How to make full image sharing a reality

Aug 7, 2016

2014 07 25 13 26 17 310 Cyber Informatics 200

"No man is an island ... every man is a piece of the Continent, a part of the main." This may not be the most famous quote from John Donne's 1624 work "Devotions upon Emergent Occasions," but it seemed most apt when contemplating data sharing. And that leads me to the thought for this article: Why are we still talking about data sharing after all these years?

The simple fact is that despite the proliferation of technological standards and profiles related to sharing, we still find ourselves as clinicians facing just as many barriers to the natural flow of patient imaging as ever, yet this is set against a backdrop of increasing patient mobility, both in healthcare and wider lifestyle terms. Most commonly, these boundaries are located at the institutional level between which imaging cannot easily pass in parallel with patient flow. However, similar sharing issues are also evident when the scale changes to cover towns within a region, states within a union, or even countries within a continent.

Perhaps one of the greatest barriers to widespread sharing is the absence of a single, trusted unifying patient health identifier (PHID), which can be searched by all clinical systems so as to verify the identity of a newly registered patient. Given ever greater accessibility to foreign travel for many people, the ultimate solution would be a global patient index, but in reality, with only 15% of the world's population ever having travelled abroad, the associated financial and political costs would likely be disproportionate.

At Donne's "continent" level -- i.e., an area comprising multiple states or countries within an economic/political union -- where it can be assumed cross-border travel or migration is more commonplace, the societal benefits for sharing via a PHID make for a stronger argument.

At the country/state level where there is an even greater degree of migration within the borders for work, health, or leisure reasons, the benefits of a PHID through which a unified clinical record can be accessed by all are clear. Yet in many countries there either exists no national PHID, or what is in place is limited in everyday use (i.e., incomplete coverage, address verification issues, etc).

Elusive image-sharing

Go even tighter in, to the level of a region covering a few cities/towns, each with their own healthcare records system, and seamless image-sharing often remains as elusive as ever, even for those lucky enough to have a functioning national PHID.

The contributing factors are numerous and vary between institutions, regions, and especially countries, but supplier inertia, a lack of foresight by customers during procurement, and the absence of any national drive (i.e., investment) in this area have all contributed to the current situation. It should also be noted however the lack of mature imaging sharing standards has also been a roadblock, although this may be about to change significantly with the work being done on implementing cross-community access (XCA) solutions.

At a basic level, XCA has been designed to allow the growing number of cross-enterprise document sharing (XDS) based systems to talk to each other with a view to sharing not only imaging, but all healthcare data across institutional boundaries. Not only that, but delve into the technical details and it is clear that sharing with all the "old fashioned," non-XDS-enabled hospital systems still out there should be a simple matter of installing a small, black box (XCA gateway) at the front door and pushing the "Share" button.

But image sharing between PACS or vendor neutral archive (VNA) systems is only part of a patient's imaging journey, albeit often a vital one if their care involves multiple institutions. However, at the community level, where resource issues exist throughout many areas, the ability to share scheduling (RIS/HIS) functions remains the oft-ignored elephant in the room.

In many imaging facilities on many continents, demand already outstrips both scanning and reporting capacity and the gap is continuing to increase. All the while, the ability of subspecialists in smaller centers to cope with the inevitable peaks and troughs in demand, as well as provide a continuous service during periods of sickness or other leave, has never looked more fragile.

RCR solution

One solution proposed in a recent report by the U.K. Royal College of Radiologists (RCR) focused on new "networking" models within regions, which to some extent already has a proven track record in the realm of out-of-hours cover by trainees, based on the cooperative sharing of reporting capacity. However, widening this approach to include larger volumes of "cold" reporting and potentially even the scanning (for healthcare models where the two are by necessity routinely separated) requires not only the sharing of the background scheduling systems (RIS), but also the political will and financial ability to share the cost/profit of each step in the pathway, even between competing healthcare providers.

There have been some early attempts by companies to offer external systems which can schedule (i.e., coordinate) the reporting of exams between multiple institutions, but usually at the expense of additional financial and administrative burden. More preferable would be a way to share RIS scheduling/reporting functions seamlessly between separate RIS instances within different institutions in a region. In the U.K., such functionality already exists via proprietary sharing within a supplier's customer base, but as yet there is little if any sharing to be seen between nondomain sites and none at all between sites with RISs from different suppliers.

Perhaps unsurprisingly, there already exist appropriate Integrating the Healthcare Enterprise (IHE) profiles to describe fully integrated RIS sharing functionality, but in the absence of sufficient customer demand, many suppliers have delayed implementing such within their product offerings and we remain cast adrift in a world of separate RIS islands.

Having come full circle, it is clear the barriers to true, seamless sharing are many and varied, but the potential technical solutions are within our grasp. As ever, it is for us, the technologically aware, to push locally and nationally to get full sharing functionality in place, covering each of the scheduling, scanning, reporting, and subsequent clinical care steps along the patient's journey. For as was once said, "There is no delight in owning anything unshared."

Dr. Stephen Fenn is a consultant radiologist and radiology lead for IT at Hampshire Hospitals National Health Service (NHS) Foundation Trust in the U.K.

The comments and observations expressed herein do not necessarily reflect the opinions of AuntMinnieEurope.com, nor should they be construed as an endorsement or admonishment of any particular vendor, analyst, industry consultant, or consulting group.

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