Metricom Ocular Imaging Challenge Power Point Slides in Slide Share

1. Ocular Imaging Challenge
#1 Environment - West Coast Retina Consultants
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Main clinic and one co-located in hospital, 5 satellite clinics
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Hosted IntraHealth Profile EMR via WAN and VPN provides patient health
records, scheduling, billing, visit encounter history and reporting to all clinics –
does not support real-time import/export via HL7, nor direct db access or
other means to share data
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Topcon FA OCT 2000 plus, Zeiss Cirrus HD OCT, Heildelberg Spectralis, Optovue
rtVue – limited DICOM output and MWL capabilities – some are proprietary
format which are custom converted to DICOM
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WAN and VPN are co-located with a hospital system thus restrictive and
minimal flexibility
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Imaging and measurement devices were standalone requiring multiple re-
input for basic patient data and separate viewing for access to info, images
and results

2. Ocular Imaging Challenge
#2 Clinical Portal Strategy
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Web based portal to provide unified access for all clinical data and images
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Use Open Source or Community licensed free software technology and
integrate
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Maintain viewer platform neutrality through common web browser for PC,
MAC, tablets, pads, etc. offering jpeg, pdf as well as DICOM for images utilizing
commercial and cost free generic DICOM viewers
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Base structure uses Joomla CMS for the portal to manage permissions and
security, MySQL for unified database, free VMware Server with free Ubuntu
Linux (LAMP) images to provide web server base, Clear Canvas ImageServer
free edition on MS Windows 7 with free SQL Server Express to provide a
DICOM repository and PACS services, Conquest DICOM server for MWL, Perl,
PHP and various cost-free modules, free Mirth Connect interface engine for
HL7, XML and other data integration for current and future health systems
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Multi level security to protect patient data – VPN and private WAN to restrict
access across firewalls, Joomla web server does not store any patient data and
acts as go-between for all data requests from MySQL and SQL Server without
direct access from users.

3. Ocular Imaging Challenge
#3 Implementation
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Integrate EMR data via manually executed SQL queries to export patient
demographics, appointments, visit and encounter reports to tab delim flat files
since this is the only option to export data from Profile EMR. The flat files are
automatically processed and update the main MySQL patient database
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MySQL Appointment data produces MWL (Modality Work List) feeds and XML
feeds to the imaging systems avoiding manual data entry
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The imaging devices export DICOM where possible to the ImageServer PACS or
proprietary images that are converted to DICOM
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Visit encounter notes and measurements are input by the physicians into the
EMR and more detailed measurements and notes are input into web forms (in
development) for storage into the MySQL database and also to a statistical
repository

4. Ocular Imaging Challenge
#4 Present and Future Portal Use
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The Joomla web portal currently provides a unified view to access patient
demographics, visit history and text reports, associated web viewable images,
links to trigger an RPC capable DICOM viewer such a Ginkgo to automatically
load a DICOM study or series
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A RiscViewer is currently in development to provide a view at a glance of
patient history, trends, recommend treatments, future actions and one click
access to images and reports. A platform independent web form is in the
works and may also be offered as a custom app in the future.