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Enhancing Image Sharing in Healthcare: Insights from David S. Mendelson, M.D.

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Discover the transformative impact of image sharing in healthcare as discussed by Dr. David S. Mendelson, a key figure in radiology and clinical informatics. This presentation delves into use cases that presuppose patient consent, including various sharing models between hospitals, clinicians, and patients. Dr. Mendelson emphasizes the consumer control over information flow and the simplification of consent processes. The session covers advanced solutions like the RSNA Image Share Project, discussing patient engagement, privacy, and the evolution of digital imaging systems.

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Enhancing Image Sharing in Healthcare: Insights from David S. Mendelson, M.D.

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Presentation Transcript

  1. There is public interest! Image Sharing David S. Mendelson, M.D. Professor of Radiology Senior Associate - Clinical Informatics The Mount Sinai Medical Center Co-chair IHE International Board

  2. Image Sharing Use Cases Presume Patient Consent, Report and/or Images • Enterprise to Enterprise (Radiology or EMR) • Radiology to Clinician • Radiology to Patient • Patient to Clinician • Patient to Enterprise • Radiologist to Radiologist • Clinician to Clinician/Radiologist • Image originated from a Radiology office • Image originated with Clinician • Legacy vs. Digital (DICOM) • Research/ Regulatory

  3. Standards • DICOM • HL7 • Direct • IHE XD* family • XDS • XDS-I • XDR • XDM XDS XDS-I

  4. NHIN Direct-applicable IHE Profiles • SOAP-based Web Services and detailed metadata • XDR-Cross-Enterprise Document Reliable Interchange • - direct push model from sender to receiver using Web Services transport • Document sharing in the absence of a registry and repository • XDM - Cross-enterprise Document Media Interchange • direct push model of packaged content • Option – transport via SMTP

  5. NIBIB/RSNA Image Sharing Project A Standards Based Solution 2009-2012 2012-2016 • Consumer controls the flow of information –Patient Engagement • Simplifies Consent • Diminishes the need for BAAs between enterprises • Imaging Site to Clearinghouse • Clearinghouse to PHR • Bootstrap an IHE based network • IHE generally has not focused on consumer driven solutions but rather on institutional and enterprise workflow • Primary emphasis is Consumer Control through PHRs • Can be extended to other forms of sharing • HIE • Security and Confidentiality are drivers • Replacement / Alternative to CD • 5 Academic Institutions • Develop a solution for all Radiology Sites • Establish a clearinghouse • Engage PHRs- Image Enable • Potential for untethered full longitudinal record

  6. Image Sharing/Elements of Solution • Edge Server • Register a patient • Listens to a Radiology Information System (RIS)- looking for a complete exam • Retrieves Image set from PACS and Report from RIS • Send both to clearinghouse • PHI hidden; an RSNA ID and 2nd factor security token are used to identify the patient • Clearinghouse (XDS-I) – functions as a secure router • Transiently hold encrypted patient data • PHR • Consumer controls upload and future access • Must have RSNA ID available and know answer to 2nd factor question • Develop web based viewers • Download full DICOM data set • Misc Consumers

  7. Advantages of Approach • Push model • No Query of PACS from outside the firewall • Full DICOM data set is available • Web viewers • Download and Import to PACS • Report is available • Historical exams can be sent simultaneously • Consumer controls flow of information • Affords the patient the ability to select what information to share • Is this good?

  8. RSNA Image Share- Initial Patient experience • Patients enrolled (4 sites) in production environment- 3900 • 20 months • June 16, 2013 • Includes some test data • Approximately 1/3 have closed the loop and used the PHR • 3 Community sites live as of May 2013

  9. Patient Responses • Love it! • Its about time • This is great • My doctor was really pleased to have access to my images • Problems • Couldn’t access my images • Got my images- but difficult • My doctor couldn’t see my images

  10. RSNA Image Share Development • Version 3.0 • Vendor implementation • Incorporates Clinical trials • RSNA CTP • Version 3.1 • E-mail address as logon ID as an alternative to 8 digit code • Password- minimum 8 characters; no other limitations • Flexible send time • In testing • Expected Release – late summer • Future • Refine user interface • Dose • Quality Metrics

  11. Next steps - New NIBIB (NIH) contract • Expansion of Network • Vendor Adoption of Edge Server (Open Source) • Vendor migration to XDS for all services • Connect 2+ independent networks • Alabama-CAHIE consortium to RSNA • EMR integration • DICOM evolution • Restful services • Separation of Metadata from pixel data • Enables discovery • Viewer • Convergence of • Patient Engagement model-PHR • HIE • Provider to Provider • NHIN Direct • XDR • XDM

  12. Resources • ImageShare@RSNA.org • http://www.rsna.org/Image_Share.aspx

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