Three years since its launch, the RSNA Image Share project that was designed to help patients take control of their medical images and reports is expanding its reach by deploying systems to new facilities and enrolling patients to use the network.
The Image Share network is in use at five pilot academic institutions and could expand to nearly two dozen additional sites in the coming months, said David S. Mendelson, M.D., a professor of radiology at the Mount Sinai School of Medicine in New York and principal investigator on the Image Share project.
The project was launched through a $4.7 million National Institute of Biomedical Imaging and Bioengineering (NIBIB) contract to build a secure, patient-centric medical image sharing network based on common open-standards architecture. RSNA was charged with developing a system to enable patients to share images with physicians free of the limitations of CDs. Patient participation is voluntary and participating clinicians are spreading the word to their patients.
“We now have just over 2,000 patients enrolled in the program and have been awarded an additional two-year $5.3 million contract from the National Institute of Biomedical Imaging and to extend the number of patients and participating sites,” Dr. Mendelson said. “The contract includes two additional option years, with an additional $5.5 million to move Image Share from a demonstration project to a nationally adopted set of standards.”
While the initial sites in the network—Mount Sinai Medical Center, the Mayo Clinic in Rochester, Minn., the University of Maryland Medical Center in Baltimore, the University of California, San Francisco, and the University of Chicago Medical Center—have been enrolling patients, a growing number of other institutions have been joining the network as well.
“In the coming months, we expect to have more than 25 sites in the network from all across the country,” said Dr. Mendelson, a member of the RSNA Radiology Informatics Committee (RIC) that developed the Image Share concept, chair of the RIC subcommittee for Integrating the Healthcare Enterprise (IHE®), and a member of the RIC subcommittee for Structured Reporting.
New sites include additional large research institutions like Stanford University and the University of California, Davis, and sites such as Advanced Radiology, a multisite radiology provider in Stratford, Conn., Gillette Children’s Specialty Healthcare in St. Paul, Minn, and Texas Children’s Hospital, Houston, where 2012 RSNA president George S. Bisset III, M.D., serves as chief of pediatric radiology and the Edward B. Singleton Professor of Radiology at Baylor College of Medicine, in the Texas Medical Center.
Participating sites install a device called an Edge Server that connects local radiology systems to the network infrastructure. “We have a consultant who’s available to these sites to assist with implementation at no charge,” said Dr. Mendelson, adding that new sites are at varying points in the implementation process.
Sites use the Edge Server to enroll patients in the network. Patients receive a secure password that enables them to retrieve their radiologic images and reports. Patients sign into the network using personal health record (PHR) accounts provided by commercial vendors, currently Dell and lifeIMAGE. They retain secure access to the information and can share it with care providers when needed.
Patients will be surveyed about their experiences with the network, Dr. Mendelson said. “A health policy group here at Mount Sinai has produced a survey that we’ll provide to patients asking them to return it after they have had a chance to really experience the network with multiple providers.”
Beyond its image sharing function, a variety of secondary initiatives are planned for the Edge Server in the second phase of the contract, Dr. Mendelson said. “We want to enable the Edge Server to house radiation dose information that can be used by local dose monitoring applications and to submit to the American College of Radiology’s (ACR) Dose Index Registry as well,” he said.
The Edge Server will also be enhanced to gather and share data for clinical decision support. These data can be used to help sites demonstrate compliance with practice guidelines and to enhance those guidelines through comparative effectiveness research, Dr. Mendelson said.
“We will feed anonymized data back from our Edge Server to organizations such as the ACR to aid their guideline development efforts. This will help to close the loop regarding how ordering patterns reflect best practices,” Dr. Mendelson said.
RSNA also plans to work with vendors and standards bodies including the appropriate DICOM (Digital Imaging and Communications in Medicine) working groups to refine transfer of DICOM data and improve network performance. “The intent is to expedite the adoption of new technologies,” Dr. Mendelson said.
The Image Share network will also foster clinical trial research. The team has incorporated the RSNA MIRC Clinical Trial Processor (CTP) with the Edge Server. “We’re in the process of releasing that as a way of moving around clinical trial data which have been de-identified,” Dr. Mendelson said.
Because the participation of healthcare equipment and software developers is essential to widespread adoption of image sharing, RSNA is inviting vendors of radiology systems to link to the Image Share network by providing the same capabilities offered by the Edge Server.
“We’ll continue to provide our reference model system directly, but increase vendors’ ability to incorporate the capabilities of the Edge Server within their own products,” Dr. Mendelson said.
The computer code behind the Edge Server has been publicly released as open source so that program developers can readily integrate their products with commercial systems. During the IHE Image Sharing Demonstration at RSNA 2012, vendors had the opportunity to test and demonstrate their capability to link their systems to the network.
Expanding the project to as many patients as possible remains the central goal of Image Share, Dr. Mendelson said.
“We’re grateful to NIBIB for recognizing the importance of healthcare interoperability and for sponsoring development of a solution for image sharing,” Dr. Mendelson said. “Our primary focus is on patient engagement. We hope this leads to a standards-based, national infrastructure that makes this kind of service easily available at a very reasonable cost to any patient, anywhere, anytime.”
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