Image Sharing:The Cloud, the Roadmap, and the Business Models

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Image sharing yields an impressive host of benefits. Patient care improves with timely physician access to images, and there are much-needed efficiency gains when examinations repeated due to the inability to access prior images are eliminated. While specifications for image exchange have surfaced in the past decade, few projects have advanced outside the walls of a single health-care entity.

Proprietary solutions have proliferated, in the past year, in the form of software and technologies that leverage the Web (and cloud computing) to make image sharing possible among multiple hospitals, clinics, and imaging centers. Image-sharing projects, however, continue to be stymied by a raft of challenges on the business, legal, and clinical fronts; these include handling referrals, generating revenue, and grappling with patient-privacy issues.


Fox Chase Cancer Center

One multifacility image-sharing project—undertaken by Fox Chase Cancer Center in Philadelphia, Pennsylvania—was born of an initiative to streamline the referral process and bolster referral rates. Fox Chase Cancer Center has a staff of 140 physicians, maintains a referral base of approximately 35,000 medical practitioners, and works with a network of about 26 partner health-care institutions in Pennsylvania’s Delaware Valley, as well as in New Jersey. Some 8,000 new cancer cases are added to its patient roster each year, with about 100,000 radiologic-oncology procedures performed annually.

Not long ago, hospital decision makers concluded that a health information exchange (HIE) implementation was needed to address the volume of images and documents being generated in conjunction with such a heavy patient load. Asked what specific pain points the HIE should address, an overwhelming number of physicians (both on staff and from partner institutions) cited a lack of optimal access to images and laboratory results. Brian Vecchiarelli, clinical systems manager, says, “They wanted a full-bore, interfacility image-sharing system” that would transcend the problems inherent in the use of other image-transport vehicles, such as CDs.

The Fox Chase HIE (FCHIE) allows the sharing of images among physicians at Fox Chase Cancer Center and its partner sites via password-protected Web portal and VPN. Rather than relying on remote, distributed image storage, as used in cloud-based configurations, FCHIE was designed so that images (and patient data) reside either in the hospital’s PACS or those of partner institutions.

It is constructed on a proprietary HIE services platform that uses, as enabling tools, interoperability profiles published by Integrating the Health Enterprise (IHE). These include, on the image-sharing front, the Cross-enterprise Document Sharing for Imaging (XDS-I) integration profile. The DICOM standard constitutes another tool promoting image exchange employed by the hospital, in conjunction with the portal.

Vecchiarelli says that the image-sharing portal addresses Fox Chase Cancer Center’s referral challenges, in large measure, by making it much easier for referring physicians to supply images and data to the hospital (and also to retrieve them). “A transport mechanism of this type is essential to our remaining a partner of choice for our own partners,” he says.

Further leveraging the benefits of image exchange, the institution has constructed a clever business model for the HIE and, by extension, the portal. Under this aegis, partner institutions may—rather than merely using the portal to share images with Fox Chase Cancer Center—employ it to send images and associated data to the hospital for interpretation, on a fee-for-service basis. Two of the hospital’s partners have signed on for such services; marketing campaigns aimed at encouraging others partners to follow suit have been launched.

“Early on in the process of building the HIE, it became clear to us that the grant monies we were allotted to fund it would probably be inadequate to sustain it on a long-term basis,” Vecchiarelli states. Going forward, the fee-for-interpretation piece will be a cornerstone of the financial framework for additional image sharing, beyond the hospital’s walls.

Vecchiarelli adds that the solution’s key strength—“support for many, if not all, HIE standards”—will pave the way for one of Fox Chase Cancer Center’s next image- and information-sharing steps. He says, ”We want to make images and data available to patients through the portal.” Fox Chase Cancer Center