Cloud-based Medical Image Storage Needs Work

CHICAGO -  In the beginning, there was film, and it was good.

Then came the CD, and it was better.

Now, it’s time for the cloud, and it could be better still for the storage of medical images - if the industry can work out standardization issues, privacy concerns and potential security problems.

A session at RSNA 2012 tackled the potential of storing and sharing images online in the session, “IHE: Getting Images from the Department to The Enterprise to The Cloud.” The verdict? Using the cloud could help reduce waste and inefficiency, but it takes work.

Why? “There’s no such thing as a one-size-fits-all model,” said Christopher Lindop of GE Healthcare, speaking at the session. Any organization is going to have to tweak the system to meet their needs. The industry is trying to smooth the way with IHE, or Integrating the Healthcare Enterprise. The goal is to use established standards to help everyone’s systems talk to each other. But there’s still a way to go.

The Cleveland Clinic is implementing a cloud-based imaging storage and distribution system that goes way beyond radiology. Albert Edwards, director of IT clinical integration and interfaces at Cleveland Clinics, joked that the project should be named “No image left behind.” That means radiology, cardiology, optometry, dental - the list goes on.

Some of those departments aren’t following the same standards as everyone else, Edwards said. While many departments capture DICOM images, others use MPEGs, JPEGs or even PDFs. These images don’t have the metadata to make them easily searchable.

And searching for images is the whole point, said David S. Mendelson, MD, chief of clinical informatics at The Mount Sinai Medical Center. “When a radiologist gets an abnormal exam, the first question they ask is where’s a historical exam I want to compare it,” he said. So the ideal cloud-based solution would let doctors call up those historical images quickly and easily.

Another area where cloud-based image management may help is in reducing unneeded and duplicate images. “The rising cost of healthcare can be attributed in part to extensive imaging, and we have to bring those costs under control,” Mendelson said. “There are some estimates that 20 percent of imaging performed in the United States is inappropriate. Part of it is due to lack of accessibility of an exam.”

Consider a patient who had a CT scan done two weeks ago. He shows up at another provider’s office, but he doesn’t have the original scan. So the clinician decides to do another scan right now, just because the original scan isn’t on hand.

Mendelson and his team at Mount Sinai are working on a cloud-based solution called Personal Health Records. It’s based on a banking model: the patient owns his records and can distribute them to new health care providers as needed. The patient has an access code, like an ATM card, and can retrieve his records from any computer. When he’s meeting with a new doctor, he can pull up the records quickly and easily.

This sort of solution needs work, Mendelson admitted. Vendors need to produce software and equipment to common standards, and the industry hasn’t agreed to that yet. Security is a concern, as are HIPAA regulations. But the promise of instant historical images anytime, anywhere is great enough that these obstacles won’t stop the move into the cloud.