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The Trouble with Image Sharing, and the Opportunity

Scott Mace, for HealthLeaders Media, August 20, 2013

Six months ago, I wrote at length about enterprise imaging, the effort to bring together a common architecture for all medical images. The more I learn about the dominance of the radiology-oriented DICOM format, the more I realize that dominance is impeding innovation in enterprise imaging and image sharing between enterprises.

"Whenever I criticize DICOM in any way, generally pitchforks and torches greet me at my doorstep," said John Halamka, CIO of Beth Israel Deaconness Medical Center, during a discussion of standardization of image sharing at the July 19 meeting of the HIT Standards Committee Clinical Operations Workgroup.

"DICOM is a wonderful format for radiologists who have dedicated workstations inside an institution, but does have challenges in an Internet-enabled, mobile-enabled, Android and iOS kind of world," Halamka added.

"DICOM to me has been a wonderful standard," replied Hamid Tabatabie, founder and CEO of Life Image, Inc. "It has made radiology be years ahead of all the other 'ologies' in ability to transfer and share files. But [here] we are years after; we have run out of lipstick to put on the pig and we can use a new thing."

Now, DICOM isn't dead yet. One recent innovation in sharing DICOM images, the RSNA Image Share, is going strong and growing. But the various specialties each have their own spin on imaging. "An EKG isn't an image," Halamka noted at the July 26 meeting of the HIT Standards Committee Clinical Operations Workgroup. "An EKG is a time series. It's a waveform. And it has absolutely nothing to do with a picture… conceivably, it could be represented as text."

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