Integrating Digital Images And Reports

EyeRoute can improve the efficiency of your practice and help you and your staff prepare for a transition to EMR.

By Jeffrey P. Wick, M.D., M.S.

As the partner in our practice who has a background in medical informatics, I've been leading our efforts to update our information systems (IS). We're a large practice, a regional ophthalmic provider with 15 doctors on staff, who serve more than 75,000 patients a year. We have one main eyecare center in Tyler, Texas, and four satellite offices. We're full-spectrum ophthalmologists, providing general, pediatric, oculoplastic, glaucoma, refractive and retinal care. We have a substantial amount of patient information to oversee, so we wanted to implement technology that would allow us to manage that information as efficiently as possible.

When we began exploring our options, we determined that all IS projects should be evaluated by three criteria. New technology should improve patient care, save money by increasing efficiency, or fulfill a regulatory requirement. Specifically for our practice, we wanted the ability to efficiently disseminate patient information, particularly ancillary testing and imaging results, within our group. Because we have so many subspecialists, our patients often see different doctors in different places. We were constantly shuttling records from one site to another. We also wanted to be ready for an eventual conversion to full electronic medical records (EMR). And we wanted a system that would enable us to more easily meet future reimbursement-related government requirements.

Benefits of the EyeRoute

Once we set our goals and researched available solutions, we chose to implement the EyeRoute ophthalmic image management system (Anka Systems Inc./Topcon Medical Systems Inc.). The EyeRoute is an open system that integrates images and reports from various ophthalmic instruments into a single, secure, digital environment in a HIPAA-compliant manner. The EyeRoute is compatible with more than 20 different types of instruments from various manufacturers, including digital fundus cameras, perimeters, optical coherence tomographers, optic nerve analyzers, ultrasonography devices, the IOL Master (Carl Zeiss Meditec) and wavefront aberrometers. The EyeRoute also can interface with most EMR packages. The system consists of PC hardware, a Microsoft SQL database and networking technology bundled together.

For our practice, the EyeRoute offers several benefits:

■ Instant access. We can view, organize, edit and transport patient images from anywhere (remote office, home and on the road) via Internet Explorer. The system also will work with other standard Web browsers, such as Mozilla Firefox.

■ Increased efficiency. By providing easy access to old and new patient images, EyeRoute eliminates the need for paper versions of test results. Therefore, we reduce the time spent searching through paper charts to locate specific test results. Our doctors are self-sufficient, which frees technician time. We can easily copy and paste images and reports into PowerPoint and Word documents. Also, EyeRoute seamlessly integrates with EMR, which will be our next IS project.

■ Enhanced communication. We can give consulting and referring doctors instant access to patient images. In addition, we can improve patient education and compliance because we can easily show patients their actual test results, past and present, in the exam room. This offers patients a tangible visual image that helps provide an understanding of their condition.

■ Elimination of paper-chart problems. We no longer risk misplacing images and reports or filing paper tests in the wrong patient chart. EyeRoute automatically files tests electronically, using multiple patient identifiers, such as last name, date of birth, etc.

EyeRoute at a Glance

With the EyeRoute, ophthalmology offices can deploy a high-quality digital image management system at an affordable price. The basic system consists of capture stations, viewing stations, central patient records and central storage (Figure 1). The entry-level configuration allows ophthalmology departments to capture studies from multiple diagnostic instruments, store them on a central network, view them from multiple locations and back them up to DVD for disaster recovery. Additional modules can be added to increase the system's functionality and automation capability: • EyeRoute-Web allows instant access to patient and image data from virtually anywhere. • EyeRoute-CSG automatically retrieves images from ophthalmic capture stations for viewing in a standard Web browser. • EyeRoute-DICOM enables electronic communication with DICOM-compatible systems. • EyeRoute-HL7 provides flexible communication with hospital information systems. The EyeRoute enables ophthalmic physicians and staff to view, organize, edit and transport patient test and imaging results, saving money, increasing productivity and improving patient management. Furthermore, because EyeRoute performs functions that most electronic medical records packages don't, it's the key to realizing the benefits of office computerization. For more information about the EyeRoute ophthalmic image management system, contact Topcon Medical Systems Inc.: Phone: (800) 223-1130 E-mail: EyeRoute@topconmedical.com Web: EyeRoute.topconmedical.com

Figure 1. The EyeRoute ophthalmic image management system automatically integrates images and reports from various ophthalmic instruments into a single, secure digital environment.

