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Bringing radiology imaging from PACS to PHR services

Don Fluckinger, News Director

A federally funded project that ports radiology imaging studies from picture archive and communications systems (PACS) to Microsoft's free-to-consumers personal health record (PHR) service via LifeImage Inc.'s Web service proves a couple of things. First, HealthVault

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is far from dead, unlike what some are saying about its main competitor, Google Inc.'s Google Health. Second, patients no longer need to lug thumb drives or CDs from one specialist to another.

A two-year, $4.7 million radiology image sharing project -- bankrolled by the National Institute of Biomedical Imaging and Bioengineering -- includes radiology departments at the Mount Sinai Medical Center, University of California at San Francisco, University of Maryland, University of Chicago and the Mayo Clinic. After a planned second-year expansion to other providers and satellite clinics, the network ultimately could serve more than 300,000 patients.

Radiological Society of North America (RSNA) leaders researched the best method for supplying images to patients digitally. They settled on HealthVault and LifeImage, which hosts radiologist-to-physician image-sharing Web services, and charges the radiologist. The project uses the Integrating the Healthcare Enterprise Cross-Enterprise Document Sharing, or IHE XDS, and XDS for Imaging, or XDS-I, standard profiles.

Stakeholders in the project unveiled the technology at the RSNA annual meeting last November, and plan to demonstrate live data exchange at the Health Information Management Systems Society, or HIMSS convention in Orlando later this month. Ultimately, they plan to release open source code to facilitate image sharing throughout the U.S. health care system.

Vendors not charging patients for radiology imaging

"There's this impedance mismatch between what [radiologists] and hospitals do in their provider-centric systems … and patients," said Dr. Paul Chang, vice chair of radiology informatics and medical director of enterprise imaging at the University of Chicago Medical Center. Many patients traditionally get their scans done at freestanding radiology centers, a process that requires patients to take CDs containing the images back to their specialists, he noted.

"[Electronic medical records] and PACS, they're designed for me as a physician. Not so much for patients," Chang continued. "But modern-day health consumers are not passive patients. They want choice, … mobility and the ability to move from one institution to the other to get second and third opinions. But there's a barrier: The information they need resides in systems that weren't designed for them."

Microsoft plans to use iSite code in upcoming versions of HealthVault to provide a "diagnostic-quality viewer" application, said Chang, who years ago helped write the image viewer included with Philips Electronic Corp.'s iSite PACS. The code will let patients and providers view radiology imaging studies; without it, HealthVault is only a file-storage mechanism that can show thumbnail views.

The most important aspect of this project is that it's basically kicking everybody in the rear and saying, 'Look, we've got to get our act together.'

Dr. Paul Chang, vice chair of radiology informatics and medical director of enterprise imaging, University of Chicago Medical Center

Just the capacity to store images puts HealthVault ahead of other patient-controlled PHR services, such as Dossia and Google Health, Chang said, adding that, when researchers approached Google, the system couldn't even store medical images, let alone view them. (Google Health users can upload files as large as 4 MB, and their accounts have a storage capacity of 100 MB.)

That facet of Google Health, along with Microsoft's software development kit for HealthVault, which lets developers build sophisticated applications to run on it, made HealthVault an obvious choice for piloting the radiology imaging project.

LifeImage got into the act when it agreed to serve as a free consumer clearinghouse, transporting images over its network from radiologists to participating PHR services.

"The most important aspect of this project," Chang said, "is [that it's] basically kicking everybody in the rear and saying, 'Look, we've got to get our act together. Our kids don't buy CDs for music anymore. Netflix prefers to stream its movies rather than sending physical media. We should be able to embrace this technology -- it's not rocket science.'"

Google disinterested in radiology imaging?

LifeImage can port radiology images to other PHR platforms for the project. The company, however, endorses provider-agnostic vendors like Microsoft that can aggregate all a patient's data in one location, said CEO Hamid Tabatabaie. That way, patients don't have to keep track of data at multiple sites -- as opposed to hospital-specific PHR services.

"It's kind of against our religion to [work] with patient portals at hospitals, because, by definition LifeImage exists to get things out of silos," Tabatabaie said. "To me, a patient portal is lipstick on a silo."

Google, meanwhile, seems "disinterested for the time being" in making its system more image-friendly, Tabatabaie said, leaving Microsoft as the big player left.

A Google spokesman declined to comment, saying the company wouldn't provide details on third-party discussions. Last summer the search engine giant said it continued to see a market for PHRs, and wanted to invest in its partnerships with providers.

For its part, Microsoft is attempting to break down the silos and make images from disparate PACS vendors viewable to patients using HealthVault. The vendor is working with "all the major players" in radiology to integrate their systems with HealthVault, said Dr. Khan Siddiqui, principal program manager in Microsoft's medical imaging health solutions group.

But where will all these machinations get them? The general idea of PHR services -- and the marketing of them to consumers -- is still a work in progress.

"The initial assumption that patients will line up, log on and get their own personal health records set up is turning out to be a fallacy," LifeImage's Tabatabaie said. However, they will go online for health care-specific tasks, he said, such as renewing prescriptions and booking appointments, at the behest of their physicians. That slow growth of online activity eventually will validate efforts such as this radiology imaging project, he added.

Let us know what you think about the story; email Don Fluckinger, Features Writer.


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