Imaging Solutions and Electronic Medical Records (EMR)

When choosing an electronic medical records (EMR) system for an ophthalmology practice, a top consideration to examine is in the system's ability to handle images of high resolution. In fact, our practice has a multi-sub specialty including glaucoma and retina, both which require electronic images to be viewable from devices such as digital fluorescein cameras, ocular coherence tomography, GDx and HRT.

Many electronic medical records systems have built-in viewing modules. Certain practices may choose to consider a solution with more robust capabilities such as the ability to view multiple images simultaneously, or the ability to view images over a wide area network between office locations.

Steve Thomas, CRA of independent imaging consultant Florida Opthalmic Consultants, recently spoke with me about the key factors which practices should consider when selecting imaging systems for ophthalmologists:

Accessibility:
Can you access the information from office to office if your practice grows requiring that need? How easily/quickly can you view these images across a wide-area network? Will you be able to do any "tele-medicine" with the equipment?

Usability:
Do you need to hire special staff to operate the equipment? If not, does the manufacturer provide extensive training to your existing staff? Is ease of use offset by a lack of capabilities?

Interoperability:
Is it a self-contained system? Will it dovetail easily with your existing EMR system? Or is the "digital" part from a third party manufacturer, complicating service issues when the system goes down?

Affordability:
This is based on your patient volume - how many fluoresce in angiograms (FA) and fundus photos (FP) are typically performed? Based on the revenue from this volume what does the system cost to run and maintain?

Durability:
This is based on the reputation of the manufacturer and the average amount of use. Can you get it fixed fast if it breaks? Who provides the technical support?

Expandability:
After the system has been in use for a number of years, will you need additional computer resources to manage the increasing patient image information? How do you backup this information to protect loss?

Licensing:
Is the system licensed per practice, per doctor, or per user? If it is per user, does the system limit how many users can be logged on at any one time? Can you network the system into all your exam rooms without having to purchase additional licenses?

Resolution needs:
What image resolution (for FA and FP systems) will be required to suit your practice needs? Don’t fall into the higher-res-is-better trap – a high-resolution image viewed on a lower-resolution monitor may lose critical fine details, such as micro-aneurysms, due to compression. It is important to match the resolution of the system to that of your monitors with the lowest resolution.

Here I haven't discussed some of the technical uses such as hardware or software interfaces between different devices. These are, of course, important considerations - they should only become a part of your overall needs for your ophthalmologist imaging style.