Connecting to a More Efficient Future?

New image management systems keep you in the loop, even when you're out of the office

BY RENÉ LUTHE, SENIOR ASSOCIATE EDITOR

Having the latest diagnostic equipment is, indisputably, good for your patients and for your practice's reputation. However, managing and accessing all the data they generate can be hard on practice efficiency. It takes time and manpower to sort through files to find test reports and images, and for physicians to flip back and forth between papers to interpret changes. For consults and referrals, technicians must find the appropriate images, copy them and give them to patients or send them to the appropriate doctor(s). And for physicians who belong to multiple-site practices, those state-of-the-art diagnostics aren't helpful should you need to consult them when you are not in the same building they are.

But the ever-innovative ophthalmic industry is on the case. Companies are creating solutions that access and store all the data from disparate diagnostic devices and communicate with EMR systems. Not only do they make a practice's life easier by having all the important information in one place, proponents say that these connectivity systems increase productivity, allowing you to see more patients.

Of course, adding such a system means one more capital expenditure to justify and another new system to learn, so it's understandable that some ophthalmologists — already gun-shy about adopting EMR — would hesitate. To find out if such systems are right you for, we asked a few early adopters how they made the switch and what factors you should consider.

Who Needs It?

Shelling out more money in a climate of declining reimbursements and an economic recession understandably seems dubious, but Lon Dowell, director of marketing at Topcon Medical Systems, which makes the EyeRoute Image Management system, says it only takes a few questions to help physicians see how much time a connectivity system could save them:

► How much time are you spending compiling data?
► Are you walking from the patient lane to the instrument and back to the patient?
► Are you waiting for prints more than developing a treatment plan?
► How many minutes do you spend looking for images that are not in the patients charts?
► When you need to analyze diagnostic images, do you need to go back to the instrument or review station?
► Are decreasing reimbursements impacting your bottom line?

Confronting these questions often reveals wasted effort and makes clinicians see the potential savings in a connectivity system, industry representatives say.

“Increasing workflow efficiency that allows doctors to increase their patient volume is the important part of this whole paradigm,” says Mr. Dowell. Increased patient volume helps to ameliorate the effects of reduced reimbursements. Moreover, he says, increased efficiency enables the doctor to have a higher-quality encounter with each patient.

Paul Chace, of Chace and Associates, agrees. The maker of the iViews imaging system, he reports that most of the practices that have purchased iViews are smaller. “It actually makes more sense for these one- and two-person practices to have it because they can increase their patient flow and revenue,” he says.

Just What Can It Do For You?

Image management systems can integrate images and reports from all types of ophthalmic devices into one secure digital environment via a Web browser from nearly any location. They integrate with existing IT environments and EMR systems. They enable physicians to view, organize, edit and transport information and images, and to rapidly see and compare images. Additionally, they save time and resources by eliminating the need for exam printouts.

You'll need to check with the various companies to learn the special features of their respective systems, but among the features they offer are:

► An “open architecture” that accesses data from the devices of various makers. Image system makers should offer a list of all the devices with which they are compatible.
► The ability to view onscreen full-size images captured by disparate devices side by side.
► Sort images according to categories such as left eye/ right eye or the last two visit dates.
► Display both static and dynamic data, so you can view still images as well as video.
► Collect discrete data to be categorized.
► Graph the data historically to aid assessment of change over time.
► Variable image compression. Systems such as OIS's Symphony Web allow users to change the amount that your images are compressed as you are reviewing them, without affecting resolution.
► Seamless transfer of data to the EMR system.
► Prompt accommodation of the upgrades of diagnostic devices. Mr. Chace says that he works with many instrument manufacturers directly and therefore is generally apprised when an upgrade is planned.
► One-time entry of patient demographic data to minimize mistakes and save time.

A Smoother, More Efficient Practice

Julia Haller, MD, ophthalmologist-in-chief at Wills Eye Hospital and chair of ophthalmology at Thomas Jefferson University in Philadelphia, says that at a large institution like Wills, with patients coming in for clinical studies as well as patients referred in from private practices, and a large staff to handle them all, a connectivity system makes life much easier. Wills began using Topcons EyeRoute last summer. The hospital's capability and efficiency have definitely increased, she says.

“In days of yore, it was necessary to have the technician take the pictures, figure out who wanted what, print them out the pictures, Xerox them, fax them, give them to the patient — all those different things depending on what each individual doctor wanted,” Dr. Haller explains. “Now they can just be uploaded to the Web site and accessed from there.”

EyeRoute also offers an application for iPhones. Dr. Haller says that she is getting one soon. “You can be getting on a plane in Hong Kong and still have the ability to review the angiogram of an emergency patient back at Wills in Philadelphia,” she says.

Szilárd Kiss, MD, assistant professor of ophthalmology at Weill Cornell Medical College, reports a similar experience. He uses the OIS Symphony connectivity system and a Web-based EMR. “My colleague was flying with an airline that had WiFi and he was viewing images from his patients and completing the medical records while on the plane.”

