Radiological Images Take Another Step Toward Easy Sharing

Carequality and RSNA pilot programs with early adopters will start by midyear.

Traditional electronic medical record sharing has not included images, but that is changing, according to officials at Carequality and the Radiological Society of North America (RSNA).

The catalyst, as so often is the case lately, is COVID-19. Survivors of COVID-19 may have long-term damage to their hearts and lungs. Radiological images, whether in the form of CT scans, MRIs, or images generated by ultrasound waves, offer important clues to properly manage the health of these patients.

Previously, image-sharing between different silos of healthcare information technologies was very much a hit-and-miss proposition.

A new image exchange initiative started by Carequality and the Radiological Society of North America (RSNA) is perhaps the first industry-wide effort to bring image exchange to the internet.

"We want radiology data treated the same way all other healthcare data is," says David S. Mendelson, MD, professor of diagnostic, molecular and interventional radiology at Mount Sinai Health System in New York, and  a member of the RSNA Radiology Informatics Committee.

RSNA Image Sharing Makes Compact Disc Shuffle Unnecessary

It’s not the first time technology was utilized to make image sharing easier. But the last such effort, starting in the early 2000s, produced not a common internet-based exchange, but millions of compact discs, generated by the leading radiological imaging software of the day with patients.

"That was regarded as a great replacement for duplicating film, which was very costly, bulky, and difficult to do," Mendelson says. "CDs still remain the primary way we exchange images outside your local office. If a patient needs to take an image somewhere else, [office staff] usually give you the CD."

And yet, staff members still had to produce those CDs, and transport them from the production site to the patient. Worse, many of those CDs came with proprietary viewing software, which had to be procured and installed by or for patients.

It was an improvement over film duplication, but "human nature being what it was, many complained," Mendelson says. "People in that era in our radiology informatics committee would sit around discussing, why can’t we do what people do with videos, photos, and music on the internet?"

HITECH Act Kicked Off RSNA Image Share via the Internet

Although isolated examples of radiological image downloading could be found among imaging vendors, the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 began to answer the question more broadly.

The National Institute of Biomedical Imaging and Bioengineering, part of the National Institutes of Health (NIH), sponsored what came to be known as the RSNA Image Share. Hosted by RSNA, RSNA Image Share enabled participating radiology sites to share imaging records with patients via secure online accounts.

NIH wanted Image Share to be based on industry standards, according to Mendelsohn. For that reason, RSNA chose standards from IHE International.

Mendelsohn, who also co-chairs IHE International, says RSNA Image Share allowed patients to have full control over their images in an image-enabled personal health record. "We’ve had tens of thousands of patients enrolled over a four-to-five-year period," he says. "We’ve matured this, and validated that it worked."

Patients surveyed who used Image Share told RSNA they appreciated the service and liked it "a lot better than CDs," Mendelsohn adds.

The initial NIH funding for Image Share came to an end, but to keep the initiative going, RSNA looked around for other interested partners, which is when it found Carequality.

Carequality, founded in 2014, has moved from its initial interop startup mode as an initiative of The Sequoia Project to its current status as a distinct corporation that executive director Dave Cassel likens to what the telecom industry has done with cell phone networks.

"You just expect to make phone calls, and not have to think about who the carriers are for anybody you’re calling," Cassel says.  "It’s conceptually the same idea here. You still sign up with a carrier, whether that’s your EHR vendor, a regional HIE, or some sort of interoperability service provider, but then once you’ve done that, you are able to exchange with all of the other participants of all of the other networks and services."

In May 2020, Carequality announced that it had exchanged one billion total clinical documents since the first document exchange in July 2016.

Carequality and RSNA Will Let EHRs Do the Sharing

Together, Carequality and RSNA have been working since December 2019 on the image exchange initiative they announced, along with an implementation guide. These resources are aimed at expanding the kinds of information that can be exchanged via Carequality to include the kind of image exchange RSNA already facilitates.

Then came the COVID-19 pandemic. The two organizations just revealed that a Carequality pilot program with early adopters of the implementation guide that has completed initial connections in testing. These connections will go live soon and could aid in treatment of pandemic victims whose EHRs, until now, have not included sophisticated medical imaging such as DICOM. Because of Carequality's involvement, these connections will span multiple vendors’ EHRs.

"Our internal goal is to have the final version of the implementation guide supplement formally adopted by the Carequality steering committee for production use," Cassel says. It should be part of the Carequality framework by the end of June, he adds.

Mendelson says the pilot will provide two forms of image exchange transactions—one based on the DICOM image standard, and the other utilizing HL7 FHIR for more Web-based health IT software.

Software vendors are starting with DICOM because they know it so well, Mendelson says.

Cassel says while EHR vendors are planning to embrace this type of exchange as well, the initial wave of implementations more typically will be image‒centric vendors such as Life Image, Inc., Philips, Nuance Communications, Inc., and Ambra Health.

As the image‒centric vendors "go live, and as there is more of a critical mass of participation by the imaging systems, it’ll make more sense as an ancillary activity for the Epics, Cerners, MEDITECHs, and others of the world to find ways to integrate with the exchange that’s occurring between the core imaging systems, in a way that makes sense for EHR users," Cassel says.