NEW YORK – A two-year image-sharing project spearheaded by the Radiology Society of North America (RSNA) and funded by a grant from the National Institute of Health/National Institute of Biomedical Imaging and Bioengineering is gearing up to conduct patient recruitment.

The goal of the project is to enable standards-based image exchange directly under consumer control, said Chris Carr, director of Informatics for RSNA. The project, which commenced in September 2010, will initially connect five major hospitals via a central cloud and enable electronic access to images versus the traditional exchange of CDs.

[See also: Study: Clinical decision support reduces unnecessary imaging.]

There are plans to expand to additional medical centers and satellite imaging centers and to include exchange of information for imaging clinical trials in the future, Carr said. Investigators from the initial five sites will measure patient satisfaction in the areas of elimination of redundant tests, timely advice and treatment, and the degree to which consumers can fill in the communication gaps among hospitals, according to David S. Mendelson, MD, of Mount Sinai Medical Center, which is one of the participating hospitals.

The five initial hospitals are in the process of deploying edge servers, which allow them to communicate to the outside entities within their firewalls, according to Hamid Tabatabaie, CEO of LifeImage. The healthcare IT company is serving as the "digital clearinghouse" or central node that connects the Mayo Clinic, University of Maryland Medical Center, Mt. Sinai Medical Center, the University of Chicago Hospital and Medical Center and the University of California at San Francisco Medical Center to the outside world, he said.

In the first quarter 2011, once testing is complete, patients who are undergoing an imaging exam at the five hospitals will be invited to opt in to the pilot project and receive their medical images and reports via a personal health record account rather than CD.

Image-sharing is a relatively new area of the health information exchange (HIE) market, Tabatabaie said. It is also a more expensive component of HIE, requiring greater bandwidth, storage and more sophisticated transmission protocols.

There are two ways to think about HIE, according to Tabatabaie. One is enterprise to enterprise or physician/provider to physician/provider exchange of patient information. The other is consumer centric or the patient communicates with his or her various healthcare providers.

Through the RSNA project and its partnership with Microsoft (consumers can capture and share patient information, including medical images, via the HealthVault platform), LifeImage is participating in the consumer-centric HIE model. Major medical centers are also deploying LifeImage's services to be able to share images with their healthcare partners.

The trends of consumerism in healthcare and interoperability playing a bigger role in the Stage 2 meaningful use criteria may be significant drivers to incorporating image-sharing in HIEs, but Tabatabaie points to other more compelling drivers - financial cost savings and radiation exposure concerns.

The concept of accountable care organizations (ACOs) – the integration of primary care physicians with other members of the healthcare system to form a care team that is rewarded for controlling costs and improving quality – is gaining favor among payers and providers. By definition healthcare providers are sharing the cost of managing a patient, which translates to avoiding unnecessary or duplicative exams and expensive procedures to keep those costs down.

[See also: Study: Clinical decision support reduces unnecessary imaging.]

This model upends the traditional fee-for-service model, in which the volume of expensive procedures is proportional to the dollar amount of reimbursement. Sharing medical images among the care team members through an HIE in real time is the easiest and most seamless way to cost-efficiently manage a patient's exams and procedures.

With the passage of the Affordable Care Act and its health insurance exchange requirement, the payer market has become even more competitive. ACOs are one way payers can compete, Tabatabaie said. Currently, payers worked with radiology benefit management organizations and the pre-authorization process to avoid unnecessary exams. "Now they can also use IT as a cost-saving tool by having access to a patient's imaging history and sharing it with providers," he said.

More importantly, the ability to share patients' imaging histories will impact patient safety. "We're finally at a point where radiation exposure is no longer a backroom conversation; it's very much front and center," Tabatabaie said. "As the volume of imaging exams has increased, so has the exposure and therefore the priority of the topic."

With studies showing a correlation between excessive radiation and various types of cancer, being able to capture the history of a patient's imaging exams so you can calculate the lifetime exposure is very important, particularly for the young and elderly or chronically ill populations, he said.

Whatever the drivers for including imaging in HIEs, the bottom line is that it will contribute to a more cost-efficient, higher quality of patient safety and care.