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155 Executive Briefing: The Big Picture: Interoperable Medical Image Exchange The concept of transmitting diagnostic medical imaging files has been around for at least 30 years. By 1993, Digital Imaging and Communications in Medicine (DICOM) became an internationally accepted standard for healthcare organiza- tions to handle, store and transmit medical images to a Picture Archiving Communication System (PACS). Teleradiology was the first use case for transmitting images from a PACS in one location to another PACS where a remote radiologist could "read" and interpret the exams. The handshake between the two PACS installations was complicated, time consuming, ex- pensive, and for some time it required use of the same equip- ment at both ends. The difference between PACS' ability to exchange informa- tion and an interoperable image exchange is akin to fax ma- chines versus Facebook, says John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston. Medical image exchange basically allows the ability to easily send images from hospital to hospital regardless of the PACS system they use. Dr. Halamka says. "Why would you fax when you have Facebook?" The value of medical image exchange In essence, a medical image exchange network is a cloud- based platform that enables organizations, individual physi- cians or even patients to send and share medical images with outside organizations or physicians. The images do not have to be stored centrally, and when they need to be shared across entities, they are transported through the cloud. Apart from the ease of use, medical image exchange also holds significant value in the spheres of patient safety and economic incentives. First, excessive imaging can be harmful to patients, as excess exposure to radiation from multiple images can elevate the risk of damaging side effects. Imaging has long been the primary diagnostic tool in an acute care setting, so providers often default to image or reimage patients who present in their emergency rooms, says Mony Weschler, chief technology and innovation strategist of Montefiore Medical Center in Bronx, N.Y. The ability to access and view images from other provid- ers can drastically decrease the number of times patients are exposed to radiation due to duplicative imaging. Additionally, images are critical to tracking patient prog- ress through treatment and evaluating the efficacy of a treat- ment plan. While an initial image can show the acute onset of an ailment, physicians need a series of prior images to see whether a tumor, for example, is getting bigger or smaller, which will in turn inform treatment decisions. This becomes an issue when patients go to different facilities for different care purposes or decide to switch providers. "If a patient's whole healthcare is provided by Montefiore, it's very easy with the click of a button to see all the priors and that the tumor is grow- ing or shrinking or if the treatments are working," Mr. Weschler says. "But if a patient comes from other organizations, then you're missing that [access to priors]." Not only is excessive imaging detrimental to patients' health, but the new reimbursement practices set forth by the Affordable Care Act encourage providers to reduce duplica- tive imaging as a cost containment measure. "Under the ACA, you're given a fixed amount to keep patients healthy, and re- dundant and unnecessary testing is a cost [center], not a profit [center]," Dr. Halamka says. "There's this imperative for sharing images across competitive organizations, especially things like CT or MRI, which are very expensive imaging tests. That never existed before." The ACA has also spurred merger and acquisition activity. However, consolidating organizations are often functioning on disparate PACS systems. From a business standpoint, bringing those systems together carries significant cost measures. "As an IT guy, the cost of ripping and replacing everybody's PACS system to have unified image sharing is prohibitive," Dr. Halam- ka says. "What I need is some kind of glue that allows me to take my existing imaging infrastructure and now share images across different manufacturers' PACS systems because we're a merged system." Then there are patients, who are increasingly signing up for more affordable health plans and higher deductibles. Con- ventional wisdom says that as image sharing becomes more prevalent, patients will use it to seek second opinions and shop around for quality and affordability. In this era of patient engagement, physician loyalty has taken a back seat to patient satisfaction and convenience. An enterprisewide solution Even within organizations, hospitals can face barriers to image exchange. Though imaging has traditionally been viewed as mostly residing in the radiology department, nearly all subspecialties require and produce images. The problem is that most departments have their own imaging devices, creat- ing information silos. "You've got radiology, cardiology, pulmonology, gastro- enterology — and every one of them has their own imaging device," Dr. Halamka says. At the same time, care teams from various departments and specialties are expected to collabo- rate more closely than ever before. Hamid Tabatabaie, CEO of medical image exchange net- work lifeIMAGE, says care collaboration among different pro- viders necessitates interoperability and access. "Nearly half of the doctors in the U.S. practice a specialty or subspecialty that interacts with imaging data," he says. "Whether it's to receive a referral or access a patient's history, access to prior imaging is important to enable collaboration among clinicians during the diagnosis and treatment planning." IT leadership as the intermediary Given multi-disciplinary demand, hospitals and health sys- tems need a central strategy for coordinating image exchange initiatives across the enterprise. The IT department can spear- head this, given its objectivity among departments and ability to translate between clinical and technological needs. From Mr. Tabatabaie's point of view, which is the vendor Sponsored by: The Big Picture: Interoperable Medical Image Exchange