Practice Development Feature
No more running to the filing cabinet Integrated electronic ophthalmic images and records can make operations more efficient and improve patient care – but make sure the system does what you need
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few months back, Michael Jacobs MD, a comprehensive ophthalmologist in Athens, Georgia, US, implemented the FORUM image and report management system from Carl Zeiss Meditec AG, Jena, Germany. The system’s ability to instantly combine information from a range of ophthalmic diagnostic devices at the click of a button has had a huge impact on the efficiency of his practice – and even his clinical effectiveness. “As a physician my time is much better spent because I have the studies I want to see when I need to see them and I don’t have to go down the hall trying to find a printout,” Dr Jacobs says. The system is highly customisable, allowing him to choose among images from field analysers, OCT, fundus cameras, IOL Master and corneal topographers depending on the patient’s condition. “You will be able to create templates for different types of glaucoma, diabetic retinopathy, AMD. It enhances my ability to assess patients. Not only do I have all the tests over time, but I can review them simultaneously.” The system also helps with patient counselling, Dr Jacobs adds. “They can see the black spot in their visual field is getting smaller or the swelling on the OCT is getting better. I believe it leads to increased compliance. It’s a great extra benefit I wasn’t anticipating.” And there’s the cost savings. “My techs are singing the praises of FORUM. When a patient goes from one machine to the next they just click on the patient’s name
and it is added to their record. They spend less time inputting patient information and more time testing patients.” The cost of printing and handling paper records is also reduced, Dr Jacobs notes. While Dr Jacobs has not yet moved to an electronic medical record, he can scan records into the FORUM image system, making notes available along with diagnostic images. He plans to buy an EMR soon to meet new government requirements, but bought the image management software because it better met his clinical needs. He looked at several EMRs that can import PDF images of tests, but they were not as flexible as FORUM. When he does choose a record system sometime in the next two to three years, the image management software will be able to communicate directly with it in both directions in part because it incorporates DICOM data interchange standards, he notes. A number of software vendors offer electronic ophthalmology records with advanced features including the ability to input images and data from all kinds of diagnostic devices. For example, ifa systems AG, Frechen, Germany, which currently serves more than 7,000 ophthalmologists and related professionals in 15 countries, and stores data on more than 70 million patients, can pull images from slit lamp cameras, fundus cameras, A/B scanners. It can even integrate specialised software routines that interpret data from visual field analyzers, OCT and HRT scanners.
Journal Watch
by Sean Henahan
Shining a light on eye cancer A new technology, bioluminescence imaging (BLI), should allow doctors to detect tumours earlier, and to quickly choose a method of treatment that doesn’t necessarily involve surgery. Researchers in Shanghai developed an animal model in which they could induce human ocular tumours, and then use the new imaging technique to diagnose and monitor the tumours. Bioluminescence imaging takes advantage of light emission from one of several organisms. The three main sources are the North American firefly, the sea pansy (and related marine organisms), and bacteria-like Photorhabdus luminescens and Vibrio fischeri. The DNA encoding the luminescent protein is incorporated into the laboratory animal either via a viral vector or by creating a transgenic animal. Q Huang et al, Ophthalmology & Visual Science, “Non-invasive visualization of retinoblastoma growth and metastasis via bioluminescence imaging”, 2009 50: 5544-5551.
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by Howard Larkin
“As a physician my time is much better spent because I have the studies I want to see when I need to see them and I don’t have to go down the hall trying to find a printout” Michael Jacobs MD The ifa system can even do things like set up automated phoropters based on the patient’s last prescription. It also supports all types of administrative and billing activities, and enables co-management arrangements through data networks among separate clinics and medical offices. The firm’s software complies with international data exchange standards including HL7 and DICOM, and its engineers promise interface support for all types of electronic ophthalmology devices. It also supports administrative and billing systems, and customised clinical, quality improvement and management reports. But taking advantage of the quality and efficiency gains possible with sophisticated record and image management systems requires effort from physicians, says Marlene Jones, a consultant with PivotHealth, Brentwood, Tennessee, US, who has overseen implementation of medical record systems at dozens of medical practices – often after an attempted implementation has failed. She offers the tips below for a successful transition to EMR. * Select a physician champion. This person often has an affinity for computer technology and may naturally take over, especially in smaller practices. In a large practice you might consider hiring a temporary medical director with specialised computer training to manage the transition. * Involve physicians early. Physicians who will be working with the system need to get on board to make sure their needs and expectations are met. A set of objectives for the system should be established along with a preliminary budget. This will help create a sense of ownership and expectation for the project and guide the selection process. * Review multiple systems. EMR and image management systems have a variety of interfaces and capabilities and costs can vary widely. The best way to figure out what might be best for you is to look at several systems, as Dr Jacobs did.
* See how systems work in live practices. Ask current users about their experiences and visit them if you can. This will help you understand how well the system might meet your practice needs. Be sure to ask about training, technical support and upgrades because these are critical. * Make sure you have adequate hardware. Modern systems often require computing power well beyond what was available even a few years ago, particularly if you host the system onsite. Technical issues such as backup and system recovery are also essential. Some vendors now offer records on a remotely hosted model, which can reduce the cost of equipment and on-site technical staff. * Train, train, train. This means everyone, most especially physicians. And be prepared to foot the bill for some lost productivity during the transition period. * Be prepared to re-engineer workflows. This can be difficult for physicians, but it is essential. A consultant who knows how to get the most out of a system can be helpful. Feedback to physicians on how well they are adhering to revised practice standards can be very helpful. Vendors such as ifa may be a good source for implementation assistance. They also offer extensive online training and technical support. Some vendors are even moving toward a model of selling EMR systems not as software and hardware, but as an integrated solution installed and maintained by the vendor as a service for a monthly fee. But whatever system or approach you choose, make sure it fits your practice needs before you invest. mjacobsmd@athenseye.com