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