Medical imaging–first X-Rays, and later CAT scans, ultrasound, and MRIs–was one of the first areas of medicine to computerize, and images are routinely distributed in digital format around the world for diagnosis, training, and storage. But the field still fails to capitalize on many of the advantages that other parts of the computer field take for granted: access anywhere, seamless integration, and (perhaps most important for a health field) clear enforcement of permissions.
I talked last week to Hamid Tabatabaie, CEO of lifeIMAGE, one of the companies providing ways to share images in various cloud configurations, and got some useful background on the field of medical imaging and its challenges.
Like all areas of cloud computing (and health IT, for that matter), this one is growing fast. Right after talking to Tabatabaie, I heard two more announcements of cloud services for medical images, one from DR Systems (whose eMix service was the first cloud service for medical images) and another from Merge HealthCare. Other areas of health IT have a woeful history of misunderstanding and riding roughshod over the needs of the clinicians and patients who use them; Tabatabaie assured me that lifeIMAGE is different. Here are some areas we discussed.
Formats and standards
Most images adhere to one of the DICOM standards. But like the HL7 standards for electronic health records, DICOM provides enough wiggle room for images to come down the pike that can’t be read in the software a particular radiologist owns. One radiologist I spoke to groans whenever a patient walks in bearing a CD. He knows he’s likely to spend a precious and unreimbursed quarter of an hour getting the image to open. Worse still, he usually can’t display images from two different sources in the same program, so he can’t do the intensive, probing kind of examination that radiologists need to do–for instance, to compare an image from a fracture or a cancer site from four weeks ago with an image from today. Tabatabaie told me that lack of access to patient imaging history accounts for a substantial number of repeat exams, which amount to 20 billion dollars of the annual 120 billion spent on imaging in the US alone.
In contrast, lifeIMAGE understands enough different formats that it can displays any two images side by side more than 98% of the time.
Storage, transmission, and access
But the real business of lifeIMAGE is helping doctors and institutions exchange images. Smaller health care providers can use lifeIMAGE as a public cloud service, letting it be custodian of the images, but larger ones are likely to set up lifeIMAGE software on their own servers. To exchange images, lifeIMAGE uses standards-based protocols, which helps prevent vendor lock-inand addresses customers’ demand for interoperability between services.
What about the self-employed radiologist, the small physician, or any institution that hasn’t signed up with lifeIMAGE? Here’s where sophisticated permissions come into play. An institution using lifeIMAGE–whether on its private network or on the lifeIMAGE cloud–can provide any individual with access to an image. Although community physicians with long-term relationships to a hospital will create accounts on lifeIMAGE, an institution can also set up a temporary username and password for urgent needs, such as a request from a trauma center. Options for sharing include:
Giving the individual the right to download the image
Withholding the right to download the image, but giving someone the right to view it while it remains on the lifeIMAGE site (this must involve some form of Digital Rights Management)
Withdrawing rights after they have been granted
Granting rights for a limited time period
Granting rights to a group or class of images
Transmitting an image after removing identifying information (useful for training)
The cloud may or may not be the right way to store sensitive health information, but the medical imaging field realizes it has to handle distributing processing somehow. I’ll be interested in hearing how doctors and patients respond to the current wave of companies entering the space, and whether some convergence and interoperability take place.