EHR

Image Management Systems organize a wealth of photos

Ophthalmology practices take a lot of pictures. Tracking them down is finally getting easier.

Bill Kekevian, Senior Associate Editor

Much of the diagnosis and management of diseases in ophthalmology is reliant upon images of the eye. As a result, an ophthalmology office features imaging devices aplenty. From fluorescein angiography devices to OCT and fundus cameras and even visual fields tests, the imaging devices result in a plethora of files to be stored. With the industry-wide shift away from print-outs and paper records, many of these devices feature the ability to store images directly on the machine. The problem is, an ophthalmology office has a lot of machines, often made by different manufactures and they aren’t always compatible. This can make image retrieval a cumbersome process in which clients must be tested using the same machines in the same locations and sometimes requires recalling data stored in two different locations for one patient.

This conundrum was the impetus behind picture archiving and communication systems (PACS) development. PACS are designed to manage a practice’s multitude of images in one, centralized location.

The limits of early systems

Before PACS software, some manufacturers introduced a limited way to manage images. “We’ve had people who’ve had image management systems for years, but they have typically proprietary, meaning that vendor would have to figure out how to get pictures out of the machine and then they would figure out how to link that with some patient demographics and display that for you. It was not integrated,” says Michael Boland, M.D., Ph.D., an assistant professor of ophthalmology at Johns Hopkins School of Medicine and the director of information technology at The Wilmer Eye institute, both in Baltimore, Md. Dr. Boland presented at the AAO last year on the issue of image management.

In his presentation, Dr. Boland stresses that ophthalmology is “really all about collecting data and then using them to make decisions.” The problem, as he sees it, is that “not all systems speak the same language,” he says.

The location dilemma

For practices with satellite offices, patients were limited to seeing the doctor in only the location in which they originally saw him or her, or else their images will have to be sent to a satellite, which doesn’t always work out. “Have you seen a fax of a color OCT report,” he asks in his presentation.

“It’s especially important in glaucoma care so you can detect progression. You can’t do that without the old tests,” he says.

The reason for these troubles, he says, is that the field “didn’t have the standards built for ophthalmology. In other words, you need to have a standard way of describing a visual field or an OCT or a fundus photo so you can start mixing-and-matching systems, which is what radiology has been doing for 20 years.”

The solution: a standard protocol

“Now there’s a complete set of standards as part of DICOM that can be used to integrate all these devices,” Dr. Boland says. He’s referring to the Digital Imaging and Communications in Medicine standards, a standardized protocol for medical image management.

We’ve got somewhere around 20 visual fields machines. They all operate under a shared database, so no matter where the patient’s being seen I have access to all of their old tests.”

PACS software makes it possible to retrieve a patient’s entire imaging history all at once. For the doctor, that means instantly being able to view visual fields tests, OCT images, and disc photos all at once. Several PACS systems even allow users to make annotations for future viewings.

Simplifying workflow

Dr. Boland says PACS software is practically designed to make the staff’s job easier. With this system in place, “a patient checks in at the front desk. Once it acknowledges the patient’s arrival, it then produces a worklist that is then available at each visual field, OCT, fundus camera, etc.” This means technicians and other staff are “not typing demographics. There’s no risk of mistyping names or birthdays or any of that. Just find the right patient, confirm their identity, select them from the list, do the imaging and then save that image back to the DICOM system. It’s significantly helped technician staff, because they spend less time typing demographics into these devices. It also helps on the technical side because we spend less time worrying about trying to track down images,” he says. “It’s really tightened up the workflow significantly and it’s made the technician’s work, frankly, easier.”

Talking to vendors

“Our experience is that the standards-based approach is very helpful,” he says. He even suggests asking vendors you’re dealing with for the DICOM conformance statements. “That is a very specific document that explains which parts of DICOM they have implemented. That’ll help you understand what data the machines share. The AAO has also put together a survey of both device vendors and image management vendors asking them which parts of DICOM they implement and that’s available at the AAO website.” OP