In an era of widespread deployment of PACS, moving images and reports from one facility to another remains a challenge. David Mendelson, M.D., chief of clinical informatics at New York-based Mt. Sinai Medical Center, described at HIMSS12 how the personal health record could be a solution to the problem.

In the current environment, patients often tote copies of their radiology images and adjoining reports on CDs, he noted. But oftentimes, CDs are written to proprietary viewing formats and difficult to open at the receiving institution. Increasingly, patients are seeking second opinions from other radiologists about their images, he notes, adding that at Mt. Sinai, nearly 5 percent of CDs brought in by patients cannot be opened.

Mendelson describes a project undertaken by the Radiological Society of North American to develop an agnostic network, in which images and reports could be easily downloaded to a patient-controlled PHR. Five organizations participating in the project, RSNA Image Share, received $4.7 million in grant funding from the federal government to launch the effort, which is now in the early stages of operations and has about 500 patients enrolled. Other participants include Mayo Clinic, University of Chicago Health System, the University of California San Francisco, and the University of Maryland. Last August, the production system for the project went live.

In the set-up, a patient registers for an account under a participating provider. The Image Share operates an edge server, which scans the local hospital’s radiology information system, looking for recent studies for that patient. It does a DICOM query, based on the patient’s credentials, and once it finds a study, it will encrypt it and send it to a central clearinghouse residing on another secure server. Later, using a PHR tied to the system, the patient can retrieve their study and images, using an associated viewer embedded in the PHR. The patient can also grant access to their account to other specialists with whom they would like to share the reports or images. Four of the five project sites are now live, with the fifth about to go live, Mendelson says.

Mendelson acknowledges that using the PHR as the central vehicle for sharing radiology reports would not be a cure-all for the multiple issues involved in sharing patient data outside the boundaries of one organization. But the set-up manages to sidestep some of the difficulties inherent in using CDs. And health information exchanges are usually not prepared to disseminate actual images, he added. “People thought the CD was going to be the cure-all for transporting film, but now physicians have these CDs flying everywhere,” he says.

The RSNA exchange is built partly on standards from IHE, the organization’s joint effort with HIMSS to create workable data standards. The XDS standard enables sharing of documents across disparate provider settings, and includes a sub-set standard that facilitates sharing of actual images. The XDS-I standard, for images, creates a manifest of images related to a given patient, and shows their location in the originating PACs.

In the next phase, the Image Exchange will expand to 28 organizations, with the founding members building out connections in their area. The project is working with four PHR companies, which Mendelson did not identify. One business model being discussed is to charge patients a monthly maintenance fee to participate. “If you can move movies around on the Internet, you can use this,” he says.


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