EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/87458
24 EW NEWS & OPINION October 2012 Digital diagnosis: Finding new trails by Maxine Lipner Senior EyeWorld Contributing Writer With the Anoto pen, a patient's information can be digitally transferred from the chart directly into the system in seconds Source: Robert A. Jasa Innovative solutions for ophthalmologists T hese days just having an electronic health records (EHR) system doesn't qual- ify your office as digitally savvy. A triad of innovative approaches including a digital pen used at sign-in, software that allows for the automated transfer of images from multiple ophthalmic diagnos- tic devices, and an app that allows you to securely swap patient X-rays, photos, and other high-resolution data are setting a new high-tech bar for ophthalmologists. Inputting info One noticeable difference at the Pacific Cataract and Laser Institute (Chehalis, Wash.) is the use of the Anoto pen (Lund, Sweden), which enables patients to digitally input their health history into the system the first time they come to the of- fice. "One of the time sinks in the front office is getting health infor- mation and then getting consent forms signed," said Robert A. Jasa, director, Healthcare Informatics, Pacific Cataract and Laser Institute. "The fact that the pen could put the information into a field in the chart was a big deal." The pen has a camera built into it and watches for a dot pattern on the page. "That dot pattern has in- formation in it that tells the patient what forms are being filled out and what fields that information goes into," Mr. Jasa said. With the tech- nology, they are then able to match the form with a customized tem- plate from their EHR software. "Based on my experience, we've been seeing these health history forms take 20-30 minutes to enter into the system," Mr. Jasa said. "But with the pen we just drop it in the document and within a few seconds it's in the system." Image software At Weil Cornell Medical College (New York) ophthalmic practitioners are making use of Merge Eye Care PACS software (Chicago) to bring images from ophthalmic diagnostic devices into the equation without disrupting the patient's broader EHR, according to Nathan Radcliff, M.D., director, Glaucoma Service. Practitioners at Weil Cornell Medical College use the Epic EHR (Verona, Wis.) for office visits. But there is a distinction between EHR software and software meant for image man- agement, Dr. Radcliff stressed. While it is possible to include some images in the text-centered EHR software, it's very cumbersome to do so. It was hard to look up and access the images filed under miscel- laneous, and these were utilizing too much of the system's data space, Dr. Radcliff found. "Epic is designed to present text information to the viewer," he said. "It's not designed to reconstruct high-resolution im- ages." As a result, these ended up taking over much of the available data storage as well as the network's bandwidth. "There's one network, one series of servers that are running Epic, and then all of a sudden ophthalmology is using 90% of the whole university's data," Dr. Radcliff said. It also meant that other special- ists accessing the patient's medical record had to wade through the many ophthalmic images stored there that had no bearing on their specialty. The new Merge Eye Care PACS software, however, is only under the purview of the ophthalmologist. This also enables practitioners to include a lot of visual information such photography or OCT, that was- n't possible with EHR software Dr. Radcliff explained. He described Merge as a web- based image management system designed to allow for automated transferring of images from multiple ophthalmic diagnostic devices to a common interface that allows practitioners to rapidly access data. Among the various devices that the department has connected to the Merge Eye Care PACS are fundus photography, anterior segment photography, visual fields, OCT, ultrasound biomicroscopy, and the IOLMaster (Carl Zeiss Meditec, Dublin, Calif.). "The concept is that the moment the test is done and you hit print, instead of it printing out on a piece of paper, it's immedi- ately available in any location throughout our department," Dr. Radcliff said. The software also tracks whether a test has been com- pleted and if the doctor has re- viewed the images, thereby speeding workflow. One new possibility with Merge is the automatic alignment of old and new images using "flicker chronoscopy." Dr. Radcliff cited the case of a woman who 6 years earlier was suspected of having glaucoma, but when she returned recently and the archived image of her retina was aligned with a new one, it was found there was no change. "I could tell her with great confidence, 'You don't have glaucoma because glau- coma is a disease of change and you haven't changed in 6 years,'" he said. The software also boasts an auto-montage feature that allows for automatically fitting together differ- ent images of the retina, something that would manually take hours, he said. All this has helped to revolu- tionize how images are transferred within the institution. The book on DocbookMD Digitally transferring images and other data from the patient record to practitioners at different facilities has also become possible with an app known as DocbookMD (Austin, continued on page 26