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Christopher Carr Director of Informatics, RSNA

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1 Christopher Carr Director of Informatics, RSNA
RSNA Image Share: Patient-controlled Image Sharing Based on IHE Profiles Christopher Carr Director of Informatics, RSNA

2 Image Share: Overview Pilot project funded by the NIH – National Institute for Biomedical Imaging and Bioengineering (NIBIB) – $4.7m (Oct. 2009) $10.8m (Oct. 2012) RSNA is prime contractor, working with researchers/developers from six institutions Currently deployed at seven sites; 28 sites in deployment pipeline Translational research: test viability of patient-controlled sharing of images over Internet

3 Participants

4 Industry Participants
Clearinghouse PHRs

5 Image Share: Rationale
Medical imaging is a high-value, high-cost, rapidly expanding medical service Current method of sharing via CDs is beset with inefficiencies and frustration Studies show significant rates of redundant imaging procedures due to inaccessible priors Patient empowerment is a key goal of current federal initiatives

6 Image Share: Background
RSNA has history of sponsoring projects that promote standards in imaging and health IT DICOM demonstrations starting 1992 Integrating the Healthcare Enterprise founded 1997 Engagement in HL7 and DICOM committees Projects in terminology (RadLex) and structured reporting Image Share is based on a foundation of IHE profiles – Cross-enterprise Document Sharing for Imaging (XDS-I.b)

7 IHE XDS-I.b UKRC 2012

8 Cross-enterprise Document Sharing
Care Site Imaging Center Community Health Center Regional Hospital Emergency Dept Local Clinic Repository Registry Health Information Exchange Network Regional UKRC 2012

9 XDS and Health Information Exchange
Distributed model of electronic health record Patient information accessible throughout network History assembled at need via query Based on network of trust (“affinity domain”) “Subject discovery” performed at registry using IHE Patient Identity Cross-reference profile

10 IHE Patient Identity Cross-Reference

11 Concerns about HIE Model
Privacy and security of protected health information Shared legal liability among participating institutions Complexity of accurately assembling records based on demographic information US federal agencies seem inclined toward patient-controlled models

12 Patient-controlled Image Sharing
Information is shared directly with patient, who controls all subsequent access Relies on Personal Health Record (PHR) accounts No unencrypted patient information accessible in network Security “key” is provided to patient, who uses it to retrieve information into PHR

13 Image Share Network

14 Image Sharing Systems Overview

15 Image Share Edge Server

16 Process Steps Edge Server maintains list of completed studies
Site personnel enroll patients and query Edge Server for their studies Patient generates a password to accompany security key Study (or studies) sent to Clearinghouse Patient creates/logs in to PHR account Patient retrieves studies Patient uses PHR to share studies with subsequent care providers

17 Image Share Log In

18 Patient Search Results

19 Patient Security “Key” Printout

20 PHR Image Viewer

21 PHR Report Display

22 Image Share Current Stats (6/13)
Patients enrolled = 3896 Exams sent to Clearinghouse = 15,190 3.5 exams /patient Patient utilization of PHR (~40%)

23 Patient Engagement Help Desk established to provide patient support
Sites provided with support and training for patient recruitment personnel UKRC 2012

24 More Information Available
Edge Server Code and Related Design Documents: General Information: Demonstrations at RSNA meetings

25 Image Share Future Plans
Expand network: 21 sites currently in queue Enable site-to-site transfer: new release of Edge Server (v. 3.0) enables image retrieve Add capabilities to support research trials

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