As the number of available ophthalmic diagnostic devices continues to grow, so does the quantity of clinical images, videos, and data collected within a practice. Keeping these materials well organized and easily accessible can become difficult due to the sheer volume of information acquired. Recognizing this challenge, several manufacturers have developed data management systems that are capable of integrating images and data from a range of ophthalmic devices into a single-source system.
While many practices have been transitioning toward a paperless environment with the adoption of electronic medical records (EMRs), image and data management systems can also increase practice efficiency, improve workflow, and yield cost savings. Further, these systems provide remote access, allowing physicians who are on the go or are practicing at satellite locations to facilitate communication and patient management. This article presents an overview of several platforms currently on the market, detailing their key features and capabilities.
SYNERGY OPHTHALMIC DATA MANAGEMENT SYSTEM
The Synergy Ophthalmic Data Management System (Topcon) integrates images and reports from Topcon devices and more than 130 other manufacturersí systems into a single digital environment. According to company literature, physicians can use the web-based system to view, compare, annotate, and transmit patient images seamlessly and securely from virtually anywhere, including workstations, remote computers, and iPhones. Results can be viewed wherever there is Internet access, without requiring a virtual private network.
The Synergy software features a simple point-andclick graphical user interface. The platform allows users to view all images for a patientís examination without opening additional windows or launching review software for each device. Physicians can navigate through image thumbnails or through patient histories. Synergyís drag-and-drop functionality allows data from multiple examinations, such as optical coherence tomography (OCT) and visual field images, to be viewed side-by-side for fast comparison. Several visual fields can be viewed simultaneously to show subtle changes over time. Videos can also be managed, stored, and reviewed directly within Synergy.
Current and historical exams can be compared quickly and efficiently, according to Topcon. Historical comparison analysis allows users to identify progression from the patientís previous status. The Community Portal feature enables physicians to communicate and share information with colleagues in real time. Other features include the Patient Journal and the ability to create interpretation reports (Figure 1). Synergy EyeRead Image Referral Review Module provides a seamless electronic workflow to help establish an image reading network with referring physicians.
The Synergy system is available in three product configurations: (1) EyeRoute Synergy Enterprise for large, multisite clinics and large image-intensive practices; (2) EyeRoute Synergy for large multisite private practices; and (3) EyeRoute Synergy Online for single-site practices.
Synergy integrates with most EMR systems and is scalable to fit any size practice. The platform offers complete interoperability among ophthalmic devices and EMRs and leverages standards such as HL7 and digital imaging and communications in medicine (DICOM).
FORUM
The Forum (Carl Zeiss Meditec) eye care data management system (Figure 2) streamlines practice workflow by providing local and remote access to all patient examinations. According to company literature, its paperless data transfer, even between multiple practice sites, can increase workflow efficiency and save time, space, and money. Forum automatically prepares case-specific displays and combined reports to present diagnostic data in clinically relevant ways, according to Carl Zeiss Meditec.
With just two mouse clicks, the Forumís clinical display function automatically selects the relevant images and reports for reviewing different clinical cases. Examination data are presented in clinically relevant ways (eg, with the clinical displays), and users can also compare a patientís left and right eyes.
Forum Archive & Viewer version 3.1 features the Forum Glaucoma Workplace, an application that enables quick and efficient glaucoma assessments in the examination lane. This feature allows interactive analysis of visual field data and automatically generates reports that combine structural and functional information. Forum centrally stores raw data from the Cirrus HD-OCT (Carl Zeiss Meditec) and the Humphrey Field Analyzer, to enable progression analyses independent of where the patient was examined. Cirrus HD-OCT Review software can be launched from the Forum Viewer to provide access to OCT data from virtually anywhere.
The system is offered in two main configurations: (1) Forum Archive (a central storage solution for ophthalmic examination data, and (2) Forum Archive & Viewer (a comprehensive software solution for eye care data management). The Forum Viewer App for iPad (Apple Inc.) is also available for increased flexibility and remote access to patient data.
According to the company, Forum can easily be integrated into an existing information technology (IT) infrastructure using recognized standards. Using the DICOM standard, Forum connects diagnostic instruments from Carl Zeiss and other manufacturers; non-DICOM instruments can be connected with Forum Link tools. Forum integrates with EMRs, practice management systems, and hospital information systems using DICOM, HL7, and other interface standards.
MERGE EYE CARE PACS
Formerly known as OIS Symphony, Merge Eye Care PACS (Merge Healthcare; Figure 3) enables users to automatically import images and diagnostic reports from multiple diagnostic devices into a single web-based system and review them anywhere. According to the company, data can be integrated from different devices to create a complete digital record; these data can be viewed from any webbased location at any time.
