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

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

Participants

Industry Participants Clearinghouse PHRs

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

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)

IHE XDS-I.b UKRC 2012

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

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

IHE Patient Identity Cross-Reference

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

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

Image Share Network

Image Sharing Systems Overview

Image Share Edge Server

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

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

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

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

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