Exams Portability in Europe: first steps Antonio Fernandes CHLC – Lisbon, Portugal Tiago Baptista CHLC – Lisbon, Portugal XIX Symposium Neuroradiologicum Bologna, 5 October 2010

Outline The idea Benefits National Projects The Situation in Portugal Implementation Issues Conclusion

The idea Radiological Exams available everywhere in Europe whenever they are needed An Italian physician in Rome could easily access the CT scan done by a Portuguese physician, in Lisbon. of a portuguese a patient spending his holidays in Italy. This patient hadn’t brought his CD or film.

Benefits Images always availableFaster diagnosisBetter patient care

Benefits Elimination of repeated exams ▫Cost savings for the patient and/or the Healthcare System ▫Less visits to hospitals ▫Less exposure to radiation Colaboration between radiologists, even between countries Facilitates international telerradiology Unique opportunities for research

National Projects Scotland 5M citizens 3,8M radiological studies per year authorized doctors 2PB managed storage

National Projects 2 data centers in different locations Workstations installed in hospitals, with a common user interface. Access from home is also possible through VPN Data downloaded in a fast and smart way Primary identification through the Community Health Index (CHI)

National Projects Finland 5,3M citizens authorized professionals 500PB in the next decade Valued at 20M€

National Projects eArchive ▫Storage of citizen’s health records, including radiology images ePrescriptions ▫Electronic prescriptions to be accessed directly at the pharmacies eAccess ▫Access of citizens over 18 to their own health records, to set permissions and monitor access

The Situation in Portugal Sharing of exams in sites belonging to the same enterprise Lack of exams portability in remaining cases Citizen Card with chip and digital certificates Very good internet infrastructures Political support for projects that use new technologies to facilitate peoples lives It has the conditions for following on Scotland and Finland’s footsteps

Integration of different hospitals Solution Cost efficiency Required commitment Easier implementation and use Deployment of the same PACS over the portability region -++ Integration different PACS systems – IHE integration profiles +--

Document Repository Imaging Document Source Document Registry Document Consumer Imaging Consumer Provide and Register Register Query Registry Retrieve Document Retrieve Images Basic workflow of IHE XDS-I.b profile

Centralized Storage Economies of scale on data centers Better disaster recovery capabilities Decentralized Storage Easier to implement Capitalizes on existing infrastructures Storage of images

Patient Identification Creation of a European Health Number Creation of National Health Numbers Citizen ID/Phone Number/Bank Account IHE PIX/PDQ or PID protocol Ease of implementation and use Required Commitment level

Privacy Privacy should be of high concern ▫Countries have different privacy and data protection laws ▫A European archive would have to comply with the stricter of those laws ▫A system like the Finnish should however be enough to comply with these laws

Legislation Legislation is needed for successful implementation ▫The use of the system must be mandatory for both public and private radiology facilities

Conclusion It is technically possible to implement exams portability in Europe Great commitment of European Authorities to tackle the implementation issues is needed Legislation should be put into place A Taskforce should be constituted Participation of the European Society of Neuroradiology would be important

Please send your ideas/comments to join this work group: Disclosure: Antonio Fernandes, bord member,S24 Group