By Matt Wood
We share images online as second nature. Facebook users alone upload more than 300 million photos a day, not to mention millions more shared on services such as Instagram, Google+ and Flickr, or simply sent to friends by email. Besides maybe connecting a camera to the computer with a USB cable, not one of those photos requires any kind of physical handling; it all takes place through the cloud. So when we need a copy of a digital X-ray image to bring to a doctor for a second opinion, why do we have to wait for someone to burn it to a CD that we then have to carry to the next appointment?
I asked this question to Paul Chang, MD, professor of radiology and vice chair of the radiology informatics program at the University of Chicago Medicine, and he said, “Isn’t it surprising how far behind we are?”
Medical images, just like the ones you take with your smart phone, are all digital now, and yet most hospitals still require patients to transport their X-rays and CT scans on a CD or DVD. There is no efficient standard for sending radiology images from one hospital to another on the internet, or letting patients have a copy they can access later online—not yet at least. Chang and a team of radiologists and software developers at the University of Chicago, along with four other medical centers around the country, are working on a pilot program that should make sharing medical images online just as easy as posting a photo to Facebook.
In 2009, the Radiological Society of North America (RSNA) launched its Image Share project to build a network for sharing medical images through common internet standards. The project is funded by a $4.7 million contract with the National Institute of Biomedical Imaging and Bioengineering (NIBIB), a division of the National Institutes of Health. Along with the University of Chicago, four other institutions worked on the project: the Mayo Clinic, Mount Sinai Medical Center, the University of California, San Francisco and the University of Maryland Medical Center, Baltimore. Chang and his team developed much of the software, and the network is now enrolling its first test patients.
Chang contrasted the way we no longer buy music on CDs to how patients are forced to carry around their images. “Unfortunately, unlike using iTunes or being able to download music on the web, for images, the vast majority of hospitals around this country still require the creation of some physical media transport,” he said. “That’s problematic at multiple levels. You’re using patients as couriers—sick patients, health consumers—that are being used essentially as pack mules.”
The other problem with this current system is the CDs aren’t just full of JPEGs that can be viewed on any computer. They’re bundled with special viewing software, specific to the image management, or Picture Archive and Communication System (PACS), at the hospital that created them. This can pose compatibility and security issues for healthcare providers on the receiving end if they aren’t familiar with that software.
The new image-sharing network uses an “edge appliance” that packages the image data used inside a hospital into something that can be sent over the internet. The radiology department that created the images will be able to send them online to another provider through a secure, private, web-based system, just like transferring money through your online bank account (you can try a demo of such a site here).
How is it that hospitals lag so far behind when other industries have been conducting business online for years? Chang said healthcare IT tends to lag behind other industries for a couple of reasons. One is a tendency to think that medical bits and bytes are somehow different than everybody else’s because of heightened privacy and security concerns.
Chang said this is an incorrect assumption, and pointed to banking as a counter-example. “You’re telling me that at my bank security and privacy isn’t important? It’s even more important I think,” he said. “What’s more an invasion of my privacy, if I had unauthorized access to your health record and images, or unauthorized access to how you spend your money?” Chang said this tendency to think medical data needs special treatment beyond the security standards we use to transfer money and pay our bills has slowed the adoption of new technologies in healthcare environments.
A second problem has more to do with the changing business model of healthcare. In the past, patients generally spent all of their time within one healthcare system. They would see their primary care physician, get referred to a specialist and have lab work and tests done all within the four walls of the same hospital. Healthcare organizations didn’t need to design their computer systems to interact with others outside the firewall, but things have changed.
“Now we’re a complex healthcare ecosystem where patients are health consumers. They’re no longer passive patients. They choose,” Chang said. “We depend on people coming to us for second opinions and advanced care, so that model is increasing. When you have that complex inter-institutional requirement, now more advanced interoperability methodologies are required.”
Chang and his team are now working on a way of integrating their edge appliance software into applications already in use hospitals and clinics, so that more providers can use the image-sharing network. He said this kind of project is one step toward creating the Holy Grail of healthcare IT: a comprehensive, patient-controlled, online personal health record. Such a system would allow patients to store all of their medical information online—be it images, test results or medication history—and share it with physicians, specialists and insurance companies as needed.
As for the late start on adopting technology we now take for granted on the internet, Chang said there’s a hidden benefit to that.
“The one advantage of being late to the game is we didn’t have to reinvent the wheel. We can take advantage of technology that’s been vetted and demonstrated to work,” he said. “That’s the reason why we’ve been able to do this quickly, so even though we’re behind we’ve been catching up, and I think we can leapfrog it.”
This is our second installment in a series about technology and radiology here at the University of Chicago Medicine. In June, we wrote about the Human Imaging Research Office that helps researchers with imaging needed for clinical studies.