Patient-directed image sharing: Here to stay by popular demand

RSNA, CHICAGO—A patient-controlled system of sharing diagnostic images over the Internet rather than by CDs is doable for providers and desirable to patients—including older folks.

That was among the key findings in a study rolled out during an RSNA press conference led by Giampaolo Greco, PhD, MPH, assistant professor in the Department of Population Health Science and Policy at the Mount Sinai School of Medicine in New York City.

Greco and colleagues enrolled 2,552 patients, mean age 50.4, who underwent radiology exams in four academic centers and established online personal health record (PHR) accounts using the RSNA Image Share network.

“Medical images are a driver of medical decisions and, therefore, the way that we share them has an impact on both the quality and cost of care,” Greco said. “Currently CDs are the most common mode by which we share images across facilities and providers, but there are important limitations [for patients trying] to access images through a CD.”

For example, the disc may become lost or rendered in a way that the receiving institution is unable to read; plus medical records scattered across multiple providers and multiple CDs “results in fragmented medical history, which is difficult to access,” said Greco. “Issues with access can lead to delays in care and repeat tests. Electronic personal health records have the potential for improving care as they offer broader access to images.”

Greco said the median number of exams uploaded per patient during the study, which ran from July 2012 to August 2013, was six. Study participants were offered a brief survey to assess patient and physician experience with the exchange of images, and 502 patients completed and returned their surveys, according to RSNA.

Most of the respondents—some 96%—responded positively to having direct access to their medical images, and 78% viewed their images independently. There was no difference between Internet and CD users in satisfaction with privacy, security and timeliness of access to medical images. A greater percentage of Internet users reported being able to access their images without difficulty, compared to CD users (88.3% vs. 77.5%).

Encouraging as the results were, additional research is needed “to explore the impact of this solution with respect to quality of care metrics and utilization,” said Greco. asked if, during the study, patient access to radiology reports—which were automatically included with the images—pressed radiologists to be mindful about making the reports more user-friendly and less potentially frightening.

David Mendelson, MD, chief of clinical informatics at Mount Sinai Medical Center and principal investigator for RSNA's Image Share project, took the question.

“I have no data to present, but I will tell you that giving the report to the patient certainly means you’re likely to get a phone call back on more than a rare occasion: ‘Please explain this to me,’” he said. “And that may be a good thing for the profession of radiology.” 

Whether or not such sharing and responding has a broad impact on workflow for referrers, radiologists or both remains to be seen, he acknowledged. 

Mendelson added that he has been in touch with numerous private radiology practices that have launched online patient portals. “They didn’t really expect much participation, yet they are routinely anecdotally reporting 60% to 70% of patients coming to their portals and looking at their images,” he said. “Whether the patients know what’s in those images or not, I’m a little bewildered by that. But they routinely report it’s a big PR success for them because it binds the patients to their practice.”

He said RSNA is exploring ways to integrate patient portals with RSNA Image Share, hoping to make it easier for patients to export their images outside the radiology practice.

Debra Copit, MD, director of breast imaging at Albert Einstein Medical Center in Philadelphia and a member of RSNA's public information committee, said she wonders how radiologists are going to have to change and adapt to make reports more patient-friendly.

“We had a course on this a couple of days ago where referring doctors gave us advice about what to include and what not to include in reports—things that scare patients, like the word ‘massive’ or ‘grossly,’” she said. “These are things that are part of our everyday language in radiology, so it’s interesting. But the future is here now; the patients are demanding this, and with good reason. The whole CD thing has been a complete disaster, and this has to be the future because the future is here now.”

Click here for more on RSNA’s Image Share network.