RSNA: Department mindset must keep pace with image sharing tech
CHICAGO—As network and internet-based image sharing strategies begin to overtake physical media such as CDs, care providers need a different mindset when it comes to image communication, according to a presentation on Nov. 27 at the 97th annual scientific meeting of the Radiological Society of North America (RSNA).

David S. Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center in New York City, explained that with new image sharing technologies come new challenges and new considerations for radiologists.

“Make no mistake, it’s a new era where patients want access to their information,” said Mendelson. “Patients today are educated consumers and they want to understand, or at least many of them want to understand, what’s been done to them, what are the implications and the result, and some of them may want to even look at their own images.”

Part of the new considerations that must be made by radiology departments is who the image consumers will be. Rather than simply delivering an exam to a referring physician, images need to be communicated efficiently to consulting physicians, researchers performing clinical trials, the patients themselves and, in some cases, to other radiologists for a second opinion.

Increasing communication efficiency while maintaining security, confidentiality and HIPAA compliance has always been the driving force in the image sharing discussion, but with each new technology, there are new challenges. For example, when CDs replaced film as the dominant sharing method, there was a lack of conformance to standards, files were not in DICOM format, images were not readable on different viewers and there were issues with discs that were defective or incorrectly labeled, said Mendelson.

In fact, these errors caused so much confusion among clinicians that the American Medical Association issued a formal complaint to the RSNA. “It really wasn’t the RSNA’s fault, but that’s our responsibility as radiologists,” said Mendelson. “We’re going to take the blame when radiology services are seen as troublesome.”

Mendelson pointed out that even the Mayo Clinic in Rochester, Minn., which made reducing these errors a focus, was shown to have unreadable disc errors 0.6 percent of the time and incorrect disc errors 0.2 percent of the time, which is not insignificant considering the large number of referrals Mayo receives. Mendelson’s own organization, Mount Sinai, estimates that 5 percent of its own images have some sort of format issues.

New image sharing techniques also have their challenges. Sustainability is a problem for health information exchanges, as are image integration and bandwidth issues. Point-to-point networks work for partnerships of two organizations, but don’t scale up very well.

The patient-centric personal health record, in which patients can download, view and distribute their own images, is another newer strategy. Mendelson compared this to the banking model with the radiology site acting as the bank and access points for patients acting as ATMs. Patients use a password and pin number to access the information and share it with their provider.

The problem with this model is that some patients may not want to be that involved in the process. There is also the issue of financing these new systems. However, Mendelson said payors may be willing to contribute if they see it will eventually reduce costs. Controlling costs underlies much of the image sharing discussion as better communication can reduce the number of unnecessary exams.

“There are some estimates that inappropriate utilization, which covers a gamut of things, may be as high as 20 percent of imaging that’s done in this country,” said Mendelson. “Now, if that statement is even close to true, inappropriate utilization is a very expensive part of the healthcare system and as a professional organization, as a profession, we should be doing everything we can to really bring ourselves back to using imaging when it’s appropriate.”