RSNA Image Share: Patient-controlled Image Sharing Based on IHE Profiles

Christopher CarrDirector of Informatics, RSNA

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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

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Participants

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Industry Participants

• Clearinghouse • PHRs

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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

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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)

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IHE XDS-I.b

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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

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Image Share Network

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Image Sharing Systems Overview

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Image Share Edge ServerProtocol Flow

Web/JavaSrv

MIRTHHL7

DICOM

From RIS

Dbase

OS

PACS Qry/Rtrv

Firewall

Clearing House

XDS.b &

token

Edge Appliance

ADMIN

RSRCH

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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

Image Share Log In

Patient Search Results

Patient Security “Key” Printout

PHR Image Viewer

PHR Report Display

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Image Share Current Stats (6/13)

• Patients enrolled = 3896• Exams sent to Clearinghouse = 15,190• 3.5 exams /patient• Patient utilization of PHR (~40%)

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Patient Engagement

• Help Desk established to provide patient support

• Sites provided with support and training for patient recruitment personnel

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More Information Available

• Edge Server Code and Related Design Documents:– https://github.com/rsna

• General Information:– http://www.rsna.org/Image_Share.aspx

• Demonstrations at RSNA meetings

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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