Harmony from Topcon Healthcare is a web-based data management platform that connects ophthalmic instruments and professionals to enhance clinical workflows. It integrates with all devices, regardless of brand, for easy comparison and analysis of patient data on a single screen. Harmony streamlines processes with Electronic Medical Record (EMR) integration, collaborative care workflows, and secure data exchange, as well as supporting AI-powered clinical decision tools for automatic image analysis.

Harmony’s versatility and ease of access make it ideal for connecting stakeholders across the eye care spectrum. Exploring its benefits further, The Ophthalmologist recently gathered three experts from ophthalmology and optometry – Professor Paulo-Eduardo Stanga, MD, Svein Tindlund, and Matti Tyynilä – to discuss their experience of using Harmony in practice, and how it is driving truly collaborative eye care.

What is your experience of facilitating a collaborative care approach in your practice?

Professor Paulo-Eduardo Stanga, MD Founder & Chief Medical Officer The Retina Clinic – London Ophthalmic Institute

P-E Stanga: At The Retina Clinic London we ensure that referring consultants, optometrists, dispensing opticians, and any other relevant healthcare professional involved in the care of a mutual patient are kept in the loop of patient management with permanent and timely communications. We also make sure that, in addition to receiving a copy of the clinic report, both referrers and patients receive copies of all imaging results, so they can see for themselves how we reach diagnosis, what available management options exist, what the expected benefits and risks are, as well as prognosis with and without treatment and post-treatment management. Every patient seen at our clinic can communicate directly with the consultant in charge of their care.

Matti Tyynilä Chief Optometrist Instru Optiikka Oy

Matti Tyynilä: In Finland we have ophthalmologists in optical stores, which is a different setup to most European countries. At Instru Optiikka we have around 140 practicing ophthalmologists and more than 200 optometrists in just over 200 stores, so collaborative care is an everyday thing for us. As optometrists we recommend and send patients to ophthalmologists every day. The transfer of patient data is automatic, and each party knows what the other has done.

Svein Tindlund Clinical Affairs Lead Specsavers Northern Europe

Svein Tindlund: In Specsavers Northern Europe (the Nordics and Netherlands), collaborative care means delegating some of our tasks so our optometrists can free up time to work more with eye health. We focus on offering better and more tailor-made eye care services. This can only happen when we work closely with external ophthalmologists and GPs. We are 100% dependent on having the right clinical IT technology. We use Harmony for both these tracks: delegating from optometrists to assistants and making sure our optometrists get advice from external ophthalmologists.

What are the challenges/barriers to collaborative care at the moment?

Stanga: There are different challenges, depending on the clinical setting; in the UK, for example, we have the independent sector and the NHS (National Health Service). Many of the challenges revolve around ensuring that clinical reports are sent out in a timely fashion and include all the necessary information for the referral to be kept up to date about the path the patient is following and the outcome.

Another common barrier is that it is not possible to directly share the raw imaging data with referrers. We have to spend time selecting and saving the most clinically meaningful single images from optical coherence tomography (OCT) scans; these are usually shared as JPEGs, but the recipient is unable to scroll through the entire series and process the images as desired. Being able to review the full set of OCT scans… within the reviewing software provides a higher level of information compared to single images.

Tyynilä: Finland is a big country with a small population (5.5 m). We have around 450 to 500 ophthalmologists and approximately 1500 optometrists in clinical work. Most eye care professionals (ECPs) work in the bigger towns and cities, and they do not have the right to refer into public hospitals. If we have patients who need urgent treatment, we need to find a doctor to give a referral to the public hospital. These situations are fortunately quite rare. On the other hand, we have ophthalmologists regularly holding appointments in our stores, but this depends on the size of the city or town. In some stores it is every day; in others it is once a week or even once a month.

Tindlund: One barrier is that ECPs work in silos. Unfortunately, ophthalmologists and optometrists do not speak with each other much at organisational and political levels. In Specsavers Northern Europe, however, we have set up great collaborative care models between ophthalmologists, optometrists, opticians, and assistants by focusing on patient needs. The key driver is having the right communication tools and processes that deliver the expected quality focus and control. Sharing clinical data and images is a key part.

Another barrier, unfortunately, is public care. It`s much harder for public eye care services to be creative in finding solutions; their processes seem to be based on ideas and technologies that are out-of-date. We see much more innovation in collaborative care in the private sector. Our growing populations would benefit from a change in this public-private dynamic.

How are technological advancements such as Topcon’s Harmony platform helping to advance collaborative care and improve patient outcomes?

Stanga: Harmony allows us to integrate various imaging modalities into one place. This increases clinical efficiency by ensuring that less time is spent navigating different platforms whilst not losing the benefits of each imaging technology.

Tyynilä: We have more than 100 retinal cameras in our 200 stores, and a few dozen OCTs and perimeters. We store every image to Harmony; they can be viewed in every store. With the help of Harmony and the patient data system, we can share the information all over Finland and ask any ECPs in our stores to help interpret the findings.

Tindlund: We have three key goals in our approach to collaborative care: clinical quality, easy communication, and task shifting. Next is quality, where also safety is a part of the equation. Patient safety is taken care of by worklists that clearly show if a message is sent, received, read, or answered. Harmony is central in achieving all these goals.

At the same time, we need to take care of the high volume of patients needing optical aids, so we delegate more of the optometrists’ work to clinical assistants. This includes capturing objective clinical data including fundus images and OCT. Until quite recently it was common for the optometrist to do this themselves.

