The RSNA Image Share Network: 20 Month Follow-up Results from a Pilot Site
Are patients really interested in having direct access to their medical images, and do they benefit? The answer to both questions is "yes," based on a 20-month pilot study of RSNA Image Share, which includes a patient-controlled image-based personal health record.
"Patients are becoming more in tune with their health and they want to control their health records, analyze them and find out what the information means," said Anand Patel, M.D., senior radiology resident at the University of California at San Francisco and UCSF's physician coordinator for RSNA Image Share, which allows images, reports, and other types of data to be shared among different vendors' systems using standard protocols. UCSF is one of five pilot sites where the network is being tested with physicians and patients, along with the University of Maryland, the University of Chicago, the Mayo Clinic, and the Mount Sinai School of Medicine. Dr. Patel presented UCSF's results to date on Wednesday.
Medicare expenditures on imaging nearly doubled from $6.5 billion in 2000 to $11.7 billion in 2009. At least 10 percent of these costs, and possibly as much as 20 percent, are due to duplicate exams, often because images from prior studies aren't available. In response RSNA, with funding from the National Institute of Biomedical Imaging and Bioengineering launched RSNA Image Share. Patients gain direct control of their images and interpretations via a cloud-based electronic personal health record and can share access with any provider, regardless of institutional affiliation.
The UCSF study began in August 2011. Patients were enrolled while they were obtaining a CD of their imaging study or waiting to undergo their exam. Patients received a secure log-in through their e-mail for a website, accessible through a computer or mobile device, where they could see their images and radiology reports, download them and share them with their physicians via a secure link. The user interface is simple, like Flickr or Facebook. Users can change the contrast or zoom in to see certain areas of the image.
Patients were surveyed to gauge their RSNA Image Share experience, and a parallel survey was provided to their referring physicians. As of March 2013, 892 patients had enrolled and almost 800 surveys had been distributed. (The network is enrolling about 50 new patients per week, and total enrollment currently tops 1,500.)
The study looked at completed surveys from 252 patients and 81 physicians. In each of those groups, 95 percent expressed the need for a patient-controlled electronic personal health record. Four out of five patients and nine out of ten physicians were satisfied with the network. Two-thirds of the patients agreed or strongly agreed that health record privacy is important, but 90 percent of the patients were comfortable with the amount of privacy provided by RSNA Image Share.
There is some selection bias in the surveyed group, given that more than 90 percent of the patients reporting being online at least weekly for shopping and using social media, and that the San Francisco area is more tech-savvy than average, Dr. Patel said. "The main negative feedback we got was that the site was clunky—not that they didn't want something like this," he said.
More study is needed among physicians, since most UCSF physicians already have full electronic access to their patients' images through the institution's electronic health record system, Dr. Patel added.
Having images and radiology reports directly available to patients will sharpen the debate around how health information should be communicated, and by whom. "Unless we're doing a procedure, radiologists are not the patient's direct provider and haven't been following them for years," Dr. Patel said. "What's the best way for them to find out that their CT scan shows cancer? We had a couple of patients who asked whether it would be possible for them to get access to their results only after they had talked to their doctors, because they weren't comfortable reading the findings on their own." However, given the choice between immediate availability and none, most patients preferred to have the option of accessing their own information.
See a demonstration of RSNA Image Share in Booth 8140 in the Technical Exhibition, North Building, Hall B.