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Image Sharing

There is public interest!. Image Sharing. David S. Mendelson, M.D. Professor of Radiology Senior Associate - Clinical Informatics The Mount Sinai Medical Center Co-chair IHE International Board. Image Sharing Use Cases. Presume Patient Consent, Report and/or Images.

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Image Sharing

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  1. There is public interest! Image Sharing David S. Mendelson, M.D. Professor of Radiology Senior Associate - Clinical Informatics The Mount Sinai Medical Center Co-chair IHE International Board

  2. Image Sharing Use Cases Presume Patient Consent, Report and/or Images • Enterprise to Enterprise (Radiology or EMR) • Radiology to Clinician • Radiology to Patient • Patient to Clinician • Patient to Enterprise • Radiologist to Radiologist • Clinician to Clinician/Radiologist • Image originated from a Radiology office • Image originated with Clinician • Legacy vs. Digital (DICOM) • Research/ Regulatory

  3. Standards • DICOM • HL7 • Direct • IHE XD* family • XDS • XDS-I • XDR • XDM XDS XDS-I

  4. NHIN Direct-applicable IHE Profiles • SOAP-based Web Services and detailed metadata • XDR-Cross-Enterprise Document Reliable Interchange • - direct push model from sender to receiver using Web Services transport • Document sharing in the absence of a registry and repository • XDM - Cross-enterprise Document Media Interchange • direct push model of packaged content • Option – transport via SMTP

  5. NIBIB/RSNA Image Sharing Project A Standards Based Solution 2009-2012 2012-2016 • Consumer controls the flow of information –Patient Engagement • Simplifies Consent • Diminishes the need for BAAs between enterprises • Imaging Site to Clearinghouse • Clearinghouse to PHR • Bootstrap an IHE based network • IHE generally has not focused on consumer driven solutions but rather on institutional and enterprise workflow • Primary emphasis is Consumer Control through PHRs • Can be extended to other forms of sharing • HIE • Security and Confidentiality are drivers • Replacement / Alternative to CD • 5 Academic Institutions • Develop a solution for all Radiology Sites • Establish a clearinghouse • Engage PHRs- Image Enable • Potential for untethered full longitudinal record

  6. Image Sharing/Elements of Solution • Edge Server • Register a patient • Listens to a Radiology Information System (RIS)- looking for a complete exam • Retrieves Image set from PACS and Report from RIS • Send both to clearinghouse • PHI hidden; an RSNA ID and 2nd factor security token are used to identify the patient • Clearinghouse (XDS-I) – functions as a secure router • Transiently hold encrypted patient data • PHR • Consumer controls upload and future access • Must have RSNA ID available and know answer to 2nd factor question • Develop web based viewers • Download full DICOM data set • Misc Consumers

  7. Advantages of Approach • Push model • No Query of PACS from outside the firewall • Full DICOM data set is available • Web viewers • Download and Import to PACS • Report is available • Historical exams can be sent simultaneously • Consumer controls flow of information • Affords the patient the ability to select what information to share • Is this good?

  8. RSNA Image Share- Initial Patient experience • Patients enrolled (4 sites) in production environment- 3900 • 20 months • June 16, 2013 • Includes some test data • Approximately 1/3 have closed the loop and used the PHR • 3 Community sites live as of May 2013

  9. Patient Responses • Love it! • Its about time • This is great • My doctor was really pleased to have access to my images • Problems • Couldn’t access my images • Got my images- but difficult • My doctor couldn’t see my images

  10. RSNA Image Share Development • Version 3.0 • Vendor implementation • Incorporates Clinical trials • RSNA CTP • Version 3.1 • E-mail address as logon ID as an alternative to 8 digit code • Password- minimum 8 characters; no other limitations • Flexible send time • In testing • Expected Release – late summer • Future • Refine user interface • Dose • Quality Metrics

  11. Next steps - New NIBIB (NIH) contract • Expansion of Network • Vendor Adoption of Edge Server (Open Source) • Vendor migration to XDS for all services • Connect 2+ independent networks • Alabama-CAHIE consortium to RSNA • EMR integration • DICOM evolution • Restful services • Separation of Metadata from pixel data • Enables discovery • Viewer • Convergence of • Patient Engagement model-PHR • HIE • Provider to Provider • NHIN Direct • XDR • XDM

  12. Resources • ImageShare@RSNA.org • http://www.rsna.org/Image_Share.aspx

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