Integration for Better Digitalisation

Software integration in ophthalmology remains a critical point in the search for a digital optimisation of the operation theatre. Despite the high standard quality hardware for imaging, diagnostics, and surgery, ophthalmology still must deal with multiple underlying problems and technical issues.

It is a problem Bruce Allan MD said must be addressed as soon as possible. “We are not so happy,” he said during his presentation at the 2024 ESCRS Winter Meeting in Frankfurt. “Good data standards are already implemented in cardiology and radiology—but if we are talking of another image-rich specialty like ophthalmology, we are way behind.”

This lack of proper software integration can become frustrating and time consuming for a technology-savvy surgeon. Finding essential information, even writing down an operating note, can be a challenge. “We spend ages going through a forest of lenses before getting the right one,” he said. “Wouldn’t it be great if it was possible to take the lens box and just scan the barcode to find all the details already in the system?”

It is all here

A key to unlocking this issue can be in the right choice of electronic healthcare record (EHR) system. As Dr Allan observed during his “unconference” talk, to promote seamless communication, EHR systems and ophthalmic imaging devices need to conform to the same three data standards: SNOMED (Systematized Nomenclature of Medicine), FHIR (Fast Healthcare Interoperability Resources), and DICOM (Digital Imaging and Communications in Medicine).

“DICOM is the widely accepted common language for dealing with image data and metadata,” he noted. Even so, cross-device communication is still hindered by incomplete DICOM adoption in ophthalmology. “It is frustrating we cannot get our devices to speak to our electronic records,” Dr Allan said. “We have our EHR systems, we have some ‘sexy’ hardware, but they are not joined up. As of today, we are haphazardly entering this data on our own in a time-consuming manner.”

Dr Allan suggested proprietary software and the presence of airtight ecosystems as one of the main culprits in the lack of integration. “Whilst companies have done a great job with the hardware, lack of compliance with common data standards leaves users trapped in their ecosystem,” he said, noting if surgeons would like to use devices from different companies, they may not be compatible. “When companies say a device is DICOM compliant, they often mean it is only partially compliant.”

By simply implementing some data standards, Dr Allan believes the industry could see beautiful things happen. “With a bit of integration, we could go automatically from our biometry to the ESCRS calculator and straight into our EHR systems.”

Apply pressure

The goal of software integration cannot be achieved by just waiting for companies to solve it by themselves. Rather, Dr Allan argued there is a need for an active engagement of stakeholders and industry to implement a common standard. “We also need to lobby the regulators because they are not enforcing DICOM adoption. We need their help,” he said. “We also need to educate—let people know why this is important for us as surgeons.”

Bruce Allan MD, FRCS is a consultant ophthalmic surgeon at Moorfields Eye Hospital and Professor of Anterior Segment and Refractive Surgery at University College London, UK. bruce.allan@ucl.ac.uk