Summary: Imagine this: Your recurrent headaches are back, this time with a
vengeance. The constant right-sided headache and diplopia for the last 2
weeks has you worried. Your neurologist just ordered a
contrast-enhanced magnetic resonance imaging (MRI) scan of the brain and
orbits. You then recall that when you had an exacerbation some time
back, the other location where you had been treated had done a computed
tomography (CT) and magnetic resonance angiography of the head, along
with a lumbar puncture.
Dr. Shrestha is the Vice President of Medical Information
Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, and
the Medical Director, Interoperability & Imaging Informatics,
Imagine this: Your recurrent headaches are
back, this time with a vengeance. The constant right-sided headache and
diplopia for the last 2 weeks has you worried. Your neurologist just
ordered a contrast-enhanced magnetic resonance imaging (MRI) scan of the
brain and orbits. You then recall that when you had an exacerbation
some time back, the other location where you had been treated had done a
computed tomography (CT) and magnetic resonance angiography of the
head, along with a lumbar puncture.
You log on to your personal
health record (PHR), click a button and securely transmit the prior
studies along with related reports and history to your current
physician. The radiologist on call reviews your priors and related
history, and compares these to the current contrast-enhanced MRI. The
neurologist reviews the images and reports, and confident that you do
not have a worrisome lesion, you are discharged with prednisone 60 mg
orally daily for 6 weeks, tapered over 4 months. Even before you have
left the hospital, your most current imaging studies are available
online in the hospital’s tethered PHR, and you are able to, at the click
of a button, automatically transfer these over to your own PHR. Your
symptoms soon subside, but you are prepared if things deteriorate.
what just happened here? Did we just actually focus all of our
attention on the clinical conditions at hand, with full awareness of
clinical history and effortless access to priors? Did we not have to
burn CDs back and forth, worry about proprietary image standards,
embedded image viewers, lost disks, and—yikes—let’s not even go there:
printed films shipped back and forth between patients and care
providers? Did we actually not even have to fret over the
possible existence of prior studies and related history, whether within
the facility or anywhere else the patient may have been seen before? Did
we just empower the patient and give the patient control over his images and clinical content?
Mark yes to all of the above. Mark yes, too, to the power of cloud-based image exchange.
this day and age of rampant EMR adoption, Meaningful Use and
proliferation of Web 2.0 technologies, creating true interoperability
that is patient-centric and image-enabled is a virtue that needs to be
Regardless of what PACS (picture
archiving and communications system) you have and regardless of the
scale of your needs, cloud-based image exchange must be exploited
further to meet the needs of an increasingly integrated healthcare
delivery environment. Despite some simmering concerns around security,
privacy and true costs,2,3 the truth is that we now have the right technologies at hand to enable much more sophisticated, yet simpler
ways to enable image exchange—and rid ourselves of the archaic imaging
practices of printing film and burning CDs. There is no reason for us to
be handcuffed to physical transport, lost media, and proprietary file
There is a clear recognition of the need to better
define means to exchange medical images and associated reports. Whether
within hospitals, across various provider locations (eg, trauma center,
transplant center, cancer center, and radiology) or across a wider
Health Information Exchange, interoperability across the growing number
of disparate electronic medical silos is critical from a patient-care
perspective. Without this, we continue to just treat one series of
images at a time, and not the patient as a whole.
is often misunderstood, and of late, over-hyped. However, it offers
dynamic scalability, better performance, and economic sense. The
availability of different cost models, including pay-per-usage models,
opens up possibilities in how deeply and how quickly you want to embrace
There is little doubt that with the
advent of accountable-care organizations (ACOs) and initiatives, such as
the Medicare Shared Savings program, there is growing momentum to
literally reshape healthcare delivery within the next decade. Imaging
appropriateness leads the charge in the transformation of volume
to value-based medical practice. Radiology’s ability to communicate more
effectively around the treatment of care will increase its influence on
the appropriateness of the recommended studies and the follow-up
studies. Cloud-based image exchange offers a smart way to leverage existing information technology (IT) investments and embrace newer business models.
technologies are liberating images not just from the PACS vendors but
from the provider organizations too. Done right, the vendor-neutral
capabilities that are enabled can also be extended well beyond radiology
to the other “ologies,” such as ophthalmology, pathology, and
So, resolve this year to explore the most
appropriate solution to embrace cloud-based image exchange—and make life
simpler for everyone: IT, clinicians, and, most of all, patients. With
reasonable cost models enabled by cloud-based deployment options, and
maturity in standards (such as IHE/XDS-I)4 as well as actual solutions that have shown their mettle, this is one technology whose time has truly come.
- Shrestha, RB. Imaging on the cloud. Applied Radiology. 2011;40:8.
- Alford, TA, Morton, G. The economics of cloud computing: Addressing
the benefits of infrastructure in the cloud. Booz, Allen, and Hamilton.
Updated October 26, 2009. Accessed January 3, 2012.
- Rangan K, Cooke A, Post J, Schindler N. The cloud wars: $100+
billion at stake. Mendeley.
Updated May 7, 2008. Accessed January 3, 2012.
- IT Infrastructure Technical Framework. Vol. 1 (ITI TF-1):
Integration Profiles, Revision 4. 2007;1. Integrating the Healthcare
Enterprise. IHE Technical Frameworks.
http://www.ihe.net/Technical_Framework/. Accessed January 2, 2012.