Iowa Eye Association News Nov. 2003. Series 2, no. 38.

University of Iowa Department of Ophthalmology and Visual Sciences

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Update
Digital mania or illusion

"We're goin' digital…" it's a natural evolution of the highly technological world we live in. Computers and digital information surround us.

For most of my life I have been an avid photographer. The inconvenience of having a darkroom, the cost and time required of maintaining one, greatly reduced the time I could spend doing photography, although it has always been an important part of my work.

In the past few years the quality and resolution of digital photography has become comparable to film-based images and it is becoming more affordable. So it is with ophthalmic photography.

As ophthalmologists we are becoming more and more familiar with digital images, their advantages in caring for patients and their problems. Cost is still a major factor in converting from film-based to digital images, whether you are looking at an office or academic department. Standardization and flexibility are major concerns and potential problems. No one wants to end up with "a Betamax." Universal standards are being worked on by industry, the American Academy of Ophthalmology, and other interested parties. HIPAA compliance is another issue.

I believe that for us, as a large academic department, the time has come. For nearly two years we have had a committee working on various aspects of what we need and how we are going to make the transition from film to digital images and eventually an electronic medical record. It will be costly. It will undoubtedly be frustrating. It will take time to learn new ways. It will be less efficient initially, but in the long run I am confident it will be a great asset.

At the present time we have over 150,000 files containing fundus photographs and fluorescein angiograms. In addition there are countless numbers of photographic files of patients from pediatric ophthalmology and strabismus, cornea and external disease, neuro-ophthalmology, and oculoplastics, not to mention videotapes of surgical procedures and eye movement disorders. There are no plans to scan these images and so there will be a period when both film and digital images will need to be used together. There are also a host of other digital files that will need to be incorporated in the "ophthalmic digital system" under construction; optical coherence tomography, topography of the cornea, echography, perimetry, and corneal endothelial imagery are among the few modalities we will need to readily access.

Archiving and retrieval of digital images will be far faster and easier than with film-based images, but they will require a huge computer capacity and a failsafe backup system. The expectation is that there will be password-protected access to images throughout the Department and the capacity to transfer information from the electronic medical record with images to referring physicians, insurance companies, and others within HIPAA guidelines. Investigational Review Board approved clinical research will also be conducted more easily. Preparation of digital slides for research and education will be greatly enhanced. The promise is there. Implementation will require meticulous planning, the ability to satisfy differing needs and expectations, and the willingness to learn new skills at a time when practitioners have to see more patients. Savings in film, processing, storage, necessary personnel will not be sufficient to cover expenses. In fact it is likely that expenses will far exceed our present costs. The benefits ultimately should be worth the investment. Is digital ophthalmic photography an illusion or has its time arrived?

Tom Weingeist

"Together, we have a vision for the future."

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"Together, we have a vision for the future."			Copyright © University of Iowa, 2003