Much of ophthalmologists’ management of patients revolves around imaging — obtaining images from a variety of diagnostic machines and then analyzing, comparing and tracking these images to glean information about the disease state and how it is progressing.

Increasingly, practices are relying on digital data generated by images for more in-depth study and analysis. The digital data can be reprocessed so that images can be viewed in different modes, thereby facilitating a more comprehensive approach to diagnosing and managing diseases. The challenge is that images need to be stored, retrieved and transmitted.

This is where image management systems come in. Along with improved access to images, image management systems allow for:

• Linking patient demographics to the EHR
• Comparing images side by side
• Viewing image history over time
• Annotating images
• Sharing images in and out of the practice

Here are some of the factors to consider when investing in image management systems and a summary of the available platforms.

WHAT TO CONSIDER

Compliance, security

Image management systems should be compliant with the Digital Imaging and Communications in Medicine (DICOM) standard. Ideally, the images and data should integrate with other electronic systems in the practice, linking to a common version of each patient. “When a technician sits down in front of a diagnostic machine to do a test, they should be picking from a list of patients that are actually checked in that day,” says Michael V. Boland, MD, PhD. “This eliminates mistakes when typing in names or record numbers, and then the test is linked to the correct patient.”

This is about safety and quality, says Dr. Boland associate professor, Harvard Medical School and medical director of practice innovation, Department of Ophthalmology, Massachusetts Eye and Ear, Boston. “If you don’t have all of your patients’ data in the same place and available on demand, you cannot provide the best care. This is particularly true of chronic diseases like macular degeneration or glaucoma where it is critical to track progression over time.”

Systems that use the Picture Archiving Communication Standard, or PACS, can interact with imaging devices across vendors. Practices will want to ensure the platform integrates with existing hardware and software in use.

Technology

The practice’s IT infrastructure must support the image management system without overwhelming the network. An ever-growing number of digital images are housed in a large-scale database, so sufficient network capacity and hard drive space are important. The network infrastructure should be analyzed for performance to ensure it is fast enough to support the image management solution. “Modern OCT devices generate huge images, and sending those around the network can really slow things down. It will not be pleasant if it takes a long time for images to load during a busy clinic day,” Dr. Boland says.

Your priorities

When considering image management systems, practices need to identify what they want to accomplish with the solution to determine the functionality they require. Some ophthalmology-specific EHR systems have built-in image management capabilities that might be adequate for smaller scale needs, whereas larger multilocation, multispecialty practices with numerous devices may want to consider more robust systems. Some questions to answer prior to purchasing include:

• Do you need to access images remotely?
• Do you want a system that manages all output across multiple vendors and devices?
• Do you want to compare and manipulate images?
• What is your practice’s workflow, and how should images be archived?

Retina specialist David Almeida, MD, says that in selecting an image management platform, his practice “worked backward” based on the imaging systems they use. “We use the Heidelberg viewer, which incorporates nicely with our Spectralis OCT machines, and our Heidelberg fluorescein and ICG angiography systems,” he says. “We also have the Optos viewer for use with Optos widefield imaging machines.”

Dr. Alameida’s retina practice favors the viewers associated with the two imaging modalities rather than opting for an extra system to store images from the diagnostic machines in one place. It was a matter of priorities, and he admits that it is a trade-off. “In a multispecialty practice with many different imaging sources, bringing everything into one view is likely more important,” he notes. Because they considered their imaging modality first and management software second, they have a “bit more of a hybrid system.”

He and his colleagues did, however, need a way to pull the images into the EHR and found that Nextech’s IntelleChartPRO was a good fit for the retina practice. “We can pull images from our diagnostic machines into the EHR, which allows for photo documentation of findings and is then captured as part of the permanent medical record of that patient.”

Dr. Boland says vendor-specific viewers are often the best tools for that device, as they typically are able to perform more sophisticated analyses and review for that device. “It is important to be strategic and think about the practice holistically when considering the right systems.”

Practices need to look at their current mix of devices and think about the minimum number of image management systems that need to be deployed to keep all of the providers happy and provide the best care, Dr. Boland says. “Which systems are going to integrate best with your EHR platform and your current IT environment?” which varies depending on the size and scope of the practice.

Staffing

Practices need to make sure they have someone on staff who is capable of overseeing the image management effort — or get help from a consultant, says Dr. Boland. “Someone needs to ensure that all of the systems are going to tie together,” he says. “Vendors may promise compatibility, but the details are what is important. The way the integration works needs to be clean, not requiring extra steps, and make sense for the practice.”

