The project was launched in 2009 through a $4.7 million contract with National Institute of Biomedical Imaging and Bioengineering (NIBIB) to build a secure, patient-centric medical imaging sharing network based on common open-standards architecture.RSNA is overseeing development of the Web-based network for sharing images and reports at five pilot academic institutions. Mount Sinai Medical Center in New York was the first to begin accepting patients, with the other institutions to immediately follow. (See Sidebar)"We are letting patients know the network is available and inviting them to sign up if interested," said the project's principal investigator David S. Mendelson, M.D., chief of clinical informatics at Mount Sinai. "The idea of RSNA Image Share is to improve quality, safety and efficiency while engaging patients and families in their own care."RSNA was charged with developing a method for patients to control access to their information through personal health records (PHR) without relying on CDs, Dr. Mendelson said.RSNA Image Share is based on the XDS.I.b profile of Integrating the Healthcare Enterprise (IHE®), an initiative among medical leaders, software developers, societies and vendors to improve communication between healthcare equipment, systems and software. The goal is to move closer to a universal electronic health record (EHR) and help physicians meet federal meaningful use requirements in practice.Although patient participation is voluntary, interest in the network is slowly building, said Dr. Mendelson, who also serves on the RSNA Radiology Informatics Committee (RIC), chairs the RIC subcommittee for IHE and serves on the RIC subcommittee for Structured Reporting."The first patients we enrolled didn't have to share their images right away," Dr. Mendelson said. "But when we described how the system works they said, 'hey, that's neat, I'd like to be able to do that.'"After signing into the network, patients follow a series of steps that tell the Edge Server to retrieve that patient's reports and images. The Edge Server is a device that sits between a radiology department/imaging center's PACS and RIS and the Internet "Cloud." It provides security services and packages the exam for safe and secure distribution over the Internet."There is a 72-hour delay intentionally built into the process to ensure that the patient's doctor sees the results before the patient does, allowing the physician time for a discussion with the patient," Dr. Mendelson said.From a "jacket" of imaging records, patients can select those they would like to share with their healthcare team. "From that point, the patient can actually see the report and read it before sending it anywhere, so if they're concerned about some of the wording they can discuss it with their ordering physician," Dr. Mendelson said.Because security is a major concern, the project was modeled on security systems that are used by banks, in which patients are given an eight-digit code, much like the code on their ATM card, Dr. Mendelson said."Patients create a password or PIN that is known only to them, so it's just like moving your money around at the bank," he said.In coming years, project investigators will work on developing direct transfer of images for immediate accessibility—necessary, for example, if a patient is flown into a trauma center from another facility.
The participation of healthcare equipment and software developers is essential to widespread adoption of image sharing, said Keith J. Dreyer, D.O., Ph.D., vice-chair of radiology informatics at Massachusetts General Hospital in Boston and an associate professor of radiology at Harvard Medical School."RSNA has done a great job of defining the standards for companies to cooperate and move images," said Dr. Dreyer, who serves on the RSNA Radiology Informatics Committee. "The intent of this project was to light a spark among vendors to begin providing data sharing services.""One of the unique things about the project was that the team engaged a variety of vendors in the implementation and the design, and the development of components adhering to standards so that they can all play together nicely," he continued.To further widespread adoption, image sharing systems are now being made available to the public, Dr. Dreyer said."The project has created a green field for vendors who are interested in offering their services in a standardized way to the industry," he said.Dr. Dreyer encourages radiologists to attend the RSNA 2011 IHE Image Sharing Demonstration (see sidebar) featuring systems and vendors used in the network. "Attendees will see the products available that make data sharing easier."
Five academic institutions are hosting the RSNA Image Share network:
The vendors providing PHR accounts to patients participating in the network have agreed to provide sample accounts for demonstration purposes. To preview the patient experience in using an image-enable PHR, go to rsna.org/Image_Share.aspx.
The RSNA 2011 Integrating the Healthcare Enterprise (IHE®) Image Sharing Demonstration shows how images and radiology reports can be made part of a patient's personal health record, available securely via the Internet to the patient and authorized care providers. The demonstration features leading vendors in medical imaging and electronic health records and is based on interoperability specifications from the IHE initiative. To register for RSNA, go to RSNA.org/register.
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