The Future of Image Sharing

May 7, 2014

What started as a small industry trend is growing into a mandatory best practice for radiologists.

Over the years, image sharing has meant several things in radiology – mailing films, burning CDs and loading a PACS. But the future of image sharing is here, and it mostly lives in the ether.

According to many industry experts, image sharing has advanced and improved in the past few years to become easy-to-use tools that can seamlessly integrate with the wide array of health information technologies that many practices and facilities already use, such as electronic medical records (EMRs) and health information exchanges (HIEs).

Vendors and providers have quickly moved from dabbling in image sharing to helping these tools become their own niche market. The impetus, said Nadim Daher, an industry analyst with Frost & Sullivan North American Healthcare Practice, has been establishing an electronic workflow that can replace shipping CDs via courier.

“All this is essentially moving images from within an enterprise to outside the organization. It’s much broader usage than what we were doing three years ago,” Daher said. “We were doing ad hoc image share from point-to-point – it was the 1.0 of integrating image sharing into daily clinical workflow. But, information sharing is starting to proliferate. This is where we are now.”

In fact, cloud-based image sharing is on track to fulfill earlier industry predictions. Financial advisory firm Merrill Lynch estimated in 2008 that cloud-based image sharing was already a $56.5 million endeavor, and the business intelligence firm GlobalData predicted in 2012 that these tools would grow by 27 percent before 2018. The ultimate goal, Daher said, is to curb the duplicated studies that have, according to a 2008 McKinsey Global Institute diagnostic services report, racked up $26.5 billion in unnecessary healthcare costs.

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Across the industry, more providers and facilities are turning to cloud-based image sharing as an effective way to improve not only daily workflow, but also patient care.

“We’ve gone from the early adopters to the early majority,” said Hamid Tabatabaie, chief executive officer of cloud-sharing vendor lifeIMAGE. “The availability of the technology is more widely understood by more people, and more top companies are out there preaching it. And, simply, time has gone by, and adoption has increased as a result of more knowledge.”

In particular, cloud image sharing has become more common in environments where emergency care is frequently required, such as trauma services, cardiology and neurology. Use has also increased in pediatrics, especially in instances where a child is admitted to a non-pediatric hospital and a doctor needs to consult with an off-site pediatric sub-specialist, he said.

Cloud image sharing is also gaining ground among EMR and HIE vendors, Daher said. The need for integrating image sharing with these technologies has always existed, he said, and industry stakeholders are starting to take notice.

“HIEs all realize they need to be image-enabled to complete the picture of what’s been aggregated and achieved over the long term in terms of better decision support and analytics,” he said. “At the enterprise level, HIEs and EMRs are finally realizing this value.”

This type of integration will be useful both for individual providers, he said, as well as for institutions as a whole. However, sustained success will require significant buy-in from throughout a clinical setting.

Several technological changes are also driving the growing interest in and use of cloud imaging sharing, said Cristine Kao, global healthcare information solutions marketing director for Carestream Health. Patients are becoming more mobile in their searches for the best healthcare, pushing providers and facilities to adopt tools, such as vendor neutral archives (VNAs), which can easily send medical information, including images, both within and outside a health system. Such efforts both reduce costs and give facilities a manageable solution to updating or replacing their second- or third-generation PACS, she said.

“If you want to build a strategy for access to data, the VNA is the foundation,” she said. “You have to know where things belong, and you have to create an index of information. You have to address the issues of image access because it will affect your workflow down the road.”

The Patient’s Role
Even though providers and facilities will be the ones using and maintaining these cloud image sharing solutions, they aren’t the only ones influencing the industry’s move in this direction.

In many cases, patients play a passive part in encouraging providers to embrace image sharing. Increasingly, patients who have multiple physicians involved in their care teams expect these providers to communicate quickly and clearly, Tabatabaie said, so it’s imperative that practices and facilities understand the need for image sharing tools.

