Exporting Diabetic Retinopathy Images from VA VistA Imaging for Research.

The US Department of Veterans Affairs has been acquiring store and forward digital diabetic retinopathy surveillance retinal fundus images for remote reading since 2007. There are 900+ retinal cameras at 756 acquisition sites. These images are manually read remotely at 134 sites. A total of 2.1 million studies have been performed in the teleretinal imaging program. The human workload for reading images is rapidly growing. It would be ideal to develop an automated computer algorithm that detects multiple eye diseases as this would help standardize interpretations and improve efficiency of the image readers. Deep learning algorithms for detection of diabetic retinopathy in retinal fundus photographs have been developed and there are needs for additional image data to validate this work. To further this research, the Atlanta VA Health Care System (VAHCS) has extracted 112,000 DICOM diabetic retinopathy surveillance images (13,000 studies) that can be subsequently used for the validation of automated algorithms. An extensive amount of associated clinical information was added to the DICOM header of each exported image to facilitate correlation of the image with the patient's medical condition. The clinical information was saved as a JSON object and stored in a single Unlimited Text (VR = UT) DICOM data element. This paper describes the methodology used for this project and the results of applying this methodology.

Streamlining importation of outside prior DICOM studies into an imaging system.

A patient has an imaging study performed at one facility and has the study exported to portable media. Later, the patient takes the media to a different institution. The study on that media may need to be imported into that new institution's imaging system. This would be done to avoid a repeat examination, or so that the study can be on file for reference purposes. Importing prior studies is best performed by creating a new order on the institution's imaging system and then associating the DICOM objects from the prior study with it. In this way the prior study is actually inserted into the imaging system's electronic health record (EHR) and is properly indexed so that it can be identified and later retrieved as needed. In the past at the Department of Veterans Affairs (VA), importing prior DICOM studies into the VA systems had been a very slow labor-intensive process that took anywhere from 10 to 30 min to import a single study. We have developed a new DICOM Importer application that reduces the manual effort to import a prior study to less than a minute. We have redesigned and automated the process to make it much more efficient for the user. The Importer also handles contract examinations that are ordered by the VA and performed at outside imaging facilities, with similar time savings. This work is important because is addresses one of the major unsolved problems with import reconciliation workflow: how to efficiently handle the importing of prior studies.

Telehealth practice recommendations for diabetic retinopathy.

Telehealth holds the promise of increased adherence to evidenced-based medicine and improved consistency of care. Goals for an ocular telehealth program include preserving vision, reducing vision loss, and providing better access to medicine. Establishing recommendations for an ocular telehealth program may improve clinical outcomes and promote informed and reasonable patient expectations. This document addresses current diabetic retinopathy telehealth clinical and administrative issues and provides recommendations for designing and implementing a diabetic retinopathy ocular telehealth care program. The recommendations also form the basis for evaluating diabetic retinopathy telehealth techniques and technologies. Recommendations in this document are based on careful reviews of current evidence, medical literature and clinical practice. They do not, however, replace sound medical judgment or traditional clinical decision-making. "Telehealth Practice Recommendations for Diabetic Retinopathy" will be annually reviewed and updated to reflect evolving technologies and clinical guidelines.

The multimedia electronic patient record: current issues.

Complete online patient data including both traditional medical chart information and clinical images is essential in providing healthcare in a multi-facility environment. To meet this need, the Department of Veterans Affairs has developed a multimedia online patient record that includes traditional medical chart information as well as a wide variety of medical images from specialties such as cardiology, pulmonary and gastrointestinal medicine, pathology, radiology, hematology, and nuclear medicine. The ability to perform direct image acquisition from DICOM devices combined with diagnostic radiology reading from high resolution workstations allows hospitals to operate without making xray film. The wide area network connection supports ad hoc queries to records at other VA sites. The practicing physician has all of the information needed, anywhere in the hospital, at any time.