BLOG: Why Interoperability Is Essential When Transferring Patient Images

Interoperability is not a barrier to the electronic transfer of medical images. Rather, it is a necessity. The trick is finding an interoperable system. And that can be difficult.

Doing so in the past wasn’t an issue because interoperability wasn’t a factor. In the “old days” of radiology, patient images were analog. Film was the only means of storage and image transfer. In some ways, the old days didn’t go away. They just look different.

Film as a storage medium has given way to PACS. And CDs have become the medium for transporting images from place to place. The process surrounding CDs is remarkably like that of film.

Thirty-four or more years ago, patients who wanted a second opinion or were transferring care from one facility to another, drove to the hospital or clinic where past images had been taken. They asked – and waited – for their films, then physically brought them to the different facility.  A similar process is followed today when digital images are shared using CDs.

Transferring Images Electronically

Patients can forego this process if they have access to an electronic network that supports medical image transfer. Some who see Amy L. Kotsenas, M.D., and her colleagues at the Mayo Clinic in Rochester, Minn., use a proprietary network that links Mayo to the facilities from which they came. Other patients, however, may not be so lucky. They have to use CDs – some of which cannot be read; some that do not contain the needed images; some that are not brought at all.

While interpreting a new study, Kotsenas, a neuroradiologist, said “maybe we see something that looks very serious, but we can’t tell if it’s stable or not. Without those prior images, we are missing parts of the information that we need to be able to give an accurate diagnosis.”

This problem can be prevented. The technologies currently exist for doing so. They just are not in widespread use. Interoperability is the answer.

Radiology arguably is in the best position of all medical specialties to make this happen. It has developed a mainstay standard, called DICOM (Digital Imaging and Communications in Medicine), which governs the production of digital medical images regardless of equipment vendor.

Consequently, CDs might be expected to have few interoperability problems, since they store DICOM-based images. Unfortunately, the standard works best when sending images from one device to another, for example a scanner to a PACS. Trying to put images on a CD and then having those CD images ingested and read offsite can produce errors, Kotsenas said: “To expand, some CDs don’t use DICOM format and instead use non-standard formats; others use proprietary viewing software.”

A Quandary About Data Transfer

Nonetheless, it is possible to get images – and essential patient data – intact from one facility to another. Mayo routinely does so. Over the last several years, Mayo has exchanged images with its “network care partners” using an Ambra Health “gateway.”  Not all facilities, however, are network care partners, said Kotsenas, who chairs Mayo’s radiology IT committee.

The parent location of the Mayo Clinic, in Rochester, Minn., where Kotsenas works, attracts patients from around the globe. “And they may be coming from sites that don’t use Ambra Health,” she said.

These patients must use other options such as patient portals or different networks for electronic transfer.  When these are not compatible, she said, “you are back to the relatively old-fashioned way of doing things — burning CDs.”

Kotsenas, an associate professor of radiology at Mayo, is adamant that CDs need to be replaced by electronic transfer. Not only is the technology out of date, she said, but CDs can be lost or stolen, putting patient health information (PHI) at risk. To keep PHI safe, the data must be encrypted. “Which means whoever is on the receiving end has to be able to decrypt it,” she said. This adds another issue to the use of CDs.

The answer, according to Kotsenas, is a universal architecture that supports the exchange of images. Over such a network, she said, images could be exchanged like currency on ATMs.

The tricky part is getting to that point.

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Greg Freiherr is a contributing editor to Imaging Technology News. Over the past three decades, he has served as business and technology editor for publications in medical imaging, as well as consulted for vendors, professional organizations, academia, and financial institutions.

Editor’s Note: The next blog in this series will focus on the use of patient portals and how they can help in the transfer of medical images. You can read the first blog in this series, BLOG: Why You Should Not Use CDs To Transfer Patient Images, here.