December 5, 2012
Empowered Patients Control Radiology Images, Reports
By: Greg Freiherr
Once the exclusive province of doctor-to-doctor communications, radiology images and reports are migrating into the hands of patients, a trend that may soon exert extraordinary influence over the specialty. Using new technologies called "patient portals," patients can now access their medical images and the diagnostic reports on which they are based and decide who will see them.
A project involving some of the top medical institutions in the United States is sowing the seeds of patient online access to this information, just as vendors experiment with low-cost means to provide it. Preliminary research has documented that patients overwhelmingly want this access. And the benefits of obtaining it may go far beyond patient empowerment and include immediate and long-term savings to radiology operations in time and money, as well as the streamlining of medical practice overall, potentially laying the foundation for better emergency care and broadly based clinical studies.
Since 2009, the University of California, San Francisco; University of Chicago; Mayo Clinic in Rochester, Minnesota; the University of Maryland in Baltimore; and Mount Sinai Medical Center in New York, New York, have collaborated on Image Share, a project that allows patients to pull their medical images from the Internet cloud.
As part of Image Share, these institutions developed Web-based personal health records for participating patients, who arrange with radiology practices to file image and diagnostic reports in those patient records. From there, patients can view and distribute the information whenever and to whomever they choose. As part of Image Share, these institutions developed Web-based personal health records for participating patients, who arrange with radiology practices to file image and diagnostic reports in those patient records. From there, patients can view and distribute the information whenever and to whomever they choose.
"This is the next revolution in digital imaging," said David Mendelson, MD, Chief of Clinical Informatics at Mount Sinai Medical Center and lead investigator of the Image Share project. "It gives the patient ownership over their records and makes the information more accessible to physicians.
Plus, it decreases unnecessary radiation exposure that can be caused by physicians ordering duplicate examinations owing to records not being easily available."
At Houston Medical Imaging (HMI), a private imaging provider that operates in 3 sites in Houston, Texas, patients can access their images and reports using software developed by Carestream Health. Patients can register to use the software, called MyVue, after completing an imaging examination at HMI. Accessing their MyVue account as they might an online banking account, these patients can view -- and distribute -- their images and radiology reports to anyone they choose.
Better Service for Patients
Randall Stenoien, MD, radiologist and CEO of HMI, says that he installed MyVue mainly to provide better service to patients whose primary physicians sometimes refer their patients to specialists. In these cases, patients or their physicians may ask that the results from previous examinations be forwarded. In the past, HMI fulfilled those requests by burning the data onto CDs and then shipping or sending them by courier to the requested location.
Now, patients who have registered with MyVue simply share them electronically using a secure account. What used to take days -- or, in the case of requests from outside the United States, weeks -- now takes minutes. In the process, staff time at HMI is saved, as is money. Only several months after installing MyVue, those savings are already appearing, Dr. Stenoien said.
Staff is spared the hassle of burning CDs. A side benefit is that HMI staff is spared the hassle of burning CDs, just as staff at referring physician and other practices don't have to try to read them. Although image files should be compatible with DICOM readers, they may not always be. A survey of current practices surrounding CDs and DVDs used for medical imaging in US radiology departments identified access, importability, and viewing issues as problem areas, any one of which can delay patient care. Noncompliance and a lack of knowledge about compliance were the major issues, according to the survey.
The practitioners most likely to jump-start this revolution are freestanding imaging centers, particularly ones in competitive marketplaces. HMI conducts about 40,000 radiologic examinations annually. Yet, Dr. Stenoien describes HMI as a "fairly small player" in the Houston market, which includes such large network providers as Texas Medical Center -- located just down the street from HMI's main office.
As the only user of MyVue in the United States, this software helps distinguish HMI from its competitors, according to Dr. Stenoien. But that could change. MyVue developer Carestream Health is planning to commercially launch its MyVue system in 2013.
MyVue will join VueMe™, an application released in May by MIM Software (Cleveland, Ohio). VueMe is designed to allow patients to view medical images sent by their physicians to their iPad®, iPhone®, or iPod touch®. This app, available on the Apple App Store, allows patients to see and share images using a Web-based service called MIMcloud 2.0, which stores and transfers encrypted patient data.
Building Blocks for Patient Portals
If demand rises for patient access to their images, the healthcare consumer might quickly face a torrent of choices. Many major and midsized vendors of radiology information technologies have already developed viewers by which radiologists can send images to referring and consulting physicians. In each case, the image retrieval and processing is done by remote servers using encrypted routes.
As MIM Software has done with VueMe, other developers of viewers are making their products available through consumer-based distribution hubs. One, Fuji Medical USA, is using iTunes® to distribute its app, Synapse™ Mobility, which displays patient information and images stored on its Synapse PACS.
Many healthcare providers already provide portals that allow patients to access medical reports, as well as records of their procedures and appointments. One such provider, Zwanger-Pesiri Radiology Group, offers a portal to patients served by its 9 medical facilities in New York State. On its Website, the provider has posted a testimonial from one patient stating, "Thank you for instituting the use of the patient portal...Having this kind of record at our fingertips is invaluable on so many levels. I will be sure to have all procedures done at Zwanger-Pesiri in the future."
One study found that nearly 80% of adult outpatients would prefer an electronic portal to receive diagnostic test results. Patient empowerment is one of many reasons demand for patient access might soon rise. But providing patients with access to medical data that they may not be prepared to understand -- or want to know about, as in the case of disease findings -- could be problematic.
Yet, in a study published last spring in the Journal of the American College of Radiology, researchers at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, found that 79.2% of 53 adult outpatients surveyed at an imaging center would use an electronic portal to receive diagnostic results rather than traditional means, such as discussions with the referring physicians. Patients indicated they would use educational resources, including ones available online, to better understand the reports.
The Wake Forest radiology team also used 3 scenarios to gauge how patient interest in obtaining immediate access to reports vs online access to reports that is delayed by 3 days. They found that if the report showed nearly normal findings, 60.2% would want immediate access and 28.3% preferred a 3-day delay; in contrast, these proportions were 47.2% and 35.8%, respectively, when the report was seriously abnormal, and 45.3% and 35.8% when findings were indeterminate.