Imagine you sit down for a consultation with a glaucoma patient and you want to show printouts of various imaging results over time. You open the manila folder to find an avalanche of paper tumbling onto your desk, which you scramble to organize quickly for discussion. Careful: there’s a field printout that’s out of order chronologically. Whoops: another field test appears to be missing altogether. Meantime, the patient looks on, wondering how a highly renowned local eye care provider can appear so disorganized while fumbling over apparently haphazard record keeping.

This was precisely the cumbersome manner in which Robert Stutman, O.D.—who practices with another optometrist plus four ophthalmologists at the two-location Select Eye Care in Towson, Md.—educated his patients… until about three ago when he and his colleagues finally said, enough.

They researched the burgeoning market for clinical image management systems (IMS), and purchased one that, he says, has increased practice efficiency and workflow, saved time in each exam, improved patient education, and presented a more professional image of the practice to patients.

What exactly are these systems? Approaches vary, but all seek to create a central repository of diagnostic imaging and data that come from diverse sources—cameras, perimeters, OCTs, topographers and more—so that they might yield more sophisticated clinical insights. They also help itinerant doctors stay in touch by providing access to their patient records while on the go.

While many practitioners have put plans to transition to electronic health records on hold—citing uncertainties as to how the Office of the National Coordinator will administer the health care stipulations of the American Reinvestment Act—others see a more pressing need to organize their clinical images now and display them in a patient-friendly way. Dr. Stutman’s experience affirms the clinical utility and favorable cost-benefit profile associated with today’s image management systems.

Who Needs it?
Let’s say you’ve yet to consider an image management system, much less take the EHR plunge. Consider how your office currently manages its clinical images. Maybe paper printouts of images stored in file folders serves your practice’s needs. If so, an obvious question arises: Why bother with an image management system? If your image record-keeping doesn’t appear to be broken, why fix it? And at a cost that’s nothing to sneeze at, where’s the cost-benefit payoff?

Let’s revisit Dr. Stutman’s office. His multidisciplinary practice includes glaucoma and retina specialists, generating many workups for macular degeneration and diabetic eye disease. The special testing used for these and other conditions yields a large quantity and wide variety of clinical imaging results.

“We had paper charts, [but they were] just getting out of control,” Dr. Stutman says.

Given the increasingly central role that imaging plays in eye care, the process seemed untenable for the long-term. To that end, they obtained an image management system. “Our clients want to have everything in one place so they can look at progressive disease, observing change over time, with all the data right there in front of them,” says one industry representative about the benefits to clinical care.

What’s So Good About it?
Among Dr. Stutman’s chief goals was to digitally organize his images, store them and retrieve them when necessary—and wherever necessary. No longer are images confined to a single device; any computer terminal or tablet in the office can be used as an image viewer, which helps add flexibility to the office workflow. Doctors and techs no longer compete for turns at the fundus camera; one patient’s findings can be reviewed at the same time another patient is being imaged.

“In terms of organizing and accessing the patient’s special testing, it’s much more efficient than I ever thought,” Dr. Stutman says. And that’s saying something, given the practice’s volume of glaucoma, macular degeneration and diabetic eye disease, among other conditions. The sheer volume of images captured in the office signaled the need ultimately to organize all those pictures in a digital format.

“The nice thing about the system is that it has special filters that you can customize,” Dr. Stutman says. Users can confine a search to one category, such as visual fields. “You can just look at visual fields and scroll through them all.” That gives doctors the ability to observe the progression of a specific questionable field defect over time. “It’s just much easier, much more efficient, much less time-consuming,” he says.

These systems are the latest advance in a more general transition to digital images and software that facilitates swift migration of images and data from one site to another. “Image management systems are specific software programs that run outside of the EHR and are specifically designed to handle digital images,” says Michael Chaglasian, O.D., chief of staff at the Illinois Eye Institute and associate professor at the Illinois College of Optometry.

Systems also combine multiple imaging modalities onscreen simultaneously, giving you a better appreciation of the patient’s condition. “A new module of patient care has developed where the O.D. has the opportunity to bring all diagnostic imaging together, even from instruments of different companies,” Dr. Chaglasian says. “This allows us to easily and quickly view visual fields alongside the OCT and retinal photos, or to view a multi-year series of visual fields. Having quick and easy access to data that is centrally stored on the office PC network is a significant improvement over searching through paper charts.”

IMS Meets EHR
Do image management systems and EHR systems play well together? No problem, says Dr. Stutman, whose practice’s recent EHR implementation and coordination with the image management system was seamless. It didn’t hurt that a staff well on its way to being computer-savvy came to the table with powerful pre-existing skills.

In Dr. Stutman’s practice, the IMS preceded its EHR adoption. He says they weren’t quite ready to transition to EHR, but saw the value of streamlining the imaging. In a sense, the IMS adoption was a warm-up to the larger and more formidable task of implementing EHR. It was right around then that Dr. Stutman and his colleagues put computers in every room and signed on to e-prescribing, so the staff already had a head start.

“It made the transition to EHR easier,” Dr. Stutman says. “Our staff was already used to using the computers. And we already had the image part of our records, which were well taken care of. We didn’t have to make accommodations in our EHR system for all the pictures and the special testing.”

Dr. Chaglasian sees growing improvement in IMS/EHR compatibility. “EHR vendors and IMS vendors are working to create a seamless linkage between the patient’s EHR record and their IMS record,” Dr. Chaglasian says. “At present, I’ve been able to use the two side by side without a significant loss of efficiency. I’ve been working with my EHR and IMS vendor, and in the near future they will be connected for an even quicker transition.”

Putting It Into Practice
From anecdotal reports, it sounds like anyone who’s reasonably tech-savvy can adjust to use of such a system. The techs just take a picture, make one or two clicks on the source machine, and the image is sent to the server. “It happens immediately,” Dr. Stutman says. “When they bring that patient into the exam room, they pull it up on the screen for the doctor.”

You might expect a steep learning curve with a system of this sophistication, but Dr. Stutman says his is a very user-friendly system. And given the relative newness of these software packages, the vendors tend to roll out upgrades with new features fairly rapidly. Systems are also scalable—they can expand or diminish as your practice’s usage dictates.

Is it worth it? Upfront costs vary widely, depending on the capabilities of the IMS and number of office locations involved—from about $10,000 for a basic image viewer at a solo practice to perhaps a six-figure price tag for a multi-office setup that links dozens of devices.

Not everyone will find that the convenience of a high-tech solution to a practice’s deluge of data justifies the investment. But Dr. Stutman points out the impression it creates with patients. “I think you deliver better patient care, and you look better doing it,” he says. “It definitely has made our operation look more efficient as well as more patient-friendly. It’s also a lot easier to educate patients.”

Image Management Systems on the Market
System	Vendor	For More Information
Forum Eye Care Data Management	Carl Zeiss Meditec	www.meditec.zeiss.com/forum
iViews Imaging System	Chase & Associates	www.iviewsimaging.net
IMS/CL Clinical Image Management System	HAI Laboratories	http://hailabs.com/software/image-management
DigiVersal	Kowa	www.kowa-usa.com/kowanewweb/medical/solutions.html
Medflow Imaging	Medflow	www.medflow.com/imaging.php
Axis Image Management	Sonomed Escalon	www.sonomedescalon.com/axisimagemanagement.html
Synergy Ophthalmic Data Management	Topcon Medical Systems	www.topconmedical.com/products/synergy.htm