Health information exchanges are expanding into new states and regions, delivering fast access to patient health information. But image exchange is all over the map. Some HIEs are exchanging images via cloud systems and viewers; others are looking for a business case and more seamless ways of exchange.
One HIE that is getting the picture is the Rochester RHIO, which was founded in 2006 and now serves 10 counties in the Finger Lakes region of New York. The RHIO includes 15 hospitals, three regional reference labs and many radiology providers and serves 1.2 million patients.
Axolotl provides the RHIO’s HIE services to members who use a variety of imaging vendors and PACS (Carestream, Fuji, GE/IDX and others), says Ted Kremer, MPH, executive director of the Rochester RHIO. When a radiology report is sent to the HIE, a web service call performs a DICOM fetch from each of the connected PACS, stores it on a separate image edge server and keeps that information on disk for 30 days, Kremer says.
“When someone calls up a radiology report through our HIE services, there’s an embedded link to the image, again using a service-oriented approach. They click on that link, it pops up a PACS-independent viewer that we provide, and provides diagnostic quality viewing,” says Kremer. “Of course, the better the monitor, the better the viewing.”
The service, which has been in place since July 2009, is available to all Rochester RHIO participants, who must download the PACS-independent viewer onto their PC to see images, he adds. With regard to Health Information Portability Accountability Act (HIPAA) compliance, “any covered entity that wants to look at a radiology image would first have to go into a community portal and note that they have patient consent, then with that consent, they can look at reports and images,” says Kremer.
Patients and doctors appreciate this service, he says. “As much as sometimes RHIOs will say, ‘how often is it used?,’ it’s the one service patients have actually credited with saving lives.” Patients also value image exchange as a timesaver, because they can more easily access and present images to their primary care physicians.
Image exchange also brought radiology providers to the table: “We now have 23 different radiology data sources connected to the RHIO and about half of them are image-enabled,” Kremer says.
|Profiles of Exchange|
|Images can be exchanged within an HIE in a variety of ways, says David S. Mendelson, MD, chief of clinical informatics, at The Mount Sinai Medical Center in New York City.
“You can use the internet to provide a fairly elegant solution today to move just about any kind of data, and that includes radiology images. The catch is that today vendors use proprietary solutions: Only people who have purchased a specific solution can share images,” says Mendelson, a member of the RSNA Radiology Informatics Committee, and representative to Integrating the Healthcare Enterprise (IHE) and co-chair of IHE International.
Mendelson is principle investigator for a National Institute of Biomedical Imaging and Bioengineering-National Institutes of Health (NIH) grant to set up a framework for open source image exchange through RSNA using IHE profiles.
The IHE’s XDS-I.b (cross-document enterprise sharing-images) profile provides for non-proprietary image sharing. XDS-I.a, designed for RHIO and HIE use several years ago, takes images’ large storage requirements and large bandwidth criteria and requisites into account, but the internet has moved on. Now, “we’re trying to bootstrap the XDS-I.b profile to reflect more modern internet standards” and solutions, such as web services, he says.
IHE.net describes a document source and document consumer, such as two separate hospitals. Between them is a middle layer that represents transactions that occur in the cloud to exchange images. “We’re trying to [modify] that platform to allow patients to place their images and their reports into PHRs,” says Mendelson. “From there the patient has complete control of the exchange and sharing of their images and reports. This potentially is a significant addition to the alternatives with regard to image sharing; thus beyond the conventional notion of [HIEs] between hospitals and doctors.”
RSNA hopes to demonstrate a prototype at RSNA 2010, says Mendelson.
Each image provider ends up having a small edge server where images are kept. The issue of image storage also presents a business opportunity: “We can