IMAGE SHARING. Review and Update - A Fond Farewell to CDs 2012

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1 IMAGE SHARING Review and Update - A Fond Farewell to CDs 2012 David S. Mendelson, M.D. Professor of Radiology Chief of Clinical Informatics The Mount Sinai Medical Center Co-chair IHE International Board

2 Image sharing- Why? Benefit of historical exam during interpretation Rapidly growing cost of healthcare especially growing utilization of imaging Overutilization- Inappropriate Utilization Prevent duplicate exam because a recent exam is inaccessible Radiation exposure- reduction Quality Expedites clinical care through easy availability of imaging examination

3 Who are our customers? Patient Radiology Physician 2 nd Radiology Patient Consulting Physician Clinical Trial

4 CDs- Problems Different data formats Non-Dicom Different viewers End-user confusion Defective Discs Disc must be in your possession Patient Identity Wrong Patient on Disc Time consuming Clinician s are confused They share their confusion with their Radiologist Mayo Clinic Unreadable Disc 0.6% Wrong- 0.2% Mount Sinai- estimates 5% cannot be imported Rare wrong patient

5 Issues for exam import Accuracy of the foreign information Compatibility Legal? TRUMPED BY OTHER ISSUES Responsibility??? Changes to the exam or report after import How does one become aware?

6 Sharing Healthcare Information in the Cloud 2 nd Radiologist Hospital Primary Doctor Imaging Center Specialist 2 nd Hospital Patient Patient Surrogate

7 NHIN Direct-applicable IHE Profiles SOAP-based Web Services and detailed metadata XDR -Cross-Enterprise Document Reliable Interchange - direct push model from sender to receiver using Web Services transport Document sharing in the absence of a registry and repository XDM - Cross-enterprise Document Media Interchange direct push model of packaged content Option transport via SMTP

8 PHR- Image Enabled Consumer Control Simplifies Consent Full Longitudinal Record

9 Information and Image Exchange- Internet Historical Images anywhere anytime as needed Patient consent models bandwidth EMR integration- bidirectional Regulatory Image quality Dose Peer review

10 XDS.a to XDS.b transition XDS.a XDS.b SOAP with attachments SOAP (Simple Object Access Protocol - updated version) References HL7v2.x Images excluded necessitating XDS-I ebxml (e-business extensible Markup Language) MTOM (Message Transmission Optimization Mechanism) HL7 v3 WSDL (Web Services Description Language) Includes images ebxml (updated version Lays groundwork for IHE Security (XUA [Cross-Enterprise User Assertion], XCA [Cross Community Access])

11 XDS-I.b

12 NIBIB/RSNA Image Sharing Project A Standards Based Solution

13 NIBIB/RSNA Image Sharing Project A Standards Based Solution Consumer controls the flow of information Patient Engagement Diminishes the need for BAAs between enterprises Imaging Site to Clearinghouse Clearinghouse to PHR Bootstrap an IHE based network IHE generally has not focused on consumer driven solutions but rather on institutional and enterprise workflow Primary emphasis is Consumer Control through PHRs Can be extended to other forms of sharing HIE Security and Confidentiality are drivers Replacement / Alternative to CD 5 Academic Institutions Develop a solution for all Radiology Sites Establish a clearinghouse Engage PHRs

14

15 Image Sharing/Elements of Solution Edge Server Register a patient Listens to a Radiology Information System (RIS)- looking for a complete exam Retrieves Image set from PACS and Report from RIS Send both to clearinghouse PHI hidden; an RSNA ID and 2 nd factor security token are used to identify the patient Clearinghouse (XDS-I) functions as a secure router Transiently hold encrypted patient data PHR Consumer controls upload and future access Must have RSNA ID available and know answer to 2 nd factor question Develop web based viewers Download full DICOM data set Misc Consumers

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23 Image Enabled PHR

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26 Advantages of Approach Push model No Query of PACS from outside the firewall Full DICOM data set is available Web viewers Download and Import to PACS Report is available Historical exams can be sent simultaneously Consumer controls flow of information Affords the patient the ability to select what information to share Is this good?

27 RSNA Image Share- Current State 4 Academic sites are live Mount Sinai, UCSF, University of Maryland, Mayo Clinic Last sites are navigating local issues and hope to be live within a few months 2 Community practices are implementing Patients enrolled in production environment Nov 1, 2012

28 Image Share- Current State Extension to 15 other clinical sites and 8 research sites is under active planning 2 community practices are currently implementing Current version 2.1 Includes Site to site if patient wishes to bypass PHR Use cases-trauma, Consultation Version 3 in testing Adds clinical trials on same network by integrating CTP

29 Next steps - New NIBIB (NIH) contract New Funding awarded by NIH for 2 years + 2 option years Expansion of network Vendor Adoption of Edge Server (Open Source) Vendor migration to XDS for all services New use cases Leverage XDS infrastructure/ network PHR HIE XDR Edge Server as a platform QA, Comparative Effectiveness, CDS..

30 Future Directions Refine Workflow Initial workflow is to replace a CD Exam updates Download DICOM data and archive in a local PACS EHR Integration Edge server as a platform Radiation Monitoring Peer Review Quality Metrics

31 Conclusions We live in a heterogeneous world needing multiple solutions CDs and portable media have both advantages and drawbacks Compliance with standards helps We are transitioning to network/internet solutions Security and confidentiality are even more difficult ONC and State policies will foster these solutions Solutions are evolving Proprietary solutions are often easier to implement Solutions based on open standards will provide the patient with greater flexibility Interoperability will require an adjustment to the way we all think of healthcare data

32 Cloud Sharing- a Transition Proprietary Cloud Services Standards Based Cloud Services

33 Resources

CONTENT CLINICAL IMAGE & Management, Redefined. EMC Perspective

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