Open Access

Maine launches the nation's first statewide image archive to improve patient access

When it comes to sharing X-rays, ultrasounds, and other images, an information gap exists. With no widespread digital networks for sharing images, patients often bear the burden of obtaining and transporting their images from one provider to the next.

Typically that process requires the provider who captured the images to burn them to a CD or print them out on plain film, which the patient must then carry to his next provider. Not only is this an archaic and expensive way to share images in this day of digital transmission, but it also leaves a great deal to chance. CDs and films can be lost or damaged, or the receiving providers may simply the unable to open a specific type of file.

While regional electronic health record (EHR) exchanges, databases that allow providers to share patient records in digital formats, have been established in some locations to make image transmission and medical record sharing more efficient, many of those systems are either inconsistent or are not accessible to all practitioners. As a result, patients who switch from providers in one region of a state to providers in another region or those who switch to providers within the same region who do not have access to the local EHR exchange are still responsible for obtaining copies of their images. Failing to do so may result in duplicate tests and unnecessary radiation.

In an effort to overcome those issues and improve patient care, one state is creating the nation's first statewide medical image archive. HealthInfoNet, an independent and nonprofit health information technology organization, is leading this initiative in Maine. The pilot project officially launched in May 2012, but it didn't gain momentum until January 2013 because the state's hospitals spent much of the previous year focused on meeting the requirements of Meaningful Use Stage 1, says Todd Rogow, director of information technology for HealthInfoNet. Now, 20 of the state's 38 hospitals are participating in the pilot and offering feedback along the way.

Consolidating Millions of Images

Maine's statewide medical image archive will be an extension of HealthInfoNet's existing health information exchange (HIE), which provides real-time patient data to clinicians throughout the state via a provider portal. Since its creation in 2008, the HIE has contained image reports but not actual images. The addition of the image archive will add value to the HIE while also helping Maine's providers prepare to share images through the Nationwide Health Information Network's Direct Project and CONNECT system — federal initiatives designed to encourage medical record sharing, Rogow says. Moreover, it will support the goals of accountable care organizations (ACOs) by making images and reports readily available to the multiple organizations that make up an ACO, he says.

Following a rigorous proposal process, HealthInfoNet selected Dell to develop and operate the image archive. The cloud-based system will accommodate the roughly 1.8 million medical images that Maine's health-care providers produce each year as well as past records, which for some practices date back as many as 10 years, Rogow says. Providers will be charged a "very low" fee to upload their images to the system, although Rogow declined to specify that cost. Organizations participating in the pilot project will initially be invited to send 60,000 images each. Those images will go through tests and performance checks to ensure the archive is performing properly. Once the system is deemed ready, efforts will begin to migrate the rest of the data to the archive.

Radiologists will be able to access the archive using their existing PACS. However, some providers will need to upgrade their systems to be compatible with the archive. Each organization will be responsible for covering the cost of those upgrades. "Some PACS vendors are ready to connect to an external archive source for images, but that's relatively new in the marketplace and the whole PACS environment," Rogow says. Practices will also be outfitted with onsite digital storage hardware, which will replace such outdated backup systems as tape recordings. Dell will install and refresh that hardware over the years at no cost.

"There’s nothing more frustrating for a radiologist than knowing that there’s a study out there at another organization that could help but not having access to it." — David Silsbee

Benefits Outshine Costs

The archive will offer providers myriad benefits, the most significant being improved patient care, says David Silsbee, chief information officer at Cary Medical Center in Caribou, Maine, and a member of HealthInfoNet's technical advisory committee. Like the rest of HealthInfoNet's HIE, the archive will operate in real time. That means that when a practice submits a new order for a patient, the system will automatically retrieve any relevant studies that other providers have contributed to the archive on behalf of that patient. Having immediate access to such images as well as the patient's medical history could give physicians insights they wouldn't have had otherwise. "Access to historical studies is key for radiologists," Silsbee says. "There's nothing more frustrating for a radiologist than knowing that there's a study out there at another organization that could help but not having access to it."

Other benefits of the archive include long-term cost savings and disaster recovery. HealthInfoNet estimates that Maine's providers could save $6 million over seven years through reduced storage and transport costs. Silsbee says that some providers are eager to join the archive for the disaster recovery function alone. "At least one [facility] was about to make a very substantial investment in additional local storage that was going to cost them six figures," he says. "They were going to hold off on that investment, hoping the archive would meet that need for them."

While health-care organizations could see substantial savings over the long term, Rogow admits that some practices may be hesitant to participate due to the upfront costs of PACS upgrades and image-loading fees. "It's hard to convey future savings to an organization," Rogow says. But once organizations see all of the information that the archive will provide, those concerns are sure to fade, notes Silsbee. "We really feel the benefits outweigh the costs," he says. "To get access to all that rich content out there, it's a cost we're willing to bear to improve the quality of care."

Maine Uniquely Suited for Archive

Most states would have difficulty implementing a statewide image archive because many providers are proprietary when it comes to patient data. But Maine is uniquely situated to make it work. That's because when HealthInfoNet was founded in 2006, the state's four primary health-care organizations agreed to not compete over data, Rogow says. "There's a lot of respect among members," he says. "We've been able to keep everyone on board with exchanging their data, [in spite of the fact that] it's a voluntary structure."

Maine is also well-suited for the program because of its size. The state is geographically large but has only 1.3 million residents and 38 hospitals, which makes coordinating a statewide exchange more manageable than in heavily populated states like California and Texas. Mark D. Alson, MD, FACR, a radiologist and president at Sierra Imaging Associates in California, who has recently expressed concerns about the fact that not all providers have equal access to EHR exchanges, says Maine's image archive is a step in the right direction, and he hopes it will encourage additional data sharing in states like his. "It sounds to me like Maine has gotten everybody on board," Alson says. "That's a good thing. That way ... you avoid patients having to get repeat studies and having to get copies of their studies."

While not all states are prepared to implement statewide image archives, other New England states are intensely watching Maine's efforts. Connecticut and Vermont have shown particular interest, and both are now considering forming their own archives, Rogow says. As Maine's archive goes online, confidence is high that the project will be a success, serving as a model for closing the gap across the nation. "When it's all up and running, it should be a seamless transition," Silsbee says. "We're extremely excited about the prospect."

By Jenny Jones
Jenny Jones is a freelance writer.

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