August 27, 2012
2 min read

New standards for EHR users set tone for retinal imaging, comprehensive eye exams

Interoperability standards enable the storage and transmission of digital retinal thickness maps and comprehensive eye exam results.

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Teams of ophthalmologists are completing standards and protocols for the storage and transmission of digital retinal thickness maps and routine eye examination results with electronic health records.

Two ophthalmic work groups recently completed Digital Imaging and Communications in Medicine (DICOM) standards for ophthalmic thickness mapping storage and transmission and an Integrating the Healthcare Enterprise (IHE) framework for general eye examination data storage.

Electronic health records (EHRs)are designed to partially or completely replace paper files and improve the safety and efficiency of patient care.

Flora Lum

Moving from a paper basis to an electronic format benefits [physicians] because they can receive data in an electronic format so that they can exchange it across their different offices and with their colleagues in an electronic format,” Flora Lum, MD, American Academy of Ophthalmology policy director for quality of care and knowledge base development and executive director of the Hoskins Center for Quality Eye Care, said.

Retinal thickness mapping

Previously, EHRs had no capacity to store digital images such as retinal thickness maps; physicians had to scan images into their EHRs, Lum said.

 “You can always scan an image and that can be in an electronic health record, but it doesn’t provide you much information,” she said. “Whereas, using DICOM standards, you get all that information. A doctor can actually look at the broad data itself. But if all you get is a scan, you can’t do anything with that.

The new DICOM standards also let physicians transmit digital images, Lum said.

They can send [images] to a referring physician or the physician they want to refer the patient to,” she said. “It makes it a standardized format to store the data and exchange the data with their colleagues.

The ophthalmology work group is working on DICOM standards for corneal topography and wavefront measurements, Lum said.

We think we’ve covered the major imaging technologies now,” she said.

It remains to be seen whether stage 2 meaningful use criteria for EHRs will include DICOM digital imaging standards; stage 1 criteria did not include the standards but inclusion of them was proposed for stage 2, she said.

Eye evaluation framework

The IHE framework defines a Clinical Document Architecture (CDA) document that can handle eye examination data. Criteria for meaningful use of EHRs issued by the Centers for Medicare and Medicaid Services mandate the use of CDAs to transmit basic patient information across EHRs, Lum said.

The problem with the CDA as it’s written now is that it’s a routine visit,” she said. “It doesn’t have any eye visit-specific data elements such as visual acuity. … Now we have a general eye evaluation CDA that contains basic elements of a comprehensive adult eye examination.

The CDA elements are based on the AAO’s preferred practice patterns for comprehensive adult eye examinations.

Work groups are working on a CDA structure for transmission of eye exam information between subspecialty settings, Lum said.

Right now, EHRs just can’t talk to each other,” she said. “There’s no common format to pull the information and send it to another EHR. The general eye evaluation CDA solves that. Now we’re going to subspecialty areas. We’re working on cataract — one preoperative, one operative and one postoperative — so there’s a standardized format to send those. We’ll probably look at glaucoma next and other subspecialty areas.” – by Matt Hasson

  • Flora Lum, MD, can be reached at the American Academy of Ophthalmology, P.O. Box 7424, 655 Beach Street, San Francisco, CA 94120; 415-561-8592; email:
  • Disclosure: Lum has no relevant financial disclosures.