“With the RHIO, he could have logged in, and I could have had him look at those images,” Thompson says.
A wide range of local healthcare facilities in upstate New York, including 19 hospitals and imaging providers, submit about 130,000 medical images to the RHIO's image exchange each month.
“We can get that report immediately, and now we can actually look at the films and compare them,” Thompson says. “It's so important in medicine to be able to look at the patient today and say: 'While I see this, was that abnormality there before?' Now you can have a comparison.”
How quickly medical images can be shared is an issue facing physicians across the country even as federal funding has been made available to establish medical image networks that would allow providers to share images across hospital systems, geographic regions and competing picture archiving communication systems, or PACS.
While more hospitals have moved toward digital imaging, the most common method of exchanging medical images is still to provide patients with a CD of their images, according to a spokeswoman for the Radiological Society of North America.
The practice of sharing images on CDs can lead to duplicate scans, which means higher costs and more patient exposure to radiation. More scans are often necessary when a CD is lost, can't be accessed or providers have difficulty sharing images between PACS.
A study conducted by Chilmark Research in the fourth quarter of 2011 and funded by LifeImage, a provider of medical image-sharing technology, found that only 43% of healthcare providers are using the technology (See chart, below).
“What we're going to need to have in the next few years is really comprehensive access to information,” says Dr. Harry Greenspun, senior adviser for healthcare transformation and technology at the Deloitte Center for Health Solutions. “You don't want to be going from one system to another system to get a view of the patient. We're ultimately going to have to fold all these things in together or at least have them work together in a way that's seamless to both providers and to consumers.”
Several types of medical image-sharing models have emerged, some of which are patient-centric and others that focus on provider-to-provider exchanges.
Three years ago, the RSNA received $4.7 million from the National Institute of Biomedical Imaging and Bioengineering, or NIBIB, which is part of the National Institutes of Health, to establish the RSNA Image Share, a patient-focused network that allows radiologists to share medical images with patients.
At the state level, Maine and Indiana have announced plans to incorporate image sharing into their health information exchanges. In addition, a number of geographically based image-sharing networks have also been established, such as the Rochester RHIO, which has been awarded $22.3 million in grants from the Health Care Efficiency and Affordability Law for New Yorkers. The 2004 law aims to implement health information technology infrastructure in an effort to improve the quality of care.
“The real goal here is to get all the vendors off their proprietary solution and using some basic standards so that everybody can play nicely together, at a reasonable cost,” says Dr. David Mendelson, chief of clinical informatics at the 1,029-bed Mount Sinai Medical Center in New York.
Mendelson also serves on the RSNA's radiology informatics committee and is the principal investigator for the RSNA Image Share network.
Five academic medical centers—Mount Sinai; Mayo Clinic in Rochester, Minn.; UCSF Medical Center in San Francisco; the University of Maryland Medical Center in Baltimore; and the University of Chicago Medical Center—are participating in the network, which began enrolling patients in 2011. About 2,100 patients are currently enrolled in Image Share.
“The goal is to reduce redundant imaging,” Mendelson says. “A lot of times patients are in a sub-acute setting and they are going doctor to doctor. We think payers will be interested in the long run if we can develop preliminary data.”
Patients who participate in Image Share use a password or PIN to access their account and can then choose which images to share with their physicians.
Some studies have suggested the benefits of patient-focused image-sharing networks. In a study presented at the Society for Imaging Informatics in Medicine's annual meeting in June, the authors concluded that making the patient an active participant in image sharing is good for the radiologist as well as the imaging enterprise.
“If widely implemented, such programs could reduce the number of lost and unnecessarily duplicated studies, allow patients to keep a more consistent and coherent record of their imaging experience, and provide studies more reliably to referring physicians,” the authors wrote.
Another study, published in August in the Journal of American Medical Informatics Association, found that a patient-controlled access-key registry allows unaffiliated healthcare facilities to share information and protect patient privacy with “minimal burden on patients, providers and infrastructure.”
The Image Share network received its second round of funding from NIBIB in September. The two-year, $5.3 million contract has two additional option years that can provide an additional $5.5 million to the network, with a goal to move Image Share from a demonstration project to a nationally adopted set of standards.
At this time, providers need to be invited to participate. However, Image Share is beginning to work on ways to enroll providers that have inquired about participation, Mendelson says.
He says Image Share has committed to expand to 100 provider sites, including an initiative to target 22 sites in Philadelphia in an effort to “saturate one geographic community.”