The tech industry calls this “cloud computing,” because data resides in an online “cloud” rather than a fixed location. Already a hit in business circles and colleges, cloud computing offers obvious benefits to on-the-go doctors. “You can pull images off a Web site and use them anywhere in the hospital, as well as at satellite offices in private practices,” says Odette Houghton, MD, assistant professor of ophthalmology and a vitreoretinal specialist at the University of North Carolina, who uses iViews. “What I like about this system is that it pulls up the images at once and then allows you to select the images you want to see without any time delay.”

Daniel Pope, MD, in private practice in Bradenton, Fla., is another iViews user. He reports that it has made patient education much easier. “In the past when I would do a fluorescein angiography I would have to walk down to the special test room, discuss my findings with my patient, then print the images and take them to the laser room with the patient,” he explains. “Now the patient is brought to the laser room and the fluorescein angiogram is brought up on the screen, making treatment easier and more efficient.”

Michael S. Jacobs, MD, in solo practice in Athens, Ga., just started using a beta version of Carl Zeiss Meditec's upcoming Forum data management system (the product will be launched in this country at the American Academy of Ophthalmology meeting this month). He finds that the Forum 's capabilities are particularly helpful in treating patients who have glaucoma or macular pathology.

“When I need to follow things over time, I think that's one of the real benefits of this software, because I can pull up on my screen the last four or six or eight years of visual fields or OCTs or fundus photos and I can look at them all at one time,” Dr. Jacobs says. “I can look at them side by side. It really facilitates a direct comparison between where they are today and where they were previously.”

Connectivity “makes every room usable from a viewing standpoint,” says William J. Mallon, MD, of Vero Beach, Fla., an iViews user. This and the elimination of printed test results means that connectivity systems deliver an improved efficiency he deeply appreciates.

“We can do a fluorescein angiogram in our camera room, move the patient out of there to make room for another patient who needs photographs, and we don't have to keep that first patient in there to review their scans and their fluorescein angiography with them,” Dr. Mallon explains.

Dr. Kiss also touts the greater efficiency he has seen since incorporating a connectivity system. “We had a fully integrated EMR with the only ‘paper’ aspect of the chart being the imaging/testing,” he explains. Staff would print the images, then have administrative assistants scan them into the EMR. He estimates that each physician's assistant would spend four to five hours daily scanning in documents.

“After implementation of OIS, the images are automatically linked to the patient's chart,” he says. “This not only freed assistants to perform more relevant tasks, but it also has simplified the audit process. When an insurer asks for medical records, we can print it all, directly from the EMR.”

A Plan for Every Practice

Manufacturers of imaging systems understand that a one-size-fits-all system will not work for most eyecare practices. While the more comprehensive models are in the university hospitals and other large settings, makers also offer the flexibility to purchase a system that meets the needs of your particular practice.

Topcon's EyeRoute, for example, offers an entry-level program. “If you purchase a nonmydriatic camera from us, it comes with the capability to have what we call ‘EyeRoute on Board,’” says Mr. Dowell. This entails the capability to connect two other instruments to the camera; no other hardware purchase is required. “EyeRoute will then take all of the information from these two instruments, and the database and the information will reside within a secure cloud hosting service maintained by Topcon. The doctor just pays a monthly fee and has this connectivity capability.”

Topcon also offers the option to have the infrastructure and hardware onsite. “We offer servers and the actual hardwire connection to all the instruments that you desire,” Mr. Dowell adds, explaining that EyeRoute is scalable.

CZM's Forum will be available in three modules that clients can mix and match, depending on their needs. The “EMR Gateway” creates a link between CZM instruments and the existing EMR system for transfer of patient demographic data, diagnostic images and reports. The “Archive” module connects the practice's diagnostic instruments and centrally stores their data, while “Archive and Viewer” adds a Web-based application to provide immediate remote access to data from any computer within the local area network.

What You'll Need

Integrating an imaging system into your practice may be simpler than you think. All the manufacturers offer training for both clinicians and staff, but users say that practices won't need to devote large chunks of time to this. The clinicians who are currently using them claim that they are largely intuitive. “I'm not a computer genius by any stretch of the imagination, but it's pretty easy,” says Dr. Jacobs. “It takes a little playing, but we've had it for one week and I already feel very well-versed in it.”

Be sure to check on server needs for each connectivity system. Some systems, such as the Forum, require a dedicated server. Others, such as the iViews, do not.

One thing you will almost certainly need is increased storage capacity on your server. “When you're collecting images, you have to anticipate storage needs,” says Mr. Chace. He advises estimating storage needs for three- to five-year use.

Should You Make the Investment?

UNC professor Reece Landers, MD, claims that a connectivity system “more than pays for itself in increased doctor productivity.” At UNC, he says there are image-viewing monitors and basic computers in each physician's exam lane.

Even for smaller practices, Dr. Mallon believes the increase in productivity makes a connectivity system worthwhile. When he began using one, he was the only full-time doctor in the practice, with one other part time. “I don't want to waste time doing things that aren't related to examining or talking to the patient,” he says. “I don't want to spend time leafing through a chart. If you see 30 patients a day, and if this lets you save one minute per patient, that means you have another 30 minutes to see other patients.” Or, better yet, you can go home early! OM