Electronic Ophthalmic Surgery Management (EOSM)
Patient History Record
Medical Status and History Review of systems Family and Social History
Interfaces
Diagnostic Equipment Administration Systems
Consent Forms
Surgery (Word Document) Anesthesia (Word Document)
Anesthesia Documentation
Anesthesia Questionnaire Pre-op Anesthesia Order Post-op Anesthesia Order
OP Documentation
Pre-op Record (Intra) Operative Note Post-op Record
Nurse Documentation
Pre-op assessment Intra operative Record Post op Record
OP-Report
Surgery Report (Word Document)
Data Export
Clinical Trials Surgery Registries
OP Plan
OR Planning
Attachments
EyeDraw Ifa4iPad Interface List (extract)
1. Medical History
Using ifa's SmartScreen technology, a user can easily enter all the relevant patient OP information. The user is then able to generate meaningful data (e.g., based on SNOMED terminology) and export it utilizing the query function for reports, clinical trials, disease registries, and other outcome databases. The structured data formats are available for: - Past medical history - Past ocular history - Family history - Allergies and risks - Medication history - Social history The user selects terms from "pick lists" associated with standard codes such as ICD or SNOMED and their compatible terms with clinical modifiers for precise documentation.
The OP record can be fully integrated into the clinical EMR: Dashboard
2. Interfaces
The connectivity guarantee is important for any paperless ophthalmic OR. Interfaces are designed for data import from ophthalmic equipment and for exchanging data with administration systems (HIS/Hospital Information Systems and PMS/Practice Management Systems). Equipment Interfaces More than 450 instruments and digital systems can be connected with the ifa OP management. The interfaces are based on exclusive agreements with the leading vendors for ophthalmic technology. Examples: - IOL Master (Zeiss Meditec) - PentaCam (Oculus) - Orbscan (Alcon) - HRT (Heidelberg Engineering) - Image Systems (e.g. Topcon, OIS, Kowa, Canon etc.) - Autorefractor/Keratometer (Topcon, Nidek, Canon, Humphrey etc.) The up to date list is available on the web: www.ifa4emr.com.
HIS- and PMS Interfaces The clinical OP management can be connected with the existing administration system (Hospital Information System/Practice Management System). The bi-directional interfaces are based on the international HL7 standard (Health Level 7: www.hl7.org). The ifa system imports all relevant demographic data from the HIS/PMS, stores it within the surgery record, and then exports all relevant information (e.g. diagnosis, procedure codes etc.) for billing and documentation purposes. The ifa surgery management is also designed to communicate with the integrated image data base or professional PACS. DICOM is the standard format for the integration of all kind of BLOBS (binary large objects) incl. OP videos (e.g. AVI files).
HL7-Interfaces: -
Demographic data Diagnosis codes CPTM codes Reports CDA
DICOM : -
Images Structured Reports
3. Consent Forms
Consent forms management depends on the relevant legal requirements. All documents are stored as WORD files which can be modified by merging the patient data from the medical record: name, DOB, type of procedure etc.. The merged documents can be printed, signed by the patient and the surgeon, and imported as a scanned object into the EMR. If the legal requirements allow a digital signature the patient can sign on an electronically pad (without printing the consent document). The system provides samples of various consent forms. Within the customization service all relevant consent documents can be stored and mapped to the merging functionality by the ifa consultants.
Signature pads support the paperless ASC
4. Anesthesia Documentation
The ifa surgery management provides a tool to generate all kind of data fields. The user can choose check boxes or multiple choice codes. For example anesthesia questionnaires can be created for the preanesthesia evaluation. Data fields can be structured e.g. for: -
Allergies (medications, food, latex) Current medications Problems (heart, blood pressure, kidney, lever, neurology etc.) Anesthesia history Type of anesthesia Postanesthesia evaluation (level of consciousness, status cardiopulmonary etc.)
The other alternative is the use of existing paper forms which are scanned and imported into the surgery record. Also combinations (structured data and scanned documents) can be generated within the customization process.
The iPad allows mobile computing in the OR
5. OP Documentation
The documentation requirements for surgical procedures in ophthalmology are complex and changing depending on new equipment, implants and technologies. Therefore the ifa software allows user defined data structures and vocabularies. Predefined data structures can be provided for: - Cataract Surgery - Vitreous Surgery - Retina Surgery - Glaucoma Surgery - Refractive Surgery - Plastic and Orbital Surgery
The structured data concept can be also used to generate surgery plans for the OR (see OP plan). The integration of the IOL Master is an example for save and professional device integration. More than 450 interfaces listed (attachments)
6. Nurse Documentation
For the nurse report (NR) the user can choose between two alternatives: -
Digital codes (structured templates with the EMR) Scanned paper form
The solution depends on the work flow and the preferred data use. If users require searchable NR information, ifa recommends digital code storage. If the NR is stored because of legal requirements, the scanning process with paper forms is more convenient. The scanner interface is also specifically designed for small, fast-scanning devices (e.g. Fujitsu ScanSnap).
7. OP Report
The OP notes are generated automatically by merging pre-defined text reports with the individual patient and procedure data. The basic text is a WORD document with structured merging features. Within the customization process the existing user reports are evaluated and preset for the electronica work flow. If required the OP reports can be completed with scanned documents (nurse reports, anesthesia reports, instrument print outs, graphical documents and drawing documents). The OP reports can be directly printed and/or sent by e-mail with the relevant data protection features.
