Devising—and Enforcing—an Imaging Mobility Policy
Keith J. Dreyer, DO, PhDWhen radiologists Massachusetts General Hospital (MGH) in Boston dropped off their wireless devices at the information-services department, it was a sign of the times. On a mission to verify proper encryption, IT gurus examined all manner of devices—hard drives, flash drives, tablets, and smartphones. Whether purchased by the hospital or radiologists, if the tools of the mobile technology trade could access the medical-imaging system, they had to be checked. In fact, iPhones® were forbidden until the release of iOS 3.3, which included the use of encryption and long, strong passwords, according to Keith J. Dreyer, DO, PhD, vice chair of radiology, informatics, at Massachusetts General Hospital in Boston. He describes the initiative as part of an organized effort to solidify policies, procedures, and security measures that govern how mobile devices access imaging-informatics systems. A lack of hardware standardization complicates matters, but Dreyer believes that radiologists can be trusted to acquire the proper technological specifications as progress inevitably creates more options. “Speaking as a physician, I would definitely not prefer standard hardware,” Dreyer says. “Functionality will exist on some devices and not others, such as 4G versus 3G network devices. Some will have a camera or a microphone, and some might have a bigger screen, where you might be able to view images. If you tried to impose a standard in such a fast-moving environment, I do not think it would work.” Whatever laptop, tablet, or smartphone a radiologist happens to choose, a login with a roaming number that changes every 30 seconds must be entered to access the system at MGH. “We have role-based restrictions, so only caregivers have access,” Dreyer explains. “If a patient wants to know who has seen his or her records, we must also produce an audit trail and justify why each individual was looking at a particular record. For physicians who do not have a direct relationship with the hospital, we have even tighter restricted access.” Passwords expire every 90 days, and people who end employment at the hospital are pulled from the system, with access revoked. Violators who run afoul of mobile-access guidelines are sent to a security officer and/or compliance officer; warnings, and even termination, can result. In the event of a breach, appropriate federal agencies are notified immediately. Pondering Policy The idea that a restaurant patron could peer over the shoulder of a radiologist and spot sensitive medical information is admittedly an improbable scenario. While it’s unlikely that a mobile device screen would reveal anything decipherable to the lay observer, these possibilities must at least be pondered by department heads in charge of security measures. The large screens of various electronic tablets have only intensified the debate over when and where it is appropriate to access diagnostic images. “In the past six months, we had the first FDA-approved mobile device for viewing medical images,” Dreyer says. “These kinds of things are going to be revolutionary, particularly for medical imaging, because the size of the display on an electronic tablet is likely to be adequate for primary interpretation. I think you will see a number of applications coming out specifically for the iPad®.” Dreyer has his own electronic tablet, with an internal application for visualization of all of the department’s images. The application allows him to view images on an iPhone or an iPad via Wi-Fi™ network. If that network happens to be accessed on a park bench, then there are policy and guideline implications that eventually must be addressed by industry experts. From his perspective as the ACR® Informatics Committee chair, Dreyer anticipates that these questions will quickly merit attention. “If I am looking at an iPad image to make a primary interpretation, and I am in a very brightly lit room—or even outside, in direct sunlight—my ability to see and diagnose is going to be far different, compared with a darkly lit room,” he says. “There are different methodologies to validate the accuracy of these devices, depending on the environment, and the FDA is examining these variables.” Will images accessed on electronic tablets ever be consistently viable for primary interpretation? According to Dreyer, the limited amount of literature on the topic points to the affirmative. “From there, we will need to break it down even further,” he says. He adds that a chest radiograph probably could be read, in the right situation, as might CT, MRI, and PET/CT studies, but a mammogram probably could not be read. “As a profession, we must go through all the circumstances and validate and verify,” he says. “Ultimately, vendors must understand how to make this a part of their portfolio. Will it be an augmentation to existing systems or will new systems sunset other systems that are currently based on the desktop?” A New Frontier Ultimately, mobile applications provide a potent platform for building innovations that would never have been conceived in previous eras. As one example, Dreyer points to an iPhone application that allows dermatologists to take photos of a lesion while simultaneously recording information using the phone’s microphone. These data are immediately transferred to the patient’s medical record. This innovation in dermatology offers a glimpse of the inherent potential of mobile devices in the radiology arena. With evolving RIS and PACS, the mission to develop efficient (and secure) access to images is likely to go through constant change. Technological diversity and competition will only fuel the evolution, and Dreyer believes that manufacturers will be up to the task. “There is not going to be one single device that all radiologists use, and I don’t think hospitals are going to purchase these devices for our physicians—at least, not yet,” he says. “There will be a wide variety of choices, and physicians will purchase them. One will want an Android® phone, another may want a BlackBerry®, and still another may want an iPhone or an iPad. Whatever they choose, they will all want access to our systems.” Assuming encryption can keep up with burgeoning technology, the good news for radiologists is that advances will continue to improve working conditions while benefiting patients. “This mobile technology is wonderful, and it is changing the way we care for patients,” Dreyer says. “We are putting intelligence into the hands of physicians who can access a wealth of information as they move through patient rooms, making us far more efficient. Information that already exists just becomes more available.” Greg Thompson is a contributing writer for