Patient-directed Internet-based Medical Image Exchange

Rationale and Objectives

Inefficient transfer of personal health records among providers negatively impacts quality of health care and increases cost. This multicenter study evaluates the implementation of the first Internet-based image-sharing system that gives patients ownership and control of their imaging exams, including assessment of patient satisfaction.

Materials and Methods

Patients receiving any medical imaging exams in four academic centers were eligible to have images uploaded into an online, Internet-based personal health record. Satisfaction surveys were provided during recruitment with questions on ease of use, privacy and security, and timeliness of access to images. Responses were rated on a five-point scale and compared using logistic regression and McNemar’s test.

Results

A total of 2562 patients enrolled from July 2012 to August 2013. The median number of imaging exams uploaded per patient was 5. Most commonly, exams were plain X-rays (34.7%), computed tomography (25.7%), and magnetic resonance imaging (16.1%). Of 502 (19.6%) patient surveys returned, 448 indicated the method of image sharing (Internet, compact discs [CDs], both, other). Nearly all patients (96.5%) responded favorably to having direct access to images, and 78% reported viewing their medical images independently. There was no difference between Internet and CD users in satisfaction with privacy and security and timeliness of access to medical images. A greater percentage of Internet users compared to CD users reported access without difficulty (88.3% vs. 77.5%, P < 0.0001).

Conclusion

A patient-directed, interoperable, Internet-based image-sharing system is feasible and surpasses the use of CDs with respect to accessibility of imaging exams while generating similar satisfaction with respect to privacy.

Introduction

Patients increasingly receive medical care from multiple providers, often in different practices, institutions, or geographic locations. In this complex healthcare delivery system, protected health information must be exchanged efficiently and in a manner that ensures its privacy and security, as mandated by the federal Health Insurance Portability and Accountability Act . Portable media, namely compact discs (CDs), are most commonly used to exchange medical images beyond the local environment. However, CDs may be misplaced or damaged, and data may be written in proprietary formats that the recipient is unable to access, often with image display software requiring administrative permission to install .

Several Internet-based systems for electronic sharing of medical images are now being employed . These new technologies must meet public expectations of seamless connectivity and privacy, as experienced with online banking, online shopping, and social networks, and must foster patient engagement and partnership with their providers. Currently, little evidence exists on the satisfaction of patients with technologies that pursue such goals in radiology .

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Materials and Methods

Setting

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Patient Enrollment

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Survey

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Analysis

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Results

Characteristics of the Population

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Selection of Modality to Transfer and View Images

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Experience With Access

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Table 1

Patient Answers to Survey Questions

Survey Question Agreement vs. All Others \* OR (95% CI)__\*\* Patient experience I was comfortable with the privacy and security CD 1.18 (0.41, 3.35) Both 0.68 (0.25, 1.83) Other 0.58 (0.28, 1.21) Visit was not delayed or postponed CD 0.84 (0.31, 2.27) Both 0.53 (0.19, 1.46) Other 0.50 (0.24, 1.04) Patient perspective I like having direct access to my exam images CD 0.72 (0.13, 4.02) Both 1.04 (0.11, 9.51) Other 0.35 (0.10, 1.17) I like having direct access to my medical records CD 0.36 (0.04, 3.51) Both 0.79 (0.03, 20.20) Other0.13 (0.02, 0.79) It was critically important that my doctor viewed my medical image quickly CD 0.93 (0.30, 2.88) Both 6.42 (0.36, 113.94) Other 0.83 (0.34, 2.04) In general, I am particularly concerned about maintaining the privacy of my health records CD 1.49 (0.79, 2.83) Both 1.26 (0.62, 2.56) Other 1.36 (0.83, 2.24)

Answers were grouped by modality of image sharing used by patients.

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History of Computer Use

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Discussion

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Study Limitations

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Conclusions

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Acknowledgments

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Appendix

Supplementary material

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Appendix S1

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Appendix S2

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References

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Patient-directed Internet-based Medical Image Exchange

Rationale and Objectives

Materials and Methods

Results

Conclusion

Introduction

Materials and Methods

Setting

Patient Enrollment

Survey

Analysis

Results

Characteristics of the Population

Selection of Modality to Transfer and View Images

Experience With Access

Experience With Sharing

History of Computer Use

Discussion

Study Limitations

Conclusions

Acknowledgments

Appendix

Supplementary material

References

Further Reading

A Vertically Integrated Online Radiology Curriculum Developed as a Cognitive Apprenticeship

After Detection

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