By virtue of its information technology-oriented infrastructure, the specialty of radiology is uniquely positioned to be at the forefront of efforts to promote data sharing across the healthcare enterprise, including particularly image sharing. The potential benefits of image sharing for clinical, research, and educational applications in radiology are immense. In this work, our group—the Association of University Radiologists (AUR) Radiology Research Alliance Task Force on Image Sharing—reviews the benefits of implementing image sharing capability, introduces current image sharing platforms and details their unique requirements, and presents emerging platforms that may see greater adoption in the future. By understanding this complex ecosystem of image sharing solutions, radiologists can become important advocates for the successful implementation of these powerful image sharing resources.
Introduction
Since the adoption of the Affordable Care Act, Health Information Technology for Economic and Clinical Health Act, and associated meaningful use guidelines , there has been tremendous interest in developing standards of healthcare data exchange and interoperability. Advocates of these technologies frequently cite the many benefits of data sharing for patients, providers, and institutions in terms of cost and efficiency of care.
These trends have been slower to mature in radiology, in part due to the greater complexity of sharing imaging data. Nevertheless, the potential benefits of medical image sharing are enormous, and emerging technological solutions and interoperability standards may soon take full advantage of the existing mature information technology infrastructure present in most clinical radiology departments and propel medical image sharing into a widely available tool.
In this report from the AUR Radiology Research Alliance Task Force on Image Sharing, we examine the benefits of image sharing in healthcare, review important considerations that drive implementation decisions, and describe currently available tools to facilitate medical image sharing. Throughout this work, we place special focus on the sometimes-distinct demands presented by the clinical, research, and educational contexts. We hope that this report will help to inform radiologists, clinicians, administrators, researchers, patients, and any other advocates of medical image sharing so that they are equipped to undertake a complete, multidimensional assessment of emerging image sharing solutions.
Benefits of Image Sharing
Clinical Practice
One of the principal benefits of image sharing in the realm of clinical practice is its potential to reduce the frequency of unnecessary repeat imaging and lead to more timely and accurate diagnosis. Several studies have shown that more than 30% of patients transferred between hospitals underwent repeat diagnostic imaging at the receiving facility, whereas other studies suggest that between $3 and $10 billion is wasted on unnecessary and duplicate imaging . In these studies, patients with available imaging and formal reports from outside imaging examinations were less likely to undergo repeat imaging. Any such reductions in repeat imaging would benefit patients by reducing risks related to ionizing radiation exposure, contrast administration, and delays in treatment . These reductions also help mitigate the economic burdens to both the patient and the hospital that are attributable to the problem of healthcare-attributable bankruptcy . A regional trauma network in the northwest United States organized a secure point-to-point network for image exchange incorporating over 120 facilities and achieved a meaningful decrease in the rate of repeat imaging for patients transferred within the network . Although a recent comprehensive meta-analysis found that image sharing did not reduce imaging use overall due to a lack of available data, it did report a modest and statistically significant decrease in repeat and unnecessary imaging .
There are additional benefits beyond reducing the rate of repeat imaging ( Table 1 ). Increased availability of historical studies can yield improvement in the quality of image interpretation , which in turn can lead to improved clinical decision making . Enhanced imaging sharing, particularly image sharing carried out under the control of patients, may facilitate patients’ access to their own electronic health data. In turn, improved patient access to imaging may enhance feelings of empowerment, patient satisfaction, and patient care . Finally, a mature infrastructure for image exchange can obviate the need for insecure portable media, thereby providing additional cost savings and a reduced risk of unintended breaches of patient privacy .
Table 1
Benefits of Image Sharing
Benefits in clinical radiology
Benefits in radiology research
Benefits in education
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Research
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Education and Quality Improvement
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Implementation Considerations and Challenges
Technical Considerations
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Table 2
Challenges to Image Sharing
Technical challenges
Legal challenges
Personnel considerations
Cost challenges
DICOM, Digital Imaging and Communications in Medicine; HIPAA, Health Insurance Portability and Accountability Act; IHE, Integrating the Healthcare Enterprise; IHE-PDI, IHE-Portable Data for Imaging profile; IHE XDS-I, IHE-Cross-Enterprise Document Sharing for Imaging.
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Legal Considerations
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Personnel Considerations
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Implementation Cost Considerations
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Current Image Sharing Platforms and Tools
Clinical Practice
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Table 3
Current Image Sharing Platforms
Clinical application—vendors and platforms
Research platforms for image sharing and de-identification
Educational and quality improvement platforms
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Research
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Education
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Conclusions
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Acknowledgment
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