By Justis Ehlers, MD, Cleveland Clinic Cole Eye Institute vitreoretinal surgeon
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Ophthalmology increasingly is an image-driven subspecialty. Recent developments in diagnostic testing, such as optical coherence tomography (OCT), guide management decisions and enhance our diagnostic capabilities.
This significant influx of testing can lead to information overload if the data isn’t presented to the clinician and handled in an appropriate way. In some situations, this may simply involve printing a report. However, the utility of printed diagnostic imaging reports is limited, because paper restricts the accessibility and functionality of the data. In the age of electronic medical records (EMR), an electronic image archiving and display system is the logical solution for most practices.
Three widely-used systems
Three common ophthalmology imaging solution suites are Zeiss FORUM,® Merge Eye Care (OIS) and ANKA EyeRoute. These three packages provide digital alternatives for publishing reports from diagnostic devices. Each system has advantages and disadvantages.
Functionality continues to evolve with the deployment of EMR. Many practices converted to electronic image display solutions long before converting to an EMR system. The integration of imaging solutions and EMR systems is an active area of development and progress.
Details of Zeiss FORUM
The imaging system we use at Cleveland Clinic’s Cole Eye Institute is Zeiss FORUM. Nearly all our diagnostic reports are stored and displayed within this system. This includes OCT, photography, angiography and visual field testing.
The comprehensive nature of this package offers the clinician a practical interface that improves workflow, facilitates optimal interpretation and allows integration of test results, such as visual field and OCT correlation. We utilize this system throughout our satellite network. The servers that provide the data for the software system communicate with all the community locations. This system lets the clinician access a test performed at one location, even when the patient is seen at another.
Device communication should be seamless
When making the transition to a digital interface, access to previously collected data and test reports is an important consideration.
Data integrity is a critical component for any EMR and imaging solution. An important enhancement to the consistency of patient identification and labeling is multidirectional communication among the EMR system, the diagnostic device and the imaging solution.
In our system, we place an order within the EMR system, which is then transferred to an electronic work list. The diagnostic device cam pull the order from the work list with the patient’s identifying information already populated from the EMR system. Following the diagnostic procedure, the reports are published to the image-viewing software. This ensures a seamless transition from the EMR to the imaging solution, helping to eliminate transcription errors and variability in data entry.
Historical data access is key issue
When making the transition to a digital interface, access to previously collected data and test reports is an important consideration. A practice must consider the practical aspects of importing previous diagnostic studies, and how far back to go when including such studies. If data is not included, an archiving solution needs to be in place to provide a backup if older data is needed.
The communication and interface for opening reports between the EMR system and imaging solution software also varies from system to system. In some packages, there is no direct way to open diagnostic testing within the EMR system. Others use a link that opens the imaging solution program and the patient’s information with a single mouse click. Finally, some packages have the reports embedded within the EMR system itself. All these features can potentially impact workflow and should be considered when selecting an imaging solution.
Diagnostic data display should accommodate patient needs
A final consideration is how to display diagnostic reports. As our clinical practices grow more imaging-centric, the interface for the patient as well as the clinician becomes important. Often, clinicians review the testing with the patient. The display system’s ease and flexibility is vital, particularly when patients are visually impaired.
Possible solutions include tablets, iPads, laptops, large-screen monitors and dual-monitor systems.The choice comes down to practice style and personal preference. The type of imaging and the patient population may impact which solution best fits a given practice.
Imaging solution options will continue to expand. These software packages enhance patient care and improve communication between offices and physicians. There is often a significant initial learning curve during which efficiency may suffer. But an electronic display system’s advantages over paper records are significant. Careful preparation and research regarding the system that best suits your practice’s requirements can help dramatically ease the transition.