The Trouble with Image-Sharing

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In the nationwide, government-backed push to improve access to healthcare data, one problem persists—how best to share massive radiology imaging files. Existing solutions aren’t perfect, which is why researchers are looking for simpler and more cost-efficient ways to share images.

CDs are cheap—but you get what you pay for. Hidden costs can include loss of productivity as physicians or staff struggle to open files that may or may not work on their system and can cause rifts with patients who don’t understand why providers can’t “talk” to each other.

“We’re doing in-depth surveys,” says Jeffrey Carr, MD, part of a research team at Wake Forest University in Winston-Salem, NC, that’s investigating alternative image-sharing technologies. “And our initial results are that people universally hate CDs for transferring data.”

Health information exchanges are poised to play a big role in data sharing, but large image files require substantial archive and network infrastructure that most HIEs, especially rural and underserved communities, just don’t have, says Carr, who is director of biomedical informatics and professor of radiology at Wake Forest.

The possible fixes

A number of organizations are investigating alternatives to the current image-sharing models, including Wake Forest, the University of Alabama at Birmingham, and the Radiological Society of North America. Those three groups, using federal grant money directed to RSNA, are creating different types of products using the same foundation—the IHE Cross-enterprise Document Sharing for Imaging (XDS-I) profile.

“This, we hope, will ultimately facilitate linking these and other image-sharing pilot projects after they are deployed,” says Christopher Carr, director of informatics at RSNA.

And they’re all working toward the same goal: a technology that will enable patient-controlled medical image sharing. “Patient involvement will facilitate much easier solutions,” says Yaorong Ge, PhD, an assistant professor in the department of biomedical engineering and part of the Wake Forest research team.

Although the platform and goal are the same, the models differ. The RSNA project relies on personal health record accounts from commercial providers to give patients access to their imaging data, for example. The Wake Forest technology uses a token system and walk-up kiosks with card readers at participating organizations. Patients enter a unique identifier, such as a personal identification number; swipe any card with a magnetic strip, such as a personal credit card; and answer a few questions to authorize image transfer—much like the system at an airport check-in kiosk or an ATM.

Once the patient has granted the organization permission to send or receive images, the data would be delivered electronically using the Digital Imaging and Communications in Medicine (DICOM) format to any brand of picture-archiving system. There’s no software to download or external server to log on to. Aided by the PCARE platform, the images are transferred directly from one organization’s server to another’s through a secure channel.

The researchers haven’t quite worked out the bugs yet. “You have to really make it easy and address all the concerns from the providers and the patients in order for it to be adopted,” says Ge. 


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