When computer pioneer Commodore launched its PET series of home computers in 1977, the original model shipped with a paltry 4 kilobytes of random-access memory and an operating system written in Basic.
As a pebble cast in a pond, in a sense, the first waves of the Philadelphia Health Information Exchange began there.
Monday, the exchange was given a $1.7 million grant from the National Cancer Institute to expand and carry out research on the clinical impact of a system that now connects the picture archiving (PACS) and radiology information (RIS) systems of four Philadelphia hospitals containing more than 140 million images.
"The idea for a cross-enterprise sharing of data came to me when I was doing work at the University of Pennsylvania where they had a RIS and a PACS," said Elliot Menschik, M.D., founder and chief executive officer of Hx Technologies of Philadelphia, a technology company whose software provides the connective tissue for exchange.
Menschik said he started writing computer programs for games at age 8 on a Commodore PET, which used a cassette tape to store them. He went on to earn combined bachelor's and master's degrees in electrical engineering from Johns Hopkins University, then received a doctorate in neuroscience and a degree in medicine from the University of Pennsylvania in 2000. Menschik also taught bioengineering as a member of Penn's faculty before founding his company in late 2000.
"About five years ago, it seemed the next step was cross-platform integration," Menschik said. "That had to happen in healthcare. There was very little activity in that space, but it seemed somebody had to start doing something. I ultimately settled on imaging as the ideal place to start."
National Cancer Institute spokeswoman Jennifer Thompson said the grant was approved March 28 and will be issued in two parts, with about $960,000 allocated for the first year and another $750,000 "for future cost support."
The exchange currently involves three hospitals in the University of Pennsylvania Health System -- the Hospital of the University of Pennsylvania, Presbyterian Medical Center and Pennsylvania Hospital -- as well as Children's Hospital of Philadelphia, and affords access to more than 140 million images.
According to Alberto Goldszal, director of medical informatics in the department of radiology at the University of Pennsylvania Health System, the system has had a RIS since 1987 and a PACS since 1998 and all three of its hospitals were interconnected before the exchange project was launched. In a pilot with the exchange that began about 18 months ago, UPHS can push images from its PACS and reports from its RIS in a one-way stream to Children's Hospital of Pennsylvania.
"With that avenue, we were able to test the feasibility and the clinical adoption," Goldszal said. "We believe the major communication, security and handshake issues have been tested between us and Children's Hospital."
Now the goal is to expand the network to bi-directional collaboration with other hospitals in the region, and bring in other IT systems, such as labs and electronic medical records, Goldszal said.
"Finally, we're adequately funded to do that," he said. "It is certainly part of our vision to extend it beyond radiology into other clinical areas. Radiology has been the first, because it has been the first inside hospitals, which have had PACS and RIS for some time. We hope that that will be exactly the case.
"It won't be a stand-alone thing, but it will be fully integrated on a regional or a state-wide effort. It's very optimistic, but I think it's a win-win approach."
Menschik said the model is to keep the data at the individual sites on their own PACS and RIS.
"The exchange facilitates the transfer of information through software that uses existing data such as name, date of birth and sex in each member hospital's PACS and RIS to create a central index of whose information is where."
The data is weighted and identifies the records that are likely to match those of the patient queried," he said. "All of the possibilities are offered to the clinicians, but the most likely matches are listed first."
Although for now the exchange is limited to imaging and related information, Menschik sees it as the foundation for a regional health information organization, or RHIO, a concept touted by David Brailer, M.D., the national coordinator for health information technology at HHS.
Menschik said the grant also will be used to bring the Philadelphia exchange into full compatibility with integration profiles developed by an Oak Brook, Ill.-based coalition of healthcare organizations with IT interests called Integrating the Healthcare Enterprise.
Finally, Menschik said the exchange will use grant funds to develop a research program to determine the clinical impact of improved connectivity of images and related reports. Study design is a work in progress, he said.
"We are going to develop it as we launch this new phase," he said. "We haven't identified the ideal candidates and the ideal clinical settings."
