IMAGE SHARING

There is public interest!

David S. Mendelson, M.D.Professor of Radiology

Senior Associate - Clinical Informatics

The Mount Sinai Medical CenterCo-chair IHE International

Board

Image Sharing Use Cases

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

Presume Patient Consent, Report and/or Images

Standards

DICOM HL7 Direct

IHE XD* family XDS XDS-I XDR XDM XDS-I

XDS

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

NIBIB/RSNA Image Sharing Project 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

A Standards Based Solution 2009-20122012-2016

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

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?

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

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

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

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

Resources

ImageShare@RSNA.org http://www.rsna.org/Image_Share.asp

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