Surgeons can concentrate on procedures and reduce the paper work.
8. Data Export
The ifa software suite offers comprehensive data export functionality. Quality outcome data bases, registries and clinical trial projects can import directly data from the surgery EMR. The data structures are SNOMED compatible and can be used for international projects. Integrated into the OP management is also the export interface for the EUREQUO project which is used worldwide. The registry for cataract and refractive surgery allows the comparison of the user`s quality data with international registry. The reports are developed by experts based on data outcome studies by the ESCRS (European Society for Cataract and Refractive Surgery, more information: www.eurequo.org).
9. OP Planning Chart
The OP management software generates the complete plan for the OR. Users can customize the layout for the different procedures or surgeons. The system imports the patient related data from the EMR and integrates the clinical data (visual acuity, refraction etc.) into the OP plan. The flexibility of the tool makes painless and efficient, and the plan can be printed or displayed on a computer screen (e.g. in the prep area). Additionally, a tablet PC (such as the Apple iPad) further enhances immediate access to the OR plan or any other procedure-related information.
All EMR versions are available for Apple iPad
10. Attachments 10.1.
EyeDraw
The EyeDraw tool allows all kind of drawings for ophthalmic surgery management
10.2.
ifa 4 iPad
All functions are also designed for pad computers like the Apple iPad and for Touch Screen Technology.
Interface List
10.3.
EcMR for Cataract and Refractive Surgery ifa offers a broad range of device connectivity Biometer, Ultrasound, Cornea Topography and Multi Function Devices • • • • • • • • • •
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Biometer, Optical Tomey AL-100 Zeiss IOL-Master Ultrasound Systems (biometer/pachymeter) Bio-/Pachymeter 4Optics OCP Alcon OcuScan RxP Alcon OcuScan (software) B-scan systems with video port Haag-Streit AXIS II PR (serial interface) Heidelberg OCP M + C - I 3 system Mediconsult I-Scan Nidek A-/B-Scan US 2500/20 Nidek Echoscan US-4000/500
• • • • • •
• • • • • • • • •
Oculus Pachycam Quantel Pocket Pachy Quantel Medical CineScan (video port) Quantel Medical Compact II (video port) Quantel Medical Aviso (video port) Technomed E-Z Scan B5500/ E-Z Scan AB5500 Technomed PacScan 300 A/300 P/300 AP Teknar/Mentor B-Scan III Plus Teknar/Mentor A/B-Scan III Plus Teknar/Mentor Image 2000 Tomey AL-100 Biometer/AL-2000/-3000 Tomey UD-6000 Tomey SP-100/3000 Tomey IS-500 A/B-Scan Tomey AI-510 A/B-Scan
EcMR for Cataract and Refractive Surgery Cornea Topography (examples) • •
• • • •
Bausch & Lomb Orbscan bon Optic EyeTop, EyeTop-H, Eye Top-S Haag-Streit Keratograph Nidek OPD Scan II Oculus Keratograph Oculus Easygraph Optikon Keratron/Keratron Scout
• • • •
Rodenstock Keratograph Tomey RT-6000/7000 Zeiss ATLAS Model 9000 Oculus Pentacam
EcMR for Cataract and Refractive Surgery Refraction Devices (examples) •
Autorefractor/Keratometer/ Tonometer: – – – –
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•
Autorefractor: – – – – – – – – – – – –
Nidek RKT-7700 Nidek TONOREF II Oculus Park-1 Topcon TRK-1P
Autorefractor: – – – – – –
Canon R-10/20/22/30/50/F10 Canon RK3/RK5 Hoya AR 550 Humphrey HAR-420/500/510/ 525/540/580/580 S/585/590/595 Nidek AR-310A/330A/600/660 /700/800/820/1000/1200 M Nikon NR-5000/5100/5500/8000
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Nikon Speedy Nikon Retinomax Plusoptix S04 Rodenstock PR-60 Rodenstock RA-303 Rodenstock RX-202/502/520/900 Shin-Nippon RC 380 Shin-Nippon QR-007 N Shin Nippon EZRef 8000 Tomey TR-1000/3000 Tomey RT-7000 Topcon RM-A-2000/3300/6000/6300/ 7000/ 7300/ 8000/RM-8800 Welch Allyn SureSight HandAutorefractor Zeiss Humphrey Acuitus
EcMR for Cataract and Refractive Surgery Kerato-Refractometer (examples) • • • • • • • • • •
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Alcon Handheld Keratometer Canon RF-1/10 Canon RK-1/F1/2/3/5 Grand Seiko GR-3100K Humphrey Acuitus Humphrey HAK-420 Humphrey HARK-595/597-599 Huvitz MRK-3100 P/HRK-7000 Nidek AR 530A/510A Nidek ARK510A/530A/560A/700/700A/ 760/900/2000 Nidek KM-500
• • • • • • • • • •
Nikon NRK-8000/10000 Nikon Retinex K-Plus Hand-Ker. Nikon Retinomax2 Nikon Speedy-K Potec PRK-5000 Rodenstock CX 500/520 Shin Nippon ACCUREF 8001/K 9001 Tomey RC-1000/5000 Topcon KR 7000/7000 S/7000 P/7500/ 8100/8100 P/8800