Important skills for the project manager, according to Dr. Boland, include:

• Assessing the practice’s needs in terms of image management
• Working with the chosen vendor(s) to integrate with existing clinical systems and imaging devices
• Creating and/or monitoring a project plan with tasks, dependencies and deadlines
• Implementing change management to make the deployment successful for the practice

Also, the system needs care and maintenance, so be prepared for the amount of staff time that may be required, he says. “This is a burden for the IT staff, which is another reason why practices want to deploy as few systems as possible.”

IMAGE MANAGEMENT PLATFORMS

Integrated systems

Several integrated image management systems are currently available.

The Zeiss FORUM is a scalable system that connects to the practice’s imaging devices and has features for glaucoma, retina and cataract. In the glaucoma workflow, for example, physicians can analyze data from multiple diagnostic platforms like the Humphrey Field Analyzer and the Cirrus OCT in one report to diagnose glaucoma and determine progression over time. Similarly, the retina workplace allows for viewing data from multiple modes such as ultra-widefield fundus images and OCT angiography on one screen. FORUM’s cataract solution, EQ Workplace, enables single-click data transfer and autopopulation, with access to biometry and diagnostic data for calculating IOL power and planning surgery.

FORUM integrates into a practice’s existing IT infrastructure using established standards as well as customized tools, according to the manufacturer. By centrally storing and managing all examination data it ensures patient record consistency across the network, including EHR, health information systems, DICOM and non-DICOM instruments from Zeiss as well as other manufacturers. Physicians within the practice can view examination data interactively and in clinically relevant ways, allowing for more confident decision making. Data can also be exchanged with outside practices using DICOM standard output.

Also, Zeiss recently announced its new Medical Ecosystem, a cloud-based fully-connected platform that it says “expands the integrated workflow, clinical planning, education and optimization of clinical procedures,” the company says.

Topcon’s Harmony connects ophthalmic devices in multiple locations to enable analysis of relevant clinical data on a single screen, the company says. It streamlines workflow and minimizes the need for instrument-specific software for reviewing images and data. It integrates with EHRs and is a browser-based application that can be used on a desktop, tablet or mobile device. It allows for advanced historical comparisons across multiple imaging modalities, can scroll through scans and offers flexible storage either onsite or via the cloud.

Ella Ross, MD, of the Department of Ophthalmology at the University of Ottawa, Ontario, says Harmony offers integration with devices from any manufacturer and connects with her EHR software, so patient information is sent directly to and from connected instruments. “It’s a huge time saver. Harmony also has several features that streamline my review of patient data. First, it groups my patients by the day they were seen, so I can quickly access the records I’d like to view. It also allows comparison of multiple types of images from a single exam and historical comparison, which gives me a complete picture of the patient’s eye health and has been invaluable for patient education.”

EyeClinic Imaging from First Insight is a cloud-based image management system that integrates with any eye-care EHR, helping to streamline the workflow. The system allows for quick access to data, images and diagnostic reports on any computer or mobile device, and images can be notated and viewed side by side, zoom or in pan views. “Viewing images side-by-side helps me detect changes in the appearance of the macula, optic nerve and retinal nerve fiber layer,” says Harinderjit Singh, MD, FRCSC, CEO of Southeast Retina Center in Augusta, Ga. “It’s a valuable tool for educating patients and explaining why tests are needed.”

Systems via EMR

Many EMR systems offer image viewing capabilities with a varying degree of features. For example, Modernizing Medicine’s EMA ophthalmology EHR provides image management through the platform saving time and clicks, according to the company. It is accessible on a tablet device or a web browser, opening diagnostic images directly from the patient’s chart. The system automatically receives and stores DICOM images from connected ophthalmic diagnostic devices and provides centralized access to them in the cloud. Then, they can be accessed and annotated, documented and shared using fewer “clicks.”

Another example is the EyeMD EMR PACS module, which is embedded within EyeMD EMR 2.0, providing functionality such as native OCT tomography rendering, high-resolution image manipulation and DICOM work-listing. Without the need for third-party libraries or the image servers sometimes required by other platforms, EyeMD EMR provides a hospital-grade ophthalmic imaging solution to maximize productivity while maintaining image quality and efficiency, according to the company.

CONCLUSION

Practitioners are increasingly looking for robust platforms through which to access, compare and share images in a way that is compatible with and seamlessly integrated into the practice’s workflow. From standalone, vendor-neutral solutions to those that are built into EHRs, there are many options for those seeking to ensure they are fully taking advantage of all the functionality that digital information affords. OM