|Topcon’s TRC-NW400 is capable of color photography of both the anterior and posterior segments.|
|California from Optos has DICOM-compatible, user-friendly software and a browser-based image review feature.|
Integrated ocular imaging technology provides efficient communication between diagnostic equipment and EHR.
The leading causes of blindness in the U.S. include diabetic retinopathy, age-related macular degeneration (AMD) and glaucoma. Eyecare providers are looking for multipurpose instruments to aid in the diagnosis and management of complications arising from those conditions that affect both the anterior and the posterior segments of the eye. They also expect these instruments to integrate easily into their practices, allow for rapid data acquisition with minimal discomfort to the patient and provide a seamless interface for data export into the patient’s electronic health record (EHR).
This demand has created the challenging task of facilitating secure communication between equipment and software made by different manufacturers. International standards have been set in order to make this communication effective. Digital Imaging and Communications in Medicine (DICOM) is an interoperability standard that facilitates the integration of diagnostic equipment from multiple manufacturers with the practice’s image management system or picture archiving and communication system, known as PACS. DICOM-enabled devices allow for a more streamlined clinical workflow as diagnostic data collected from any device within the clinic is accessible to the clinician in the exam lane in near real-time.
Health Level Seven International (HL7) is another interoperability standard, a sort of “language” used to communicate between information systems. Finally, Systematized Nomenclature in Medicine (SNOMED) is a systematic, collection of medical terms that can be processed by computer.
The following are examples of how some instruments meet the trifecta of easy integration, rapid data acquisition and seamless data export to EHR.
OPTICAL COHERENCE TOMOGRAPHY (OCT)
CIRRUS HD-OCT 5000, manufactured by Carl Zeiss Meditec, Inc., is now available with ZEISS AngioPlex non-invasive OCT Angiography. It has high-resolution retina and corneal scans, and software and hardware upgrades providehigh contrast 3D visualization. Plus, widefield structural damage assessment for glaucoma is available through PanoMap.
Integration into the practice is simple. By utilizing AutoCenter, Fovea Finder and FastTrac, one can acquire, visualize and analyze efficiently. Image selection is straightforward, and the captured data can be transferred to other media allowing for sharing between a practice’s devices and healthcare providers.
Utilizing the DICOM and HL7 standards, ZEISS has created FORUM, which allows for fully digital communication of patient demographics and all exam data with FORUM Archive. Patient data can be quickly accessed with the FORUM Viewer, which runs on both Windows and Mac operating systems.
Another OCT with AngioPlex technology, the AngioVue System from Optovue, provides detailed 3D images of the retina in less than three seconds, without the use of dye injections. All Optovue instruments are DICOM compatible and easily integrated into your practice’s EMR.
EIDON, from Centervue Inc., is the first true color confocal scanning ophthalmoscope that utilizes white light instead of monochromatic lasers. The advantages of this fundus camera include the ability to capture an image through a small pupil and the limitation of the backscattered light from deeper retinal layers, providing an enhanced quality to the image. It can capture a 60Â° field in a single exposure or 110Â° utilizing infrared and a programmable internal fixation target. LEDflash technology facilitates patient comfort during testing. The device is compact and controlled by a tablet with a user-friendly software interface and a joystick. It also offers Ethernet and USB as well as WiFi connectivity.
California, manufactured by Optos, is an ultra-widefield optomap imaging device. It captures 200Â° or 82% of the retina in a single image through a non-dilated pupil. Image overlay enables comparison between all image modalities (composite color images and red-free, autofluorescence, fluorescein and the newest modality, indocyanine green angiography). Additionally, comparisons can be made between different images or different dates by scrolling through all stored images.
New software presents images utilizing ProView, which displays optomap in a consistent geometry that accurately represents anatomical features in the retina. Further, ProView enables automatic image registration for disease tracking over time and inter-modality image comparison.
The device is controlled by a tablet with DICOM-compatible, user-friendly software and has browser-based image review that allows clinicians to view data on an integrated computer or tablet.
Topcon’s TRC-NW400 is a fully automated non-mydriatic camera that features auto capture, auto focus and auto alignment. Its innovative rotating touchscreen monitor allows for ease of operation and added space savings. IMAGEnet 5 is digital, DICOM-compliant software that can be utilized by the practice for acquiring, displaying, enhancing, analyzing and saving digital images obtained with a variety of Topcon photographic devices. In addition, the Wireless Review Station allows the clinician to review images from an IMAGEnet 5 capture station via Wi-Fi up to a distance of 30 feet.
Canon’s CR-2 PLUS AF is a compact non-mydriatic 20 MP digital retinal camera that is capable of color photography of both anterior and posterior segments. The camera also includes a non-invasive fundus autofluorescence imaging mode that provides the reviewer with the ability to quickly assess the condition of the RPE layer. The Canon imageSPECTRUM Image Management System software is DICOM compliant, available for use with Windows 7 and allows for efficient management of the captured images.
It can be configured as a standalone system or as a network solution. In addition, images can be exported to a removable storage media or network in various file formats.
ZEISS VISUCAM 524 is a compact non-mydriatic camera that is capable of color photography of both anterior and posterior segments. It also features red-free, stereo images and has fundus autofluorescence capability, fluorescein angiography and optional indocyanine green angiography to enhance visualization of different anatomical features. ZEISS VISUCAM 524 can be integrated with FORUM eyecare data management from ZEISS.
Integrating technology into a practice is always challenging. As practices plan for future expansion, consideration should be given to devices that support the interoperability standards so captured data can be integrated into the patient’s EHR in an efficient and effortless manner. This will allow the practitioners to dedicate their time to patient care and education.
Beata I. Lewandowska, OD, is in private practice in Miami-Dade County, Florida. Joseph Sowka, OD, FAAO, is professor at Nova Southeastern University in Fort Lauderdale, FL.
WHERE TO FIND IT:
800.970.7227 | usa.canon.com/eye.care
Carl Zeiss Meditec, Inc.
800.342.9821 | meditec.zeiss.com/usa
408.988.8404 | centervue.com
866.344.8948 | optovue.com