Article Date: 7/1/2011

Flexible High-Resolution Image Management

Flexible High-Resolution Image Management

Get digital images from old and new devices—how, when and where you want.

By Erin Murphy, Contributing Editor

Someone has to do the heavy lifting. Most physicians have amassed a wealth of images and data. But how will they access the vast amounts of data and images in a practical and meaningful way? How will practices meet the challenges of storage and device integration? The answer: Image management systems, also called data management systems, handle the job.

With image management systems, doctors view images and data from multiple devices side by side on a single screen, rather than on a dozen different device interfaces, to truly see a “big picture” view of a patient's clinical status. And they can view the information from multiple locations. What's more, image management systems streamline workflow by communicating with all digital diagnostic devices and delivering that information to electronic medical record (EMR) systems, which complete the picture with demographics, scheduling, billing and other capabilities.

If you're looking for an image management system, you have several choices—all of them prepared to pull digital data and images from your devices, old and new, and deliver them to you how, when and where you want.

Many Devices, One Screen

For all of the reasons that physicians want to compare images and data, such as evaluating surgical recovery or detecting and tracking disease progression, image management systems offer an enormous benefit.

“One of the things we've seen over the last couple of years in ophthalmology is the need to review images and exam data in one location. Doctors want to see everything on a single computer through a single platform, rather than through disparate and disconnected systems,” says Harry Colas, Product Manager at Topcon Medical Systems Inc., designers of the EyeRoute Synergy Ophthalmic Data Management System. “The technology eliminates the need to routinely interact with single devices, use their individual review software platforms and print reports for comparison or for a paper chart.”

Jonathan Shankle, Product and Sales Manager at Sonomed Escalon, makers of the AXIS image management system, adds, “Our clients want a truly web-based image management system built from the ground up to be fast, secure, customizable and accessible from any device, any operating system, anywhere. Every modality, every manufacturer must be integrated so doctors can see the patient's complete imaging history the way they want to see it without installing additional applications or extensions.”

Paul G. Chace III, CEO and Founder of Chace and Associates Technologies, LLC, makers of iViews Imaging System, points to another distinct advantage of a single, consolidated review: when it comes to detecting change or evaluating progression over time, there is no better way than viewing snapshots side by side.

“The system allows doctors to see all of their diagnostic reports and high-resolution images in one place for historical review,” he explains. “It has the ability to collect data and perform graphing over time for any data sets that doctors want, in any format they want. They can even obtain comparative historical reports based on results from different instruments.”

Pulling together and analyzing all of this data is a complex process—one that remains invisible to physicians using these systems. “It's very simple and straightforward from the doctor's perspective,” says Lon Dowell, Director of Clinical Informatics and Data Management at Carl Zeiss Meditec, Inc., creators of the Forum eye care data management system. “The Forum system is unique because it stores Zeiss instrument raw data centrally, including images and demographic data, and the doctor sees them through a flexible, web-based flex viewer. Being able to interact with raw data is a more sophisticated interaction than merely looking at static reports, and Zeiss is committed to that direction. For example, the system takes diagnostic data from the OCT and visual field test and integrates them into a single screen and a single report. We're the first to offer that capability, and we think it will become indispensible to users.”

Workflow That Flows

Traditionally, a patient scheduled for three tests entered the office, filled out paperwork and then moved to an exam lane. Technicians entered the patient's name and other data into each machine. This was time consuming and increased the risk of data entry errors. Today, both image management systems and EMRs offer a better option: automated workflow.

“Automated workflow is a key selling point,” says Dowell. “In this process, the patient provides information to a receptionist or enters it via a check-in interface, the information is recorded in the EMR and/or image management system and then all of the necessary information is automatically sent to all of the imaging devices in the office. It's called a ‘modality worklist,’ and it has been used in radiology for a long time. With no data entry at the machine, the risk of errors is decreased and practices shave off several minutes per patient encounter. This allows physicians to see more patients.”

James Messier, Vice President of Sales & Marketing at Medflow, Inc., makers of Medflow Imaging, points out how easily workflow advantages turn into clinical advantages. “Automated workflow is a big time-saver for technicians, who don't need to type in demographic data repeatedly. The device takes very little time to prepare, and the result automatically associates itself with the order in the EHR,” he says. “Think of the advantages in a busy retina practice, where the physician is ordering OCT scans, fluorescein testing and so on. The technician needs to get the tests completed, and the doctor needs to see the results.”

Fast Images Anywhere

An image management system's true feats of strength happen behind the scenes. While physicians and their staffs use a practical, intuitive interface, the system stores, archives and moves large high-resolution images across networks and in the cloud. In a robust system, this works so well that you may never give it a thought.