With the system, users can automatically acquire a copy of every image and diagnostic report captured within the practice. This picture archiving and communication (PACS) system integrates with EMR systems to deliver single-click access from a patientís progress note within an EMR to that patientís images and diagnostic reports. The system uses a combination of exclusive technologies that result in instant access to images and diagnostic reports captured at all of a practiceís locations. The system automatically and instantly scales a fullsize image and sends a high-quality version of only what will fit into the viewing window, eliminating the need to compromise between system speed and image quality. The Digital Reporter is a customizable tool that allows practices to store clinical interpretations of testing data within the Merge Eye Care PACS. The system takes the images and reports captured by the image management system and either combines or enhances them to make it easier for the clinician to identify and track pathologies.
With the Merge system, users can have full imageprocessing functionality in a web browser using AutoMontage and PerfectView. Physicians can reduce clicks by defining SmartView, a way of opening multiple test types, arranging them on the screen together, and using AutoHistory to review all prior reports. Merge also gives users the ability to review OCT fundus images and associated B-scan images, eliminating the need to license additional review software. Video files can also be added, managed, and viewed.
The system leverages the industry standards DICOM and HL7 for maximum portability and compatibility of image records. Users can connect directly to an EMR in patient context and can interpret test results and communicate them to an EMR via HL7.
AXIS
Axis (Sonomed Escalon) image management system integrates diagnostic images and reports into a single, fully searchable patient database, allowing easy review of images over multiple exams and across multiple imaging modalities. The platform features a browserbased interface to enable use anywhere with Internet access and on a range of devices such as a PC, Mac (Apple Inc.), iPhone (Apple Inc.), iPad, or other tablet.
Axis may be hosted locally or in the cloud, and any computer can be enabled to become a complete review station. The system does not require the installation of any software for review computers, meaning that, once a single installation is complete, it can be rolled out to an entire facility, according to company literature.
Axis users can easily manage all images from any diagnostic device, regardless of modality, manufacturer, or location, including OCT, visual fields, and ultrasound. Once a diagnostic test is performed, the results are automatically and immediately transferred to Axis. With the touch of a button, still images, reports, and videos from all devices and any location are viewable to the entire practice.
Users can view complete patient exam history and compare images across exams using a full complement of analysis tools, such as side-by-side OCT and fundus image comparisons (Figure 4). Axis also offers the ability to simultaneously view a patientís visual fields across time on one screen.
The Axis system allows ongoing comparison of complete patient exam history, in order to aid clinical decision- making. An image montage can also be viewed; sophisticated algorithms within Axis Montage software take multiple unique fields of view of the retina and blend them together in a single image for a complete wide-angle view. Standard manipulation, annotation, and measurement tools are integrated directly into Axis, including zoom, brightness, contrast, and drawing. The registration view aligns and overlays diagnostic images and color in a single adjustable window.
Axis is also available as an iPad app. The system is standards-complaint, with secure access control, data encryption, system security, and user access auditing. Axis uses DICOM, HL7, and other means of validated data and image transfer, and it is compatible with most EMR systems. Secure access to diagnostic images is also made available within the EMR itself.
iVIEWS
iViews (Chace and Associates Technologies, LLC) is an ophthalmic PACS system that provides image collection, processing, and diagnostic review solutions. Diagnostic review can be performed via an application on a desktop to allow access wherever the data are needed for review, according to the company.
Once the images are sent through the iViews imaging system to the imaging server, all images and PDF (Adobe Systems) files are available for viewing (Figure 5). A variety of views are available, including multiple data, serial analysis, side-by-side, and animated or nonanimated. All images and reports can be printed and exported for use in studies, presentations, and collaborations, and for insertion into an EMR system.
Instrument databases can be located onto the image server. Through utilization of the review software, all exam lanes can access data and manipulate them as though they were on the diagnostic device itself. Data can be presented graphically to track changes in intraocular pressure, macular thickness, visual field indices, IOL master values, and more.
Several search options are available, including first name, last name, and patient ID. Searches can also be conducted by physician, institution, department, diagnosis codes, CPT codes, study codes, and custom codes. Images and reports can be filtered and analyzed using built-in filters such as OD/OS, OS/OD, last two exams, last four exams, and specific devices.
The system contains an administrative feature for the management of the patient and image database. Patient demographic information, exam dates, referring physician information, and image types and designations can be managed with an administrator tool.
The iViews system can be launched from within EMR applications, eliminating the need to reenter search information to load a patient in iViews. The platform is DICOM-compliant.
CONCLUSION
Without a data management system, physicians must review each imaging report on the device with which it was acquired. By integrating clinical images, videos, and patient information from a variety of devices into one digital system, data management systems can save physicians time and space. With the ability to access data from virtually anywhere in an organized manner, these platforms can also improve both coordination and quality of care.
