RSNA: Putting patients in charge of image sharing makes for better care
CHICAGO–Patients at three major medical institutions can control the sharing of their medical images and reports with their physicians and medical providers through the use of the RSNA Image Share network, demonstrated Nov. 29 at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA). By facilitating access to imaging exams for patients and physicians, the network potentially reduces unnecessary examinations, minimizes patient radiation exposure and enables better informed medical decisions.

“The RSNA Image Share network can improve quality, safety and efficiency while engaging patients and families in their own care,” said the project’s principal investigator, David S. Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center in New York City and member of the RSNA Radiology Informatics Committee. “Our patients have begun successfully using the network to access and distribute their medical images.”

Mendelson estimated that approximately 20 percent of imaging studies in the U.S. are inappropriate and noted that unavailable images or reports is one of the primary causes of unnecessary repeat imaging.

The project was launched in 2009 through a $4.7 million contract with the National Institute of Biomedical Imaging and Bioengineering (NIBIB) 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 personal health records (PHRs) without relying on CDs.

The project is driven by two principles, said Mendelson. Consumers (patients) control images, as the committee realized that patients may be the best way to distribute images. And it is based on standards, specifically Integrating the Healthcare Enterprise (IHE).

RSNA is overseeing development of the internet-based network for sharing images and reports at five pilot institutions. Mount Sinai was the first to begin accepting patients. The University of California – San Francisco and University of Maryland Medical Center in Baltimore have also enrolled patients. Mayo Clinic in Rochester, Minn., and the University of Chicago Medical Center will enroll patients soon.

Mendelson and colleagues aim to enroll 300,000 patients in the next two years.

Participating sites also educate patients on establishing PHR accounts with selected providers that will enable patients to retrieve, view, archive and share medical images, reports and other medical documents, creating a detailed medical history accessible through any secure internet connection.

To ensure patient privacy, the project is modeled on the type of security systems used by banks. Patients are given an eight-digit code and then create a password or PIN known only to them.

After signing into the network, patients follow a series of steps that tell a component of the system, the Edge Server, to retrieve their reports and images. From a “jacket” of imaging records, patients can select those they would like to share with their healthcare team.

“By default, there is a 72-hour delay built into the process to ensure that the patient’s physician sees new imaging results before the patient does, enabling the doctor to be prepared to have a discussion with the patient,” Mendelson 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.

Initial funding can cover 28 Edge Servers, so the program may move beyond the five pilot sites. However, Mendelson has a grander vision, hoping to use the project as a model for vendors and bootstrap additional, similar programs.

RSNA Image Share is based upon the XDS.I.b profile of IHE. The goal is to move closer to a universal EHR and help physicians meet federal meaningful use requirements in practice.