Our optometrists evaluate the images and add more clinical data to them, notating the images. This is how things have worked in areas such as radiology for years. When the optometrist needs advice from an ophthalmologist, or to refer the complete case to them, they can send an invitation to an internal or external ophthalmologist. In some markets they can do with other optometrists, depending on how the users are set up in Harmony. This flexibility is highly valuable.

Have you been using Harmony in your practice?

Stanga: Yes, we have been using Harmony for over a year now. We use it as a first-line tool to gather key patient information and to perform the first review of imaging and functional test results. If further in-depth analysis is required, we can launch into the individual imaging or functional testing platforms (i.e., IMAGEnet) to use more advanced features.

Tyynilä: We use Harmony all the time in our stores. Every ECP in store has access to all patient data – with the patient’s permission, of course. When a patient visits any of our practices for an examination, all the images are in one place, together with other patient information. It makes the examinations and reaching conclusions easier and faster. In fact, we do not use the device’s own software at all – Harmony provides what we need to review images and manage patient information efficiently.

Tindlund: We use Harmony in different setups across the Nordics and the Netherlands. In one market we have a hub of remote optometrists supporting store-based opticians. This setup allows us to securely offer fundus images to thousands of patients per year, and it has helped us detect an impressive amount of eye conditions in all stages.

In other markets we have a Second Opinion System (SOS). In this case, the optometrist will send a question to a remote ophthalmologist, either out of curiosity or based on what an image or OCT scan shows. In some markets we have added optometrists to this professional hub, and optometrists can share questions with each other. Response takes a maximum of three days, and all this is tracked in Harmony. Note that we do not use it for emergency cases. The increase in clinical quality our optometrist can deliver using SOS would not have been possible without tools like Harmony. It means that all our optometrists have direct access to ophthalmology competence within a few clicks.

What benefits has Harmony brought to your approach?

Tindlund: The use of Harmony has been a gamechanger for us. Collaborative care simply is not possible without systems like this – it benefits patients, our professionals, and us as a company. Our optometrists value the clinical feedback they get from ophthalmologists, including those supporting us remotely from public hospitals using different PMS systems. Harmony makes this seamless, requiring only a browser and enabling multiple clinicians to review the same files in real time, across organisational boundaries. It also supports our goal of enabling optometrists to focus more on eye health, which is what they are trained for.

Stanga: The ability to visualise various imaging modalities all at once allows us to reach a diagnosis faster, and to even overlay the modalities to provide clinical information in a way that was not possible even a couple of years ago.

Tyynilä: Having all patient data in one place makes it easier to process and ensures that information is readily available. For example, if the optical store uses equipment like a fundus camera, OCT, or visual field analyser, the images can be shared – along with patient information – with an ophthalmologist or optometrist, who can assess the urgency of treatment. The worklist feature also helps us direct specific cases or second opinion requests to the relevant person or group.

Which features of the Harmony platform do you like the most?

Stanga: The ease and speed with which we can share reports, full sets of raw imaging data, and functional test results with referrers by combining various investigative modalities in one place.

Tyynilä: Harmony provides easy data transfer and access to all patient information between appointments when a second opinion or interpretation assistance is needed. All the images are in the same place, and image data from all devices can be easily found in one folder in the patient’s record. It is easy to compare images between new and previous visits, or between two images taken at the same time.

Tindlund: Ease of use and high focus on clinical quality are the two key factors for me. After we installed Harmony in all our northern European stores, we were also able to streamline all internal processes, managing and evaluating clinical images and making sure our assistants and optometrists were familiar with how to do their job, regardless of where they work.

We find the image analysis and modification tools easy and intuitive. Harmony is one of those tools where you do not need to read the user manual, as the symbols and their positions make sense. It is easy to find images that are waiting for evaluation, access the overview of images already evaluated and see which messages are sent, read, and answered.

What opportunities for collaborative care can technological advancements such as Harmony provide in the future?

Stanga: Platforms like Harmony will continue to facilitate greater access to the data collected in clinics in a secure and controlled way, creating seamless communication between referral and examining healthcare providers. When referrers resume care of the patient, they will have access to previously collected patient records, including imaging and functional test results. This will make it easier to decide whether to refer the patient back for further treatment. In addition, Harmony could allow for easier and more comprehensive sharing of information across sites, allowing examining healthcare providers at one site to assist with consultations at another.

Tyynilä: There are high expectations for AI in eyecare – it can speed up interpretation, support diagnosis, and help assess urgency. Devices will become more automated and remotely controlled. By combining AI-driven analysis with patient data, medical history, and anamnesis, we can generate insights that help ECPs draw conclusions more effectively. Much of this could be integrated into Harmony in the future.

Tindlund: Eyecare will see more of what is already happening: more collaborative care. Ultimately, public eyecare will be advanced enough to embrace what digitalisation really means for both patients and the healthcare sector.

For more information on Topcon Healthcare’s Harmony platform, visit https://topconhealthcare.eu/en_EU/products/harmony

Disclaimer:

The patient names and details shown in the Harmony screenshot images are entirely fictional. They are used for illustrative purposes only and do not represent any real individual or personal information. One of the Harmony screenshots portrays a mock-up illustrating how an AI-generated report may appear within the platform. Harmony functions as an integration platform for a range of third-party AI solutions, each of which may vary in report content, format, and functionality. Not all products, services or offers are approved or offered in every market, and products vary from one country to another. Contact your local distributor for country-specific information.