health services, and the other corresponding social roles via technological and organizational innovation.