Are you using all your functions?

As increasing numbers of practitioners use imaging systems in their practice, it would appear that for the vast majority the use is confined to image capture and storage. The fact that most of the imaging software systems allow a wide range of other functions does not seem to be permeating into everyday use.
This is similar in many ways to the findings of recent consumer surveys looking at the ways people use their mobile phones. As the handsets become more and more advanced and offer services from recording, memo, alarms, call transfer, and so on, the majority of users still primarily wish to use their phone to phone with. So, is the extra functionality merely a sales gimmick of benefit to a few of the more 'techie' users?

Manchester Gathering
This was, to a large extent, the underlying theme of a recent meeting where around 70 users of imaging systems were invited by Haag-Streit to attend a day of lectures and workshops.
The event began with an entertaining review of the development of camera systems for health screening given by Di Carrington, senior screener for Shrewsbury and Telford NHS. She had been involved in screening from before 1995, where service had been mainly ad hoc and based on ophthalmoscopy by clinicians, and during the introduction in December 1995 of the non-mydriatic Canon CR4.
Concerns, she recalled, included 'how do I change the film?', and 'at 1 per shot I better not make any mistakes'.
In 1997, Carrington used one of the first digital systems and it was not long before the potential for high resolution and cost-effective screening became a reality. The time freed up by this allowed consultants the opportunity to manipulate images to ease their grading. The potential for networking is now becoming a reality.
Trevor Warburton gave an excellently clear presentation on some of the technical aspects of digital imaging. He described the various file formats into which images may be saved and demonstrated how compression may save on file space and yet not necessarily result in any loss of picture (and, therefore, interpretation) quality.
Warburton summarised current thinking by stating that a compression of 20:1 is acceptable, that the best JPEG setting available on the camera should be used when taking the image, and that double compression is best avoided.
In his view, for any given file size, higher resolution and higher compression is better than lower resolution capture with lower compression. Warburton also emphasised the very important need to back up all captured data. He warned delegates that they will have hard drive failures, software failures, computer thefts or 'some other disaster'. It was essential, therefore, to have original images stored both off-site as well as on-site, a back-up of data held off-site and ideally a system of daily back-up and checking should be introduced.
Warburton himself archives to a CD, copies the CD to a second hard drive, backs-up the image database daily to another machine, backs-up that machine to tape daily, uses an automated double image facility and implements a regular 'ghost' of his Eyecap C-drive.
This apparent effort sounds more than it actually represents in time consumption, while the benefits when a system does crash cannot be over-emphasised.

Screening in Practice
Optometrist Michael Charlton followed this with a description of the use of imaging in eye health screening in Wales.
Retinopathy screening in Wales has been criticised by many for its adoption of a 'man-in-a-van' approach, yet Charlton argued that the use of his camera has extended to monitoring a whole variety of illnesses and conditions. Added to this, the facility to produce 'indisputable' records and the ability to actually demonstrate to a patient the nature or extent of a lesion is a valuable practice-building asset.

BOXTEXT: Unused Benefits
Prior to the meeting, delegates had been sent a list of the various options and facilities that the EyeCap software system is capable of. This list included functions such as data and image editing, measurement and recording of parameters, report generation and password encryption. For each, the delegates were asked to state whether the function was used, used only sometimes, understood, not understood or not used at all.
From this, a list of the top eight least-used functions (in descending order) was calculated as follows:

Personalising fields - the ability to adapt a set field to the user's own personal profile
 Measurement of parameters - for example to measure and annotate an accurate disc shape and size
 Report writer - to automatically generate default reports and referral documents related to a capture or patient data
 Annotation - to add notes on screen, such as an arrow indicating a new lesion among several already seen
 Query form - a search engine allowing the system to be trawled for a certain criterion, such as detachments or patients over 75 years and so on
 Import/export facility - allowing data to be imported or exported with other software
 Password and user rights - allowing secure site definitions to be incorporated
 Archiving - the use of an automatic archiving system, though a complete back-up of data as recommended by Warburton earlier would seem the best approach.

Bearing in mind the usefulness of most of these facilities and that most did not, once understood fully, impact upon practitioner time significantly, a series of workshops was set up to address each in turn.
The aim is to review the value of these workshops and to assess, at a future date, how delegates' behaviour, assuming they felt these facilities to be of use, had changed.
optician will report on the follow-up survey at a later date.