The US healthcare system has its own Tower of Babel problem. If you don’t recall this biblical tale, it’s a story that explains why humans speak multiple languages instead of one. We can’t understand the babel of a language we do not know, and the same is true in healthcare. What one facility calls one test or record may not be the same term used by another. This quickly became apparent on a recent podcast (SIIMcast) hosted by the Society of Imaging Informatics in Medicine (SIIM) and sponsored by Ambra Health. In this episode, hosts Jason, Prasanth, and Arjun interviewed Dr. Alexander J. Towbin, a Pediatric Radiologist at Cincinnati Children’s Hospital and renowned imaging informaticist.
Just a month ago at the HIMSS conference, there was great discussion around a new rule put in place by the Office of the National Coordinator for Health Information Technology that stated how patients should be the actors and not “acted upon” when it comes to their medical records. According to the Director of the Office of Policy for the ONC, “if a patient requests their record, and it’s not given to them electronically and for free, that’s information blocking.” Many facilities have yet to catch up to this new regulation. Just this week, I headed to a facility to physically pick up my medical records as I was told they could not be sent to me electronically. As a patient, taking the additional time to drive, pick up records, and wait for a CD to be burned is very frustrating and delays care and treatment plans.
The podcast dove into these very logistics and interoperability as a whole by focusing on medical image exchange, imaging standards, and processes to share data more readily with patients. At Cincinnati Children’s, they sought to solve two key image management problems with one solution – image sharing and teleradiology. They also required an image management product that had customization and workflow routing capabilities, an easy user interface, and clinical trial features. Dr. Towbin aimed his focus on CDs and #DitchTheDisk. Dr. Towbin said, “Rather than caring about the network, we used the best technology (vendor) to create our own network.” Today, Cincinnati Children’s uses gateways from Ambra Health to share and receive images from other image sharing platforms across their wide network and route them to where they need to be when they need to be there.
Although Cincinnati Children’s is able to send and receive imaging data, there are still many questions that loom. For example, how long should imaging be stored in their system? A large amount of data (including external imaging) is often brought in. Legally, the facility is required to house all data until the patient is 18 years of age or 7 years after the last date of service. However, since the team has found so much value in historical records (including external sources), the current policy is to keep everything.
Data normalization is another complex issue in radiology. Cincinnati Children’s receives both reference only studies for comparisons and referrals and outside second opinion requests. Procedure names can vary widely across radiology which can be particularly confusing for clerical staff. One of the hosts shared how when their hospital system merged with another, all radiology exams had to be entirely retitled. International second opinions even add an additional element of confusion with unique nomenclature.
Reports sent along with patient imaging add yet another piece to the puzzle. Sometimes reports come in as an electronic PDF, other times they are included on the disk, and oftentimes, faxed over. The clerical staff works to find and download external reports and DICOM wrap them in the image exchange system. In other cases, such as that of trauma, imaging frequently arrives without a report at all.
As patients continue along their healthcare journey, Cincinnati Children’s may be asked to share imaging with other facilities. Patients themselves can be given their images with a CD or secure electronic link, however, Dr. Towbin argues that with the enormous amount of healthcare data on a patient, it should be up to the facilities and not the patient to be responsible for the secure management of data. The question then becomes, does Cincinnati Children’s share through their own vendor of choice or do they have to use the vendor of the other facility? Dr. Towbin says, “It is pretty silly to be confined by networks. Didn’t make sense for cell phone networks and doesn’t make sense today.” Imaging networks should be allowed to share with one another, and vendors must adopt more unified standards. Some facilities are also hesitant to use cloud image sharing and “hide behind HIPAA” as Dr. Towbin suggests. They will send over a CD that is password protected with a password the patient does not even recall.
What’s clear is that there is no etiquette when it comes to sharing medical images across facilities, and the development of standards and processes will be critical to the long-term success of the US healthcare system.
Listen to the full podcast here: