In choosing an EMR system for an ophthalmology practice, a major factor to consider is the system's ability to handle high-resolution images.

At our practice we have a multi-sub specialty which includes glaucoma and retina, which require that electronic images are viewable from devices such as both digital fluorescein cameras and ocular coherence tomography, GDx and HRT.

Many EMR systems have viewing modules built-in. Some practices may want to consider a solution which has more robust capability, such as the ability to view multiple images at the same time, meanwhile scrolling through other reports, along with the ability to view images over a WAN between office locations.

I recently spoke with Steve Thomas, CRA of Florida Opthalmic Consultants, an independent imaging consultant for ophthalmologists. I asked him about the key factors that a practice needs to consider when selecting an imaging system. His responses:

1. Durability. This is based on the reputation of the manufacturer and the average amount of use. Can you get it fixed fast if it breaks? Who provides the technical support?

2. Expandability. After the system has been in use for a number of years, will you need additional computer resources to manage the increasing patient image information? How do you backup this information to protect loss?

3. Affordability. This is based on your patient volume - how many fluorescein angiograms (FA) and fundus photos (FP) are typically performed? Based on the revenue from this volume what does the system cost to run and maintain?

4. Licensing. Is the system licensed per practice, per doctor, or per user? If it is per user, does the system limit how many users can be logged on at any one time? Can you network the system into all your exam rooms without having to purchase additional licenses?

5. Interoperability. Is it a self-contained system? Will it dovetail easily with your existing EMR system? Or is the "digital" part from a third party manufacturer, complicating service issues when the system goes down?

6. Usability. Do you need to hire special staff to operate the equipment? If not, does the manufacturer provide extensive training to your existing staff? Is ease of use offset by a lack of capabilities?

7. Accessibility. Can you access the information from office to office if your practice grows requiring that need? How easily/quickly can you view these images across a wide-area network? Will you be able to do any "tele-medicine" with the equipment?

8. Resolution needs. What image resolution (for FA and FP systems) will be required to suit your practice needs? Don’t fall into the higher-res-is-better trap – a high-resolution image viewed on a lower-resolution monitor may lose critical fine details, such as micro-aneurysms, due to compression. It is important to match the resolution of the system to that of your monitors with the lowest resolution.

I have not discussed the more technical uses here, such as hardware or software interfaces between different devices and the image system. These are important considerations, but should only be a part of your overall needs analysis for an ophthalmic image style.