“Facilities must have their rationale for needing image sharing technologies on paper and get these reasons to the right people,” he said. “Otherwise, when a patient comes in with images from elsewhere, you will either over-irradiate her or cost more money by repeating the studies, thus causing a delay in care.”

But patient behavior outside the provider’s office is also driving the need for greater image sharing tools and strategies, Kao said. Patients no longer have to depend on their primary care physicians or other doctors to keep track of medical conditions and overall health.

“We’re at a tipping point, too, for a lot of consumer and patient applications. Patients are becoming more demanding, and if you look at the reimbursement metric, it’s tied to patient-physician interaction,” Kao said. “I think we’ll see a shift of power in some ways to the patient.”

For example, she said, several smartphone applications help patients track their vital signs and weight – information primary care physicians usually collect and find helpful. Finding a way to access, track and utilize this data in patient care will become increasingly important as use of electronic health records continues to spread.

Challenges That Remain
Although an increasing number of hospitals and clinics are embracing image sharing technology, there are still stumbling blocks to universal use, Daher said.  

“Breaking the resistance to cloud solutions once and for all is starting to become a reality,” he said. “I think image exchange is useful and in line with what everyone seems to agree is the next generation – we should be able to collaborate more as multidisciplinary teams, and that will require more and more image sharing among all stakeholders.”

In addition to any remaining wariness about using the cloud for image sharing, there are still pockets of providers who are ideologically opposed to sharing clinical data, Daher said. Traditionally, radiology has closely guarded the diagnostic images that are part of patient care. It’s a matter rooted in individual provider’s personalities and their approach to practice. Changing that, he said, will take time.

What Vendors Are Doing
Since several vendors revealed cloud-based image sharing solutions at the 2011 Radiological Society of North America (RSNA) annual meeting, the number of options has grown. For example, RSNA Image Share, launched in the same year, allows radiologists to share images with patients through personal health records.

Medical image sharing technology company Accelerad offers a similar cloud-based technology designed to meld with existing and future tools. GE also revealed its Centricity 360 at the 2013 RSNA annual meeting. Along with cloud image sharing, according to company information, Centricity 360 also allows providers to join private discussion groups for conversations about diagnosis and treatment.

In addition, Carestream’s Vue Motion product offers a zero-footprint viewer that can be accessed from any mobile or web-enabled device. The hope, Kao said, is that radiologists could potentially use the viewer, which has clearance from the Food and Drug Administration, as a remote viewer for clinical diagnostic reading.

Carestream is also following a recommendation from the federal government that’s designed to give patients more responsibility over and a greater role in their healthcare via electronic access. In addition to the Vue Motion viewer, the company has developed a patient portal that can tie into the zero-footprint viewer.

“Even the Center for Medicare and Medicaid Services is pushing for this type of patient portal – it’s a Blue Button Initiative,” she said. “At the government level, we’re seeing a push for patients to be more active in their own healthcare information exchange. And, industry players are realizing that if they can’t share imaging results with patients, there’s a gap. It’s a missing value for the patient.”

Ease-of-use is also a critical component to effective image sharing, Tabatabaie said. In this case, lifeIMAGE, followed the lead of many social networking platforms, such as Facebook or Twitter, when designing its cloud-based product, Connections™. This tool is designed for hospitals, providers and patients.

“Our customers put a link on their web site, and if you want to send imaging information, you simply click there,” he said. “You fill out a form request for who and where you want to send your data, and our customer gets an email alert that data is waiting. They can allow or disallow the transfer, and if they allow it, an account is automatically set up and instructions are sent for uploading the data.”

The key, he said, is making the service compatible with the current EMR and personal health record technologies that facilities already use.

As the number of vendors is in this space continues to grow, Tabatabaie said, cloud image sharing will become a definitive must-have technology. It will soon no longer be acceptable for a patient to undergo imaging at one facility and their care provider someplace else not to have convenient access to that information.

“Such a thing will be absolutely inexcusable,” he said. “The standards are there, the products are there, the service levels are there. The only thing needed is the will or the force to do it.”