A major Sydney eye clinic that sees 130 patients a day has gone paperless and completely digitised the way it handles ophthalmic data. It’s created efficiencies that allow specialists to spend more time with patients.
The major integration of a new data management solution at Westmead Hospital Eye Clinic, which included migrating more than 120,000 historic patient scans, has reduced daily clinics by up to two hours and helped the hospital save thousands per month on printing costs.
The clinic, which is part of NSW Health’s Western Sydney Local Health District, introduced Zeiss’s ophthalmic data management software, Zeiss Forum, in April this year to decrease patient monthly waiting time and improve clinical workflow.
Westmead Hospital Eye Clinic chief orthoptist Mr Michael Cosstick says implementing the fully electronic workflow took five years to come to fruition, and replaced the original system consisting of six ophthalmic devices working in a standalone capacity. This was in addition to hard copy printing for all results that were then being scanned into the hospital’s electronic medical records.
He says the existing system needed updating for several reasons including the fact each device had its own database. In the event of critical hardware failure, patient data would have been lost, and it was difficult for doctors to collate results over a long period of time across different devices.
“Often doctors had to leave their consulting room to look at results themselves. For instance, with our fundus camera, we weren’t printing pictures, so they’d always have to come to the camera to diagnose retinal pathology,” he says.
“The hard copies of our results were often labelled as of poor quality in the medical records, there was a one-to-two-day turnaround on scanning, and we were spending at least $3,000 per month on consumables associated with printing.”
According to Zeiss, Forum is a paperless ophthalmic data management solution that streamlines practice workflow by generating automated daily worklists on each device and offering multi-modality displays of all historical examination data on a single platform. Specialists can make efficient and confident clinical decisions by utilising features and plug-ins for glaucoma, retina and cataract.
Cosstick says it took several years to undertake the sophisticated Forum HL7 digital integration. Initially, this was due to difficulty in securing the hospital’s approval and making allowances in the budget.
Westmead’s eye clinic is large comprising 10 administrative staff, 10 nursing staff, six orthoptists, 27 ophthalmologists, five fellows, and six registrars. It conducts 30,000 appointments per year, roughly 130 patients on average per day.
“When it came time for integration, the devices had to be added to the hospital network, and there was a lengthy period of testing to ensure that results were populating in both Forum and the electronic medical record,” Cosstick says.
“We then had to migrate all of our existing data from our devices to Forum. This included 30,000 patients’ scans from our OCTs, and 96,000 visual field exams, some of which dated back to 1992.”
According to Cosstick, it was the first ophthalmic enterprise solution in an Australian public hospital that integrated with existing hospital medical record applications (such as iPM and Powerchart) to create a model of data storage that is both futureproof and scalable to future technological advancements.
Due to the introduction of Forum, Cosstick says medical staff have been granted 47.4 hours per month to spend with patients. Clinicians have saved 102.8 hours per month on scan acquisition and 15.8 hours per month on printing.
This means ophthalmologists can now make more informed clinical decisions based on the scan results, and detect subtle ophthalmic changes, which would otherwise be missed in a high volume, fast-paced environment.
“This ultimately allows them to specifically tend to the needs of the patient,” Cosstick says.
“I knew that we would save time each day because we were no longer printing, and the doctors now had the patient results at their fingertips, but I was shocked that we’re now saving one-to-two hours a day. This means that patients aren’t waiting as long to see a doctor, and clinics finish earlier.”
In addition, the hospital has stopped spending $3,044 per month on consumables such as paper, printer toner and stickers. One thousand sheets of paper are no longer being sent weekly to the medical records department that required 1.5 fulltime equivalent staff to accommodate the high volume.
In future, Cosstick believes Forum will have the capability to expand into Westmead’s operating theatres, so doctors can access biometry and other clinical notes. There is also scope to receive clinical test reports from community providers when assessing patients off site.
“Longer term, Forum could assist with large scale medical research especially if other major hospitals were to adopt the same system in their clinics,” he adds.
Mr Renato Antolovich, retina and glaucoma marketing manager for Zeiss Medical Technology ANZ, says Forum was first released in 2009 and now there are more than 400 sites across Australia and New Zealand using the software.
He says it’s a scalable image management solution that suits optometric and ophthalmic practices of all sizes that have both Zeiss and non-Zeiss equipment.
“It has most impact in consulting rooms of medium to high volume settings where workflow is paramount and clinicians need to make efficient and confident decisions from data spread across multiple modalities,” he says.
“Forum also reduces patient waiting times and improves data integrity by allowing end users to select patients from automated daily worklists derived from the integrated EMR (electronic medical record).”
He adds: “Zeiss ANZ is particularly proud to be involved in Westmead’s Forum integration. We are thrilled to hear of the significant improvements it has brought to the delivery of quality of eyecare, patient experience and operational costs in this high-volume tertiary institution.”