LMU University Eye Hospital Munich

LMU University Eye Hospital Munich

“There’s a fundamental change in thinking among ophthalmologists, a desire to access all of the various data in one place.”

Dr. Wolfgang J. Mayer

Case Study LMU University Eye Hospital Munich

Professional IT Services from ZEISS

Case Study: The LMU University Eye Hospital in Munich

Improving the data and workflow processes of a large eye care operation poses special challenges. In 2012, the University Eye Hospital of the Ludwig Maximilians University (LMU) in Munich, Germany installed a FORUM® data management system from ZEISS. It also commissioned the ZEISS Professional IT Services support team to handle the project management and system integration. Two of the hospital’s specialists, Dr. med. Wolfgang J. Mayer and Dr. med. Karsten Kortüm, commented on the requirements, deliverables and positive results of the project in an interview. The key points are summarized in a case study.


Dr. med. Wolfgang J. Mayer

Dr. med. Wolfgang J. Mayer Eye Care Specialist and IT Officer, LMU University Eye Hospital, Munich

„One of the key objectives was to connect all our various imaging systems and to centrally store the large volumes of information for everyone to access.“
Dr. med. Karsten Kortüm

Dr. med. Karsten Kortüm Eye Care Specialist, LMU University Eye Hospital, Munich

„Connecting all of the systems using DICOM worked out very well, but also ZEISS’ support in integrating our non-DICOM systems.“

Interview with Dr. Mayer, Dr. Kortüm on 30 January 2014

ZEISS: Please give us a short rundown of the eye clinic at the LMU in Munich.

Dr. Mayer: The eye clinic at the LMU in Munich is one of Europe's largest eye hospitals and covers the entire therapeutic spectrum of eye care. It repeatedly plays a leading role in the implementation of new surgical techniques and imaging methods. The eye clinic at the LMU permanently strives to optimize eye care workflows. Ophthalmic imaging will be advanced in the planning of a new diagnostic center. In general, eye care is in transition: the value of imaging methods for diagnosis treatment decisions is increasing, new diagnostic systems with advanced functionality are available and the need for memory is growing. One of the declared goals of these endeavors was to drive the networking of various imaging systems, particularly the central storage and availability of vast amounts of information. While looking for a suitable solution, we identified FORUM from ZEISS because of the image management possibilities offered here, the integration of various forms of imaging and, above all, due to the integration of the system with the electronic patient files. In order to also meet the needs of the LMU eye clinic regarding the management of diagnostic data, the use of such a platform was obvious.

ZEISS: The intention was then to connect the existing infrastructure with an electronic patient file to further optimize the workflows?

Dr. Mayer: The introduction of electronic patient files in the eye clinic as a new standard of digital management of patient data was one of the main goals of this optimization. The existing infrastructure of the imaging systems for diagnostics should be connected to the electronic patient files to allow us to deal with the immense amount of image information and to better structure the growing quantity of data and make it more transparent.

ZEISS: Then ZEISS supported you during the integration of various imaging systems, as well as the electronic patient files with FORUM?

Dr. Mayer: The need to optimize workflows and network different components within the eye clinic was an entirely new challenge for us. For this reason, and because of the limited offer on the market, we were reliant on external help. We were offered temporary solutions to view images or print them as a PDF. However, this was not enough for us because we were looking for a comprehensive, convenient solution that we could also use to manage patient data and make it available in the electronic patient files. This solution, particularly the integration of imaging systems with the electronic patient files, was only available from ZEISS. The intention was to solve multiple problems: from system networking to logistics up to communication between the various systems. We launched a project for this with ZEISS, in which the professional IT services team played a key role. The primary goal was to switch the paper-based workflow to a digital procedure that also incorporates non-ZEISS diagnostic instruments as well as the electronic patient files, which would lead to an optimization of the entire system.

ZEISS: What was your experience working with the professional IT services team from ZEISS?

Dr. Mayer: Outstanding. You could really see that ZEISS is also very interested in obtaining a very good results for the eye clinic. The skill of the ZEISS IT team must also be emphasized. We were able to solve any problems together and considerably improved the workflows in the eye clinic. We are still working together because new requirements always arise, which have to be integrated into the overall workflow. ZEISS was and still is interested in understanding how we work and the associated wishes and in integrating these into our local solution, as well as injecting new ideas into the development of FORUM software and obtaining useful information for future versions. Just like with any other similar major undertaking, you cannot ignore the fact that there are highs and lows. But in the end, we overcame these challenges and achieved an outstanding result.

ZEISS: Before the project got off the ground, did you expect just the purchase of FORUM software to solve all your challenges?

Dr. Mayer: Considering that we wanted a total solution that integrates many different diagnostic systems from various manufacturers, and that combines the electronic patient files with each other, we knew ahead of time that a common language was needed – DICOM –and that additional integration work would be necessary. We did not expect a turnkey product. We knew that the interaction between the individual ZEISS components worked well, but our goal was to network everything. We expected ZEISS to perform well and our expectations were met. Overall, we created a good basic solution together that can be enhanced and extended in the future.

Dr. Kortüm: The integration of systems with a DICOM interface worked very well and the support we received from ZEISS for the integration of non-DICOM systems such as our ultrasound machine went off without a hitch. Several software interfaces were implemented in accordance with our wishes. This was important because a new purchase would have meant considerable investment costs. Instead, we were able to also integrate this device into the workflow. In addition to this ultrasound machine, ZEISS was also able to connect additional systems without DICOM. And you also have to remember that just because there is a DICOM interface, it does not mean that different systems can automatically communicate with each other. The professional IT services team from ZEISS also had to adapt quite a bit here to make the workflow do what we wanted.

