7 October 2022

The College and eye care organisations call for standardisation of digital imaging

The standardisation of digital imaging across eye care services will transform efficiencies, accessibility and timely care of patients.

Eye care services specialise in the prevention, diagnosis, treatment, surgery and management of eye disease. The demand for eye care services is predicted to increase by 40% over the next 20 years1. Primary eye care delivers over 22 million sight tests a year2 and nearly 10% of all patients attending a hospital out-patient department go to the eye clinic3.

It is imperative that any innovation and improvement that creates capacity in managing this demand is prioritised. Standardisation of imaging will allow a seamless interface with technology for joined up patient care and the use of artificial intelligence that is ultimately effective in preventing avoidable sight loss

Being able to share a patient’s record and diagnostic images digitally across systems and between eye care centres in primary and secondary care, will increase the ability to make swift and efficient diagnosis and treatment decisions. 

Clinicians and healthcare professionals, patient groups and the manufacturing industry have come together and agreed that developing a set of standards will drive interoperability of digital systems and diagnostic analysis by end-users will deliver efficient and high-quality patient care. 

To improve interoperability of digital imaging and patient care, the following will guide development of digital imaging standards:

  1. Make compliance and image sharing easy and clear for all organisations involved
  2. Work towards a basic .dcm file output4 from all newly sold devices, populated with agreed meta-data5 to help clinicians identify which patient, which eye, what the imaging file is and when it was taken
  3. Create ‘sub-set’ definitions of DICOM (Digital Imaging and Communications in Medicine) standards for how imaging files should be configured, extracted and saved
  4. Move to 100% adherence to DICOM standards across our organisations over an agreed timescale
  5. Develop an audit mechanism to support adherence to the standards, which is proportionate in its impact on all parts of the sector, especially manufacturers and their customers.

This is an initiative that will only succeed if it is broad and inclusive, involving primary and secondary eye care, industry, policymakers, health service commissioners, patients and providers, making use of the expertise available to improve the interoperability of eye care imaging and significantly improve eye care for our patients.

This will bring efficiencies for both national primary and secondary care to enable long-term decision-making on investment, equipment procurement and training; all of which will lead to better outcomes for patients. In the UK, across primary and secondary care, there are several digital systems to review and analyse clinical images of the eye, supplied by manufacturers and purchased by trusts. Unfortunately, the historical lack of agreed interoperability standards means that most of these systems are incompatible with one another.

In primary care, imaging is increasingly offered in addition to sight tests so changes can be assessed, monitored over time and shared with secondary care. In ophthalmology, a huge number of digital images have to be analysed, repeated and shared with other professionals across hospital eye units, community practices and primary care optometrists.

As a result of the incompatible digital systems, images often have to be taken repeatedly, time and resources are wasted and a patient’s health diagnosis is often delayed – which can lead to avoidable loss of sight. More visits to eye units also cause stress and anxiety for the patient and contributes to waiting time delays.

The Royal College of Ophthalmologists, the College of Optometrists the Primary Eye Care Information and IT Committee and the Optical Suppliers Association are grateful for all the organisations and the industry who have contributed to the principles of interoperability outlined in this statement. It is imperative that all national health service systems in the UK use the expertise of those professions involved in eye care to make a difference, future proofing the care of patients through innovation and standardisation in the use of digital imaging systems. 

Julia's Story

An illustrative story to highlight common issues with clinical image sharing.

Julia attends for a regular eye test at her local optical practice. The optometrist observes an abnormality at the back of her eye, and in addition to the sight test takes a retinal scan (OCT) and photo, and makes a referral to the local hospital.

The optical practice is not able to select the file type from their imaging device in the format compatible with the local hospital - preventing ophthalmologists from reviewing or storing the image. As a result, Julia needs to be scanned again, and an appointment is booked in for 12 weeks’ time in the hospital retinal clinic. When Julia attends her scan in the retinal clinic, the registrar cannot access and compare her original optometrist scan, and so cannot view the progression of the abnormality over the 12 weeks. The registrar reviews the hospital scans and, after checking with senior colleagues, a decision is made to re-scan in 4 weeks.

During this time, Julia moves home and is transferred to a new hospital. When Julia arrives at the new hospital, she is scanned again. Although the hospital that referred her can share the retinal photograph, the analysis that the new service wants to perform is only available if the images are taken from their own machines, and the referring hospital’s image file cannot be read by the new hospital’s viewing software.

Her consultant at the new hospital would like to view the earlier images, even if in a different format, and is eventually able to secure them after several hours of administrative and clinical time spent liaising between the hospitals and primary optical practice. 

With consistent and effective imaging standards in place, we could change Julia’s story to one where each service and team, across primary, secondary care and other healthcare specialties, can see every eye scan and monitor how the abnormality is developing. 

We could - instead of the slow, time consuming and convoluted journey described here – set up a virtual channel for all specialists involved in a patient’s care to review the eye-scans at the outset, and therefore provide an immediate recommendation for a direct referral to the cancer centre with a scan and photo that they could use for baseline monitoring. If Julia consented, all of her scans could also be used to support research and to provide better evidence on which treatments, diagnostic approaches and interventions are most effective.

Sources

  1. The RCOphth Way Forward
  2. Optics at a Glance
  3. RCOphth Three Step Plan 
  4. A DCM file is an image file saved in the Digital Imaging and Communications in Medicine (DICOM) image format. It stores a medical image, such as a CT scan, ultrasound or eye scan, and may also include patient information to pair the image with the patient
  5. Metadata is data that describes data, but it isn't the data itself

Further information

  • Information & IT Committee
    The Information and IT Committee is a joint committee of the national optical representative bodies, providing an inclusive forum for anyone in the UK optical sector who has an interest in IT, information, uses of information, data ownership, data security, data standards and systems.

    It helps the national bodies and the sector in its collective parts formulate strategy and policy. It is currently chaired jointly by Max Halford (ABDO) and Peter Hampson (AOP) with FODO providing the secretariat.
  • OSA
    OSA is the Optical Suppliers Association, providing innovation, insight, knowledge and training for the whole of the UK optical industry. It supports a wide range of activities that benefit the sector as a whole and the people who work within it.

    It provides a thriving network for companies involved in all aspects of manufacturing, distribution and supply of lenses, frames, ophthalmic instruments and equipment, contact lenses, consumables and accessories, as well as shopfitters and providers of IT and business services to optical practices.
  • The Royal College of Ophthalmologists
    The Royal College of Ophthalmologists (RCOphth) is the only professional body for eye doctors, who are medically qualified and have undergone or are undergoing specialist training in the prevention, treatment and management of eye disease, including surgery. Ophthalmologists are at the forefront of eye health services for the UK, supporting improvements in the co-ordination and management of hospital eye services and the workforce both nationally and regionally.

    We put patient care and safety at the heart of everything we do.  We collaborate with government, health and arms-length bodies, charities and eye health organisations to influence national eye health policy with impartial and clinically based evidence.

Related further reading

Clinical Adviser for the College Daniel Hardiman-McCartney FCOptom on how to ensure a sustainable optometry workforce.

Himali Shah MCOptom, Resident Optometrist at Specsavers, Leicester North, discusses a case of a patient presenting with vitreomacular traction.

Clinical case studies can make a small but important contribution to the sum of clinical knowledge. Why do we need them, asks Kim Thomas, and how do you write one?