IHE, EyeCare and Image Management is pretty new and is unique. Unlike PACS and RIS in Radiology, Ophthalmic Image Management needs a different approach. These slides should shed some light on these differences.

1. PACS (Eye-Care Imaging Workflow)
Opportunities, Challenges &
Implementation in Ophthalmology
A OVERVIEW OF EYE-CARE IMAGING WORKFLOW…

2. Agenda
o Typical Eyecare Imaging Setup
o Why Eyecare Imaging Workflow not PACS
o IHE on Eyecare Workflow
o Opportunities in EyeCare
o Challenges in Eye Care
o Implementation at Aravind Eye Hospitals.
o Question and Answers

3. Typical Eye-care Imaging Setup

4. Typical Ophthalmology Imaging Setup
Imaging Equipment is an integral part of Eyecare Clinicans unlike Radiology, this is governed and used by Radiologist.

5. Why Eyecare Imaging Workflow not PACS

6. Evaluation of Imaging Workflow (2 decades)
EMR
HIS
RIS
PACS
Workstation
Modality
Technologist Centric
Radiologist Department Centric
Hospital Centric
Radiologist Centric
Clinician Centric

7. EMR
HIS
RIS
PACS
Workstation
Modality

8. Ophthalmology Imaging Workflow (1 decade)
EMR
HIS
Image Archive
Acq Modality
Importer (AMI)
Modality
Technologist Centric
Imaging Department Centric
Hospital Centric
Ophthalmologist Centric

9. Typical Eye-care Imaging Workflow

10. IHE on Eyecare Workflow (Integrating Healthcare Enterprise )
IHE is an initiative by healthcare professionals and industry to improve the way computer systems
in healthcare share information. IHE promotes the coordinated use of established standards such
as DICOM and HL7 to address specific clinical needs in support of optimal patient care.
o Advanced Eye Care Workflow – 2006
o Basic Eye Care Workflow - 2011
o Core Eye Care Workflow – 2014
o Unified Eye Care Workflow – 2015
◦ Takes the best features of the previous workflows
◦ Combines them into one profile
◦ Provides more flexibility for real world implementation models for systems such as EHRs and
PACS

11. Unified Eye Care Workflow Overview
oReal World Model I - EHR Implements DICOM Worklist and Integrates with a PACS
o Organizations have a PMS, EHR, centralized Image Archive/Display (PACS) and eye care diagnostic
imaging and testing equipment (fundus cameras, slit lamps, refractive measurement devices, visual
fields etc.)
o DICOM Model similar to Basic Eye Care Workflow
oReal World Model II – EHR Implements DICOM Worklist, Image Storage and Display (No PACS)
o Organizations have a PMS, EHR and eye care diagnostic imaging and testing equipment
o EHR performs the storage (not archive) and display of images/measurements
o Acquisition devices and users are responsible for the safe keeping of the images and/or
measurements created upon their system
o Acquisition devices shall be able to send “selected” images only
oReal World Model III – EHR Implements HL7 Only (no DICOM Support) and Integrates with PACS
o Organizations have a PMS, EHR, centralized Image Archive/Display (PACS) and eye care diagnostic
imaging and testing equipment
o EHR does not support DICOM so PACS implements DICOM Modality Worklist

12. Opportunities – Imaging Eye-Care
Workflow

13. Opportunities – Imaging Eye-Care Workflow
Reduce Errors and Enhance Patient Care
◦ Prevents mistaken patient identification
◦ Reduces image availability delays b
Increase and Planned Throughput
◦ Improves efficiencies for viewing studies
Reduce Operational Costs
◦ Reduces personnel requirements
◦ Largely eliminates document printing, management and storage costs
Reduce Unnecessary Imaging
Reduce Deployment Cost/Time
◦ Prevent custom interface specification time and cost

14. Challenges – Imaging Eye-Care Workflow

15. Challenges– Imaging Eye-Care Workflow
Lack of understanding
◦ Trying to implement a Radiology System as Ophthalmology PACS
◦ Lack of exposure to Technology and Standards.
Lack of Standards or Integration or Interoperability
◦ Majority of the Medical equipments are not still Standards compliance. DICOM / HL7 / CDA / FHIR
◦ Largely eliminates document printing, management and storage costs
Deployment and Maintenance Cost is High
◦ This is a complete Myth.
◦ In today’s world Hardware is economical Like Cloud / NAS and innovative business models like
SAAS make this affordable.
◦ Open Source and deconstructed PACS make this economical.
◦ Wireless connection is becoming popular and stronger.

16. Implementation – Imaging Eye-Care
Workflow @ Aravind Eye Hospitals

17. Deconstruction PACS

18. Implementation at AEH
Aravind Eye Care
HIS & EMR
Aravind Eye Care
HIS Scheduler
Innowave AMI
DCM4Chee Open
Source VNA
Weasis Viewer or
OHIF HTML5 Viewer
Patient Registration and Ordering
procedure
Convert Images to DICOM using
1. Screen Capture to DICOM
2. Print to DICOM
3. Image Format to DICOM
4. DICOM to DICOM
Order Scheduler and Status
Management
Stores Images on a NAS Box
Integrate image Streaming from
EMR
Send Order Information and
Receive Completions Status.
Type Clinical
interpretations
on EMR
2
1
3
4
5
6
7

19. Open for Questions