Cool Technology of the Week

Picture 1 This week’s Cool Technology is not about a product, but a concept.

I’ve had numerous companies (more than 5) approach me in the last 90 days with a product in development that I’ll call “Image Exchange in the Cloud”.

One of the great challenges we have in healthcare is that radiology/cardiology/GI/pulmonary/Ob-Gyn images are not easily sharable between organizations. Although DICOM is a generally accepted standard, there is not an easy to use health information exchange in most communities to send DICOM data from place to place.

Sure, we could engineer numerous point to point solutions i.e. one organization’s imaging modalities push DICOM images to another organizations image archive. However, such an approach is complex. Who owns the medical record? How long should the image be retained? What security should be used to transmit the image between organizations? How should the patient be uniquely identified if we want to storage all images for a given patient from multiple institutions together?

Here’s the solution that all the companies entering this marketplace are suggesting:

1. A cloud computing offering is made available on the web for image exchange. No IT department has to host data, manage images, or deal with security issues.

2. A DICOM image is sent to the cloud along with a list of email addresses of individuals who can access the image and the length of time they can access it i.e. 30 days

3. The named individuals receive an email along with a URL and password to access their images on the cloud. For example, such individuals could be a consulting radiologist or cardiologist who may be over-reading the study.

4. A universal web-based DICOM viewer enables the authorized individuals to view the image without installing additional software i.e. there is no need to run proprietary workstation software from GE, Siemens, Philips, Agfa, Kodak etc.

5. After the reading is done, the username/password used to access the cloud computing site expires after the duration specified.

This solution is appealing for image sharing because it is low impact on IT departments, requires no local storage, is secure, requires no special software, and is simple to implement.

I look forward to many product offerings for healthcare imaging sharing via the cloud over the next year. That’s cool.

John D. Halamka, MD, MS, is CIO of the CareGroup Health System, CIO and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing emergency physician. He blogs regularly at Life as a Healthcare CEO, where this post first appeared.

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3 replies »

  1. Why not just use PDF ? Occam’s razor applies here.
    PDF is recognized worldwide as the most reliable file format for graphically and data rich file exchange.
    PDF is no longer under the domain of its inventor, Adobe, as it is now an international standard, ISO 32000-1, Document management – Portable Document Format – PDF 1.7. and is now developed, revised and managed by the ISO committee.
    PDF can contain and represent DICOM images and metadata as well as an EHR data file such as HL7 data model for CDA (Clinical Document Architecture) data structure.
    PDF documents can be found throughout government and all business industries.
    PDF is reliable, flexible and feature-rich, which allows it to represent and manage the many information formats, including structured data, text, graphics, x-rays, and video that are used in the healthcare industry – all viewable using the free Adobe Acrobat Reader and many other third party PDF viewing applications.
    PDF Healthcare is important to the HIT industry because;
    1) Tools such as the the free Adobe Acrobat Reader and PDF file enable interoperability between disparate silos of EMR systems. Successful EHR data exchange demands an easy to use, simple to implement tool set that are widely available for people to use at the point of healthcare delivery.
    2) The “bridging” nature of PDF for even the smallest rural clinic to transition from a paper centric to the digital world.
    While we all agree that it is crucial to move HIT to the digital environment, exchanging XML data files as EHRs is not all that simple or useful to an important demographic – the patient.
    And I can open and view a PDF in any public library.

  2. Don’t forget pathology images, too. Although most non-pathologists cannot read these, at least in the inpatient setting, they should be included in the deliberations. When a patient goes from one institution where a biopsy was done to another where the definitive surgery will be done, the pathology conventionally is reviewed to assure the original diagnosis was accurate. This also allows for distant expertise to be brought to bear on difficult cases, via imaging.
    Adoption of this technology is in its infancy in the pathology community.

  3. I think this is a natural utilization of cloud computing technology and I would even suggest expanding this to educational images, lectures, case studies etc., anything that is memory/data intensive. As I understand it though, there still needs to be a portal of entry into the cloud and that the shared computing power still has to be ‘hosted’ somewhere by someone at least in actual practice (ie Amazon or Google cloud servers).
    I bet there will be great skepticism and concern that bits of private health data are “floating free in computer space” despite the relatively standard methods of encryption etc.