■ A solid investment. EyeRoute is compatible with most diagnostic instruments, so the past investments of the practice remain intact. Furthermore, the system will enhance and simplify future IT endeavors, such as our planned migration to EMR. Now that we've adopted the EyeRoute, we're definitely better prepared to implement full EMR.

■ Fast return on investment. EyeRoute quickly frees physicians and technicians to spend more time with patients, which improves our bottom line. The practice also saves on paper and ink cartridges.

■ Improved patient care. Doctors in all of our offices have access to all of the ancillary testing information they need, whenever they need it. Also, they can easily compare tests from different time periods, enabling them to make better diagnosis and treatment decisions.

Implementation in our Practice

Before we implemented EyeRoute in our practice, we wanted to know how we'd get data into and out of the system. Getting data into the system is quite simple. First, the Topcon team takes care of the installation behind the scenes, which doesn't interfere with the practice. After installation, technicians simply press a button when they use the testing equipment, and the data is automatically exported to EyeRoute. Training is available to gain an understanding of the system's features, but because the system is so intuitive, all of our doctors and staff were able to use it right away.

How to get data out was a more important consideration. In other words, how would the doctors and staff access the system? Central viewing stations, terminals in every exam room or mobile laptops are all feasible options. We decided the best solution was to have a dual-screen display in each exam room (Figure 2). In each room, we have a laptop computer on the desk, and it's integrated with a large, ultra high-definition monitor. The monitor is mounted on the wall. The physician views the patient's EyeRoute images on the laptop. At the same time, the patient sees what appears on the laptop on the large monitor. So the physician and the patient both have a clear view of the images, but they can remain face-to-face throughout the visit. We also have integrated visual acuity testing that's set up in the same manner.

Patients are very impressed by this setup. Instead of canned photos or a canned explanation, they can see their own personal test results. As I mentioned previously, this enhances patient education and compliance.

We use our setup in another way that's been effective. While patients wait in the exam room, we play customized slide shows on the large monitor. This is an excellent way to convey information about our services, such as our optical shop, LASIK, oculoplastics and our new diagnostic hearing care. We anticipate that this type of internal marketing will yield a large return on investment with EyeRoute.

I've been with EyeCare Associates for 5 years, and I can't think of any equipment or advertising effort that's yielded as many compliments from patients as the EyeRoute and our dual-screen display. We'd buy it for this reason alone, even without all of the other benefits.

Image Management Before EMR

A question that arises for practices that want to upgrade their computer systems is why not proceed directly to EMR. We gave this a great deal of thought, and we decided that implementing an electronic image management system first was the way to go.

Our thinking was this: Within our practice, and most practices, IS can be divided into three segments: front and back office applications, such as scheduling and accounting; electronic charting, which is essentially EMR; and document and image management. Often, document and image management is considered part of EMR, but in reality the two are different. Most electronic charting software isn't designed to perform document and image management, involving ancillary testing, such as visual fields and fundus photographs, which are critical in ophthalmology. We'd like electronic charting and image management to integrate, but they don't. They're different products, and the companies that design and support them are different. The importance of document and image management to our daily operations and patient care made it a priority for us.

Figure 2. A technician at EyeCare Associates of East Texas uses the EyeRoute ophthalmic digital image management system to view a patient's test results. The patient can see the results on a large ultra high-definition monitor (right). The dual-screen display is just one way practices can use EyeRoute.

Furthermore, in my experience dealing with IS projects, electronic charting technically is easy, but extremely difficult from an organizational and political stand-point. The inertia that must be overcome is substantial. For example, practices often find that some doctors, many times the most productive ones, don't want to change their practice patterns to adopt EMR. On the other hand, electronic document and image management is the opposite. The interface issues make it technically difficult, but it's much easier for the staff and doctors to accept. EyeRoute, for example, was installed without disrupting the practice. Doctors and clinical staff didn't have to change the way they practiced, and they saw the benefits right from the start. When we analyzed the situation, it was clear that implementing image management before EMR made sense.

The Right Move

Adopting the EyeRoute system was a positive step for our practice. Overall, it's been very easy to use. It's been robust, efficient and secure, and we haven't experienced any problems. The fact that it can interface with so many different ancillary testing devices, as well as most EMR packages, makes it a cost-effective, smart investment now — and for the future. OM

Dr. Wick is a partner at EyeCare Associates of East Texas. You can reach him at jwick@eyecaretyler.com.