Future funding will likely need to come from the network's users, Mendelson says. Vendors may charge radiology departments a small fee, such as $5 or less per image, or patients may pay between $10 to $25 annually to access their images.
“Our long-term goal is to make the whole nation use this network as a place to be if you want to share images,” Mendelson says. “The same infrastructure can be used for traditional health information exchange.”
When HealthInfoNet, Maine's health information exchange, announced plans in May to pilot the first statewide medical image archive in the nation, it said providers could save up to $6 million over a seven-year period through reduced storage and transport costs.
“This would reduce duplicate image studies, supporting accountable care organizations and their efforts to keep costs lower while improving healthcare outcomes,” says Todd Rogow, HealthInfoNet's director of information technology.
Healthcare providers participating in the image archive—at the most recent count, there are 29 hospitals and about 300 primary-care providers—generate about 1.4 million medical images each year, according to HealthInfoNet.
The goal is to allow the archive to integrate with existing PACS and the health information exchange.
David Silsbee, chief information officer for Cary Medical Center in Caribou, Maine, says that many of the 40-bed hospital's patients travel to tertiary centers in Bangor or Portland for care, and almost all of those patients have medical images that are relevant to those referrals.
“Radiologists place a very high value on being able to see prior studies that have been done on patients,” he says. “Up until recently, we've really been, as all hospitals have been, restricted to viewing on our own archive of relevant studies. The prospect of being able to see relevant studies from other facilities that these patients have visited is enormously attractive to our radiologists.”
It's a sentiment echoed by Dr. Irene Djuanda, a hospitalist at Cary Medical Center. She said the archive will likely improve the time it takes to track down and secure an image from another facility.
However, one challenge is that some patients choose not to participate in HealthInfoNet, which requires patient consent for participation.
“It's only helpful if they use it,” she says.
Certain challenges remain, including other IT-related projects that take precedent.
“Meaningful use is a huge one, but there are several others related to our EMR advancement,” Silsbee says. “It is very difficult to allocate the time and resources, but this is a project that immediately got senior management support once it was presented.”
Stage 2 meaningful-use requirements, finalized in September, mandate that more than 10% of imaging results are accessible through certified electronic health-record technology.
Cary Medical Center is expected to save thousands of dollars a year by using the image-sharing network. Silsbee says the hospital will continue to use a local PACS, but the archive will allow it to reduce its investment in long-term storage of medical images.
“It clearly is going to improve the diagnostic capabilities of our providers and reduce costs,” he adds. “There's just no doubt as these patients pass back and forth from one facility to another that duplicate studies are performed because of the lack of access to these studies throughout the state. I think that happens on a daily basis.”
Also in May, the Indiana Health Information Exchange launched ImageZone, a cloud-based platform that allows the state's physicians and hospitals to share medical images. According to a news release issued by the IHIE and its vendor partners, providers can use ImageZone to share images digitally from any PC or mobile device with an Internet connection.
Gundersen Lutheran in La Crosse, Wis., has partnered with other local hospitals to create a regional image-sharing network, says Andrew Johnson, supervisor of radiology information systems for the 261-bed hospital.
Seven hospitals, which are in a 90- to 100-mile radius of Gundersen Lutheran, use PACS storage contracts to share access with each hospital's image archive. Johnson says that about 100 studies come in each weekday from outside facilities or patient referrals. On a weekly basis, only five to six studies now come in from CDs.
“ER physicians … are very cognizant that these images are electronically available at all times for them,” he says.
While health information exchanges have had success sharing and accessing clinical information, imaging is unique in that the files take up more space than lab reports.
The 1.8 million medical images that Maine healthcare providers generate each year total more than 45 terabytes of data. One terabyte of data typically holds between 20,000 and 30,000 radiology studies, many of which have several images per study, Rogow says.
A task force convened by the Federal Communications Commission on mobile health, or mHealth, released a report in September that recommended the FCC make available more licensed spectrum for mobile broadband, in part to ensure reliable broadband connectivity for radiological imaging, as well as live video, remote monitoring and other medical applications.
The task force also said the national IT infrastructure should seek to accommodate medical image transmission in an effort to make healthcare delivery more timely and reliable. The report noted that using disks to transmit medical images is a “barrier to efficient and effective care.”
“Unlike a lot of health information exchange, it's not just dependent on standards and making sure your system reads someone else's images,” Deloitte's Greenspun says. “It has technical requirements that go beyond the regular exchange of health information.”TAKEAWAY:
As medical image-sharing networks become more widely adopted, hospitals should evaluate the benefits
of participating in patient-centric or provider-to-provider networks.