“Efficient image storage is a huge part of an image management product. The real key is not storage capacity, which has long been inexpensive and reliable, but rather timely image access and transfer,” explains Ian Lane, OD, Executive Vice President of Technology at Kowa Optimed, maker of Digiversal Open Image Management system and activEHR (in partnership with EMRlogic). “Physicians are using remote servers, accessing data at multiple locations and moving images over the network or Internet while the patient is in the chair. Those images must move quickly, so we're always coming up with smarter ways to achieve faster storage.”

Fast images in the exam room are essential, no matter where the exam room is. “This year, we've seen a lot of practices with 10 or 20 locations, and people want to see images instantly at any location with centralized image management. They're done moving charts between offices,” says Chace.

For those who wonder about the difference between an image management system and an EMR, this muscular capacity is key. “Image management's core capability is that it can manage large amounts of data—video, images, mydriatic imaging and so on—and move data over networks and geography to multiple clinical locations,” Harry Colas says. “It's a contrast to the EMR, which incorporates all the other key capabilities like billing and scheduling but does not handle large image volumes or integrate all of that diagnostic data. There are systems that go as far as collecting some information about the data and launching the individual device's review software, but you need an image management system to pull large amounts of data from devices and integrate the data into a single interface.”

“EMRs are something that every doctor has to face soon, but the EMR isn't enough. You need the capability to search, view and analyze images from all devices in one place,” Shankle says. “An image management system is that missing piece that EMRs lack.”

“All Devices” Means All Devices

Are all the diagnostic instruments in your practice fairly new and compliant with the Digital Imaging and Communications in Medicine (DICOM) standard? Probably not. It would be nice, but for now, an image management system can work around the issue.

Image management systems easily receive images from DICOM-compatible devices. Collecting and integrating other data requires software developers to address the workings of each device's own software. And to integrate “legacy” instruments with the image management system, developers find new ways to make it work.

“We're able to bring non-DICOM compatible devices into the workflow, so our clients can use a single image management system without visiting older machines. But those devices will eventually leave by attrition, and DICOM-compatible devices will replace them. Once everything meets open standards, there will be no more manual interaction between the device and image storage in the database. It will all be automated,” explains James Messier.

“Most of the instrument manufacturers are working hard to make their devices DICOM compatible for image management systems and EMRs, but there are often complications,” says Lane. “Overcoming that issue takes vigilance. We must constantly be in touch with all of the technology vendors so that by the time a new product or enhancement comes along, everything runs seamlessly for our customers. It's a mutually beneficial relationship because doctors don't want to buy a new device that doesn't work seamlessly with their software.”

Integrated with EMRs

A few companies such as Kowa, Medflow and Ophthalmic Imaging Systems make both image management systems and EMRs. Obviously, their own products complement each other, but they can be used with other systems as well. All companies that make image management systems need to work with EMR developers to integrate the software.

“There are many companies with EMRs. They want to work on medical charting and not necessarily images and clinical data. It works out well because we partner with those companies to make sure that our products work together smoothly. The systems work hand in hand,” says Dowell.

Rather than closely guarding themselves from each other, software companies from both areas form strong working arrangements to ensure that customers get the integrated systems they deserve.

“Our approach to device and EMR companies is the same: we want to communicate with everyone who wants to be integrated,” says Colas. “That's what our customers need, so we give EMR companies the technical capability to interact with our system.”

Coming Soon

While device manufacturers move toward image compatibility standards and EMRs adapt to the changing healthcare landscape, image management systems are drawing inspiration from the evolving world of hardware platforms.

“Many doctors are going to require the ability to view patient information anywhere, anytime, on any platform—whether it be PC, Mac, smart phone or tablet. Tablets in particular will play a large role in viewing patient images in the future,” Colas says. “Communication is key across all networks—3g, 4g and wireless—and dedicated private networks will be removed in favor of movement through the cloud.”

Viewing devices aren't the only emerging technologies that impact image management systems. Data delivery infrastructure promises to enhance them as well.

“We're working on the speed of transfer systems, and we're fortunate to have highly skilled developers who have achieved this in other fields,” says Lane. “In addition, new technologies such as fiber optics can move huge amounts of data at lighting speed, so hardware as well as software enhancements are possible. In the next year or so, the combination will deliver for doctors in really excellent time. Now is a fun time to be in this part of the industry.”

Dowell says that over time, Zeiss will develop “applications that are geared toward doctor interaction with their own data, which is where they want to be. What is important to the doctor is sometimes at odds with engineers. Native data interaction coupled with ease of use regardless of modality will answer many needs in this changing environment.” OM

Optometric Management, Issue: July 2011