Dr. Mayer: Right now, ophthalmologists are rethinking their entire approach: they are moving away from individual examinations and requesting the availability of information in one location. This makes the networking and integration of individual diagnostic systems and other IT systems necessary. Industry also has to understand that this road must be taken together: regardless of the manufacturer, all information must be consolidated and presented to doctors in a simple way if an optimized workflow is to be achieved. ZEISS has embraced this and is certainly a pioneer in this field.

Dr. Kortüm: In the end, imaging in ophthalmology is becoming increasingly important. In ophthalmology, we are witnessing a movement that took place in radiology 20 years ago. We are now faced with the challenge of universally processing clinical images regardless of manufacturer and modality. However, unlike in radiology, the framework is not yet in place, which leads to increased demand for integration.

ZEISS: How did the connection of the electronic patient files work?

Dr. Kortüm: In close cooperation with our IT service provider (MIT – Medizininformations-Technologiezentrum), ZEISS developed and implemented an interface between FORUM and i.s.h. med (note: electronic patient files on the basis of SAP R/3). In the eye clinic, examinations are not request via FORUM, but via the electronic patient files. This has various advantages: existing examinations can be shown in the electronic file, including a link to the examination data. This simplifies invoicing and existing patient information does not have to be re-entered on every device. Once an exam is completed, the results are shown in the electronic file, which informs the doctor about the current status of the patient. The clinical images are assigned directly to the patient in the electronic file and can be fetched and viewed with a click of the mouse. This solution works without a problem from a technical standpoint, but employees first have to get used to the new workflow.

ZEISS: Can you explain the workflow briefly?

Dr. Kortüm: Patients are entered in the electronic patient files one time. Different examinations on various systems are ordered there. After the exam, feedback is sent to i.s.h.med about the completion of the exam and the image data is saved in FORUM. Doctors can then access the examination results and any history via the patient files.

ZEISS: How does this integration help your daily work?

Dr. Kortüm: Overall, we now have a number of solid benefits: all patient data and images are now in the system under a uniform patient ID, be it the individual diagnostic systems or the electronic patient files. We can now request examinations for patients and routing cards no longer get lost because everything is paper-free.

Dr. Mayer: The examinations are now reproducible thanks to the integrated data management system. We have always wanted to have an overview of the examinations that have already been completed and which exams might need to be repeated. Now we can track the entire process at any time which considerably improves our daily work. Additionally, we can more easily monitor the progress of the illnesses of our patients over time and quickly check any changes. Because all this information is integrated, we no longer have to look at different systems or paper-based documents. Because the FORUM platform works with raw data, this data can be reproduced at any time.

Dr. Kortüm: Furthermore, with the integration, we have seamless documentation of the entire treatment, which of course gives us and, above all, our patients, added security.

ZEISS: Were you able to reduce costs as a result of these benefits?

Dr. Kortüm: In the past, we often had to enter patient data in every single instrument and print images for the paper file. Today, we only have to enter patient data one time and it is automatically forwarded to the imaging systems. The images are then available digitally as raw data, including all details recorded at the same time. This, of course, saves a lot of time and printing costs. More importantly, it is irresponsible from a medical standpoint to document an OCT examination with just a printout. This procedure simply delivers too much information. Enabling really good quality of the diagnosis requires all the details of the scan, including the depicted layers. We have already seen clinical cases in which very different diagnoses have been made when the doctors rely solely on a printout. With our solution, we can provide our colleagues in the eye clinic these details at any time at any workstation. This example shows that full integration of all data offers considerable benefits for the diagnosis.

ZEISS: What tips can you give to colleagues who are faced with a similar challenge?

Dr. Kortüm: Ideally, you should only use diagnostic instruments equipped with a DICOM interface because it considerably simplifies integration. This applies in particular to new equipment. During the concrete planning phase, you should first take stock of existing equipment and develop a concept to integrate it. For devices without a DICOM interface, you have to ask yourself if you really want to deal with the integration or if it might not be better to buy new equipment. This, of course, usually brings with it an improvement in your diagnostic capabilities.

Dr. Mayer: Creating a concept is a key point. You should consider in advance what your own infrastructure will look like and what you expect from networking and centralized patient management. You should also seek out expert advice from someone that can explain how such a solution to optimize the workflow can look and what is needed to make it happen. During this phase, we opted for ZEISS and made a good choice.

Dr. Kortüm: It is also a good idea to meet with the makers of different devices. You need to discuss the features that cannot be used without any modifications and thus result in relatively high costs during the integration or in the development of an interface.

ZEISS: Would you recommend the professional IT services team from ZEISS to your colleagues?

Dr. Kortüm: Without hesitation.

Dr.Mayer: A close and trusting relation with an industrial partner is vital when it comes to managing diagnostic images and integrating various IT components. You're not talking about selling a product and when maintenance and repairs are needed. The question is how the total solution will work and if it will improve your workflows. With ZEISS, we have found a reliable partner.

Dr. Kortüm: We were able to implement all our requests and requirements to the extent that the software on the different components allowed. It is not possible to compensate for every weakness in the software, but that is not the team's fault. However, everything that the professional IT team tackled, worked like a charm and is still doing so.

ZEISS: Thank you for that informative discussion.

Read the interview with Dr. Wolfgang J. Mayer and Dr. Karsten Kortüm at full length