First-hand Experience With Forum Implementation

By Nils Loewen, MD, PhD

When we bought visual field machines for our clinic a year ago, we planned to use them for evaluating visual field index (VFI) data for our patients. The devices performed well, but each one stored its own results, and we couldn't extract the data. This meant that although we had several machines, we had to use the same machine on a given patient for every visit in order to get a VFI.

We hadn't realized that the VFI would be tied to a piece of hardware, and the surprising reality of our situation was extremely frustrating. We discussed the problem with the software team at Carl Zeiss Meditec, whom we found to be very forward-looking and focused on integration. Once we made the decision to invest in the Forum package, within a month we were extracting visual field data from multiple machines and viewing it on the same screen as structural tests like OCT.

Pulling Tests Together

Visual field software integration is possible because the industry's lengthy adoption process has reached a point where these devices and many others are using the nonproprietary DICOM data standard. This allows software to integrate data from myriad machines into a single interface. Today, there's an explosion of technologies aimed at data integration.

In our case, the software is finally something that we've all been waiting for—structure and function data side by side on the same screen. When we test patients on the Humphrey Visual Field Analyzer (VFA), we know that patients may not be consistent in taking this psychophysiological test. When something suspicious pops up, we need to know if it correlates to a structural defect on our Cirrus HD-OCT or the Stratus OCT optic nerve head topographic analysis. Now we view these tests together in our exam rooms. The result is a much faster and more reliable diagnosis.

Forum is also an excellent patient education tool. When I show patients their images and functional testing on screen, it's fairly dramatic, like showing someone a fracture on an X-ray. They see that the pathology is real.

Installation process

The Forum team worked closely with Yale's IT department to handle the system's installation of the system. Together, they made sure we had adequate data storage on our servers, a physically safe place for those servers, and appropriate data redundancy in place. They also ensured that we were in compliance with HIPAA and ready for FDA clinical trials. Forum also had to integrate with the EMR rollout that Yale was undergoing at the time. The Forum team did a site visit to get the system up and running.

One feature of Forum that dovetails nicely with our EMR system is its ability to recognize patients with similar data, such as names or dates of birth and ask the operator to confirm that these patients are one and the same. This helps to eliminate duplicate records for the same patient and we don't find ourselves trying to detect disease progression with records that are missing patient visits.

As we've realized that Forum is great software, we've planned to integrate more devices into the system, such as the Topcon fundus camera. We're also planning to purchase larger computer monitors, which will allow us to view data for the left and right eyes at the same time.

Much-needed Communication

Zeiss has recognized that it's important to communicate closely with the glaucoma community and develop the type of software that our work demands.

It was gratifying for me to participate in their session during ARVO, where they wanted to know what could be improved and what we'd like to see in future Forum upgrades. They understand that it's important to listen.

On glaucoma forums, I always see doctors who are angry that their machines can't “communicate.” My advice would be to get a system like Forum and don't waste your practices's time and resources trying to accomplish this on your own. Others have spent many years and lots of money trying, with only mixed results. Forum was the right decision for us, because it's a future-proof investment.

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Dr. Loewen is Assistant Professor of Ophthalmology and Visual Science and Director of the Glaucoma Section, Glaucoma Fellowship Program, and Academic Associate Program at Yale University School of Medicine in New haven, Conn. Dr. Loewen has no financial interest in Carl Zeiss Meditec.