From apps to telemedicine and beyond, technology has become a linchpin for patient engagement. The RSNA Image Share network represents a prime example. Established in 2009 as a pilot project, with $4.7 million in funding from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and administered by RSNA, the network enables radiology sites to give patients online access to their images—for their own purposes, as well as to share with any physician or other individual whom they designate.
David S. Mendelson, MD, FACR, senior associate, clinical informatics, and director of radiology information systems at Mount Sinai Medical Center (New York, New York) is and principal investigator for the project. He says, “Giving patients control over their images and promoting patients’ engagement with their health” are the core values around which the Image Share project and the Image Share network revolve. As of mid-January 2014, more than 7,000 patients (with more than 25,000 exams) had signed up to use the network—up from about 2,000 patients in December 2012.
Several community hospitals and private practices recently joined the network. The core mechanics of Image Share have not changed since its inception at Mount Sinai Medical Center, as well as at Mayo Clinic (Rochester, Minnesota); the University of California–San Francisco; the University of Chicago Medical Center in Illinois; and the University of Maryland Medical Center (Baltimore).
Each participating radiology site installs a small edge server. The edge server collects images and reports, placing them in a secure digital package for transmission to the network’s image clearinghouse, a Web-based, password-protected repository. Patients establish a personal health record (PHR) account with one of several vendors; then, they use a randomly assigned eight-digit number and a password to download their images to their PHRs and access them on any device (computer, smartphone, or tablet) via any Web browser. In addition to sharing images with physicians and others by showing them their devices, patients can grant access to any designated physician by sending him or her an email link to the information.
Just as the number of patients enrolled in Image Share has increased, so has the involvement of health-care providers and vendors of PHR systems and services. Several community sites—among them Barnabas Health (West Orange, New Jersey); Gillette Children's Specialty Healthcare (Duluth, Minnesota); and Advanced Radiology Consultants (Shelton, Connecticut)—signed on with the network in late 2013 and early 2014. The addition of other sites to the roster is expected to occur shortly. In January 2014, four PHR vendors were participating.
Recent developments on the technology front also are propelling participation. For example, the RSNA will be providing a Web service that in combination with the Integrating the Healthcare Enterprise (IHE) Cross-community Access (or XCA) profile would allow an independent IHE Cross-enterprise Document Sharing for Imaging (or XDS-I) image exchange to use Image Share's patient-engagement PHRs.
Patients will soon have the additional option of using their email addresses, in lieu of the eight-digit code, to access the system. The email-address option was vetted by the DHHS Office for Civil Rights, which determined that it afforded network users as high a degree of data security as the eight-digit code did, when used in conjunction with a password.
Tip of the Iceberg
At Mount Sinai Medical Center, the level of patient engagement sparked by Image Share has “surpassed all expectations,” Mendelson says. In a survey of patients employing this service, more than 75% indicated that they looked at their images—not just their reports. Mendelson is surprised at the large number of patients who want to see the exams (not just have them for their records and for the use of their health-care providers).
“Patients have said not only that they enjoy having control over the way in which their images are shared, but also that they like the ability to sit down, look at exams, ask questions, and more easily get a second opinion by showing clinicians images (on their own devices or through a link),”/+ Mendelson says. Use is most prevalent among patients with an immediate medical need—for example, individuals who have been diagnosed with cancer and must visit multiple sites and specialists in the course of their treatment.
Currently, Mount Sinai Medical