The Changing Interface World
Cooperation between yourself, the EMR systems and software vendors is key.
BY FRANK D. PUZIO, O.D., F.A.A.O., Cape Cod, Mass.

Interface: a surface that lies between two parts of matter or a space that forms a common boundary.

ILLUSTRATION BY NICK ROTONDO

Reading this definition, you might think interfaces were abstract concepts. But in eye care and software circles, interfaces are an important and practical subject.

Interface refers to the transfer of data from computerized examination instrumentation to electronic medical record (EMR) software. As you structure your instruments and software in the future, you must fully understand the transfer of instrument data to an EMR system. You also must understand the interface relationship (cooperation level) between software vendors themselves.

Here, I'll provide an update on interface efforts and what they may cost. First, to fully understand the complexities of this topic, let's consider the viewpoints of the instrument companies and EMR software vendors.

Interfacing instrumentation with an EMR

Interfacing, a prime focus for instrument manufacturers, was relatively simple in the late 70s and 80s. Computerized instrumentation took readings and printed or displayed the results. Raw data were transferred by hand or stapled to a patient's paper chart.

As EMRs evolved in the 90s, however, interface became more complex. Today we want our instruments to transfer data electronically to a patient's chart.

But many instruments -- for example, autorefractors and lensometers -- don't have a provision for patient identification. Imagine the complexity of placing these instruments on your office computer network. Even if you do, how do the captured electronic data attach to a specific patient's chart? Some instruments create ASCII (American Standard Code for Information Interchange) data and others, such as topographers, produce BMP (bitmap) or other types of image files. Interfacing instrumentation is not simple.

Recently, many doctors have asked instrument sales reps about interfacing these instruments with their office software. "We've placed an RS232 serial cable port on the back of the instrument for this purpose," they've probably replied. "This instrument is fully capable of interfacing with your EMR software." But when you ask, "How does that work?" they've probably told you to call their interface engineers once you get the instrument installed.

Instrument companies have provided great instruments and service. But interfacing most instruments presents problems. Even if instruments can identify patients by name or identification number, how do the data get documented in the right place, and in the right patient's chart? Must every EMR vendor design a software interface specifically to coordinate with each instrument for each company?

Until now, the answer was yes. What a nightmare for the EMR vendors, many of which have taken up on this challenge. However, as I'll explain later, this is likely the wrong solution to a growing problem.

Most of today's interface obstacles would probably have been prevented if instrument companies and the ophthalmic marketplace had fostered cooperation and coordination years ago -- specifically, adoption of strict data protocols or standards. Long ago, the eye care marketplace adopted A.N.S.I. (American National Standards Institute) standards for ophthalmic materials, but we haven't been successful in standardizing electronic data.

Currently, there's a new push in eye care to adopt uniform medical standards, called DICOM (Digital Imaging and Communications in Medicine) standards. DICOM has become the industry standard for how image data are stored.

New solutions

Two new software efforts are being developed and sold by instrument companies themselves to assist us with interfacing.

Zeiss Humphrey Systems is rolling out its new Ensemble Software. As the company describes it, the interface software is designed with three goals:

1. Capture raw data from an instrument and make it available to EMR software.

2. Place these data onto the office computer network.

3. Take data, whether ASCII or BMP, and make them available for "compound (or layered) analysis."

With Ensemble, multiple instruments will analyze captured data or graphical images of a particular part of the eye and layer them. This is called "compound analysis," and the goal is to reach a higher level of diagnostic capability than that provided by individual instruments.

Nidek, Inc., will distribute an interface software product called NAVIS. Nidek describes its system as able to synchronize multiple electronic needs, from scheduling and billing to back office data collection. Navis has "open architecture," featuring connectivity to multiple manufacturers' devices. In product literature, Nidek welcomes other hardware and software vendors to write application software to interface with NAVIS.

NAVIS is trying to develop "modules" to interface high-resolution camera systems, slit-lamp and fundus imaging systems, B-scan and specular microscope imaging systems, autorefractors, lensometers or serial communication systems with front office and exam room workstations.

Interfacing software between software vendors

Some management software vendors have integrated EMR programs, while other EMR vendors have stand-alone systems without management software components. Don't you expect some flexibility and cooperation between vendors on your behalf? But cooperation between software vendors is rare.

Let's assume that your management software vendor doesn't have its own EMR, or you wish to acquire a different vendor's EMR and use it with your management software. For this to happen, you need two interface solutions.

First, to avoid duplication of effort, the EMR system requires a demographic interface to simply identify the patient. This is your data-
base, and I feel that if you want to share specific patient demographic identification with another system, you should be able to do so.

Second, consider all the information you collect in the examination room -- visual acuities, spectacle prescriptions, contact lens prescriptions, etc. It would be nice if the EMR software could pass these exam data on to the management system. It should also avoid time-consuming, expensive redundancy by filling in related fields in the management system automatically.

If you're the doctor, you expect this common-sense level of cooperation between vendors. For the vendor, this cooperation poses problems.

Cooperation the key

Willing cooperation is the key, and it's appropriate for vendors to charge us fair compensation for the solutions they create. I applaud companies that cooperate and allow this flexibility.

Dr. Puzio is in private practice in Cape Cod, Mass. He's the developer of OPIS Software and is a consultant for Officemate Software Solutions.