HIMSS: Is the end of the CD era approaching?
LAS VEGAS—Image-enabled personal health records (PHRs), the cornerstone of an IHE-based image sharing network, have leveraged the cross-enterprise document sharing (XDS) profile to engage consumers, David S. Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center in New York City, said during a Feb. 22 session at the 2012 Healthcare Information and Management Systems Society (HIMSS) conference. The PHR model mimics (and could augment) the CD-based image exchange model.

The use case for sharing radiology images and reports is straightforward, according to Mendelson, who detailed the following advantages to image sharing:
  • Availability of historical exams;
  • Partial containment of rapidly growing imaging costs and prevention of duplicate exams;
  • Reduced radiation exposure; and
  • Improved quality by accelerated clinical care.

The product of radiology is in information, which is found in the imaging exam, order, report and images; and the constituents have expanded to include the patient, radiologist(s), physician, consulting physician and clinical trials.

CDs have not solved the challenges of film-based image sharing. “CDs are better than film, but remain a fairly chaotic means of sharing imaging data,” Mendelson said. Problems stem from different data and viewer formats, defective disks, patient identity management and disk handling.

According to Mendelson, the Mayo Clinic in Rochester, Minn., has estimated that 0.6 percent of disks are unreadable and wrong patient data are found on 0.2 percent of CDs. At Mount Sinai, 5 percent of disks cannot be imported.

As a partial workaround to these issues, Mount Sinai has established a standard viewing environment and imports disk into PACS. Standards are essential, said Mendelson, adding that IHE includes standard portable documents for imaging and basic image viewers.

Multiple new solutions to the challenges of CDs have been touted, including internet-based sharing, virtual private networks and health information exchange (HIEs). However, each is associated with challenges, including security, costs and financial sustainability.

One of the more recent arrows in the quiver is the Radiological Society of North America (RSNA) image share network. The project was launched in 2009 through a $4.7 million contract with the National Institute of Biomedical Imaging and Bioengineering to build a secure, patient-centric medical image sharing network based on common open-standards architecture that would enable patients to control access to their information through PHRs without relying on CDs.

Five institutions partnered on the grant. Mount Sinai, University of California, San Francisco, University of Maryland Medical Center in Baltimore and Mayo Clinic in Rochester, Minn., have enrolled patients. University of Chicago Medical Center will go live in the next few months.

The network mirrors the ATM model, which eliminates consent and privacy issues, Mendelson said. An edge server registers the patient and links to RIS for the finalized report and packages the report with images from the PACS. The data are sent to a clearinghouse, which establishes a repository for the patient. The dataset can be loaded into a PHR. This mimics what the CD can do, said Mendelson.

To date, about 500 patients have moved images into PACS. Additional funding will expand the model to local sites.

However, the demise of CD is unlikely to occur soon. “We live in a heterogeneous world needing multiple solutions,” Mendelson said. The ongoing system is likely a mixed model that includes CDs, HIEs and PHRs.