A very insightful article appeared on line today in HealthImaging.com. In it, Dr. Charles Rosen, MD, PhD, professor of neurosurgery at West Virginia University School of Medicine in Morgantown said “the government approach (to meaningful use criteria) seems ignorant of the issues”. He’s right, and I suspect a good many others actually involved with patient care are in complete agreement.
I’ve written a commentary on this subject before. Spending the next 2 to 3 years figuring out how to integrate Lab Results, Medication Histories and Care Summaries into the Electronic Health Repository seems like a lot of misguided effort to replace a FAX machine. As Dr. Rosen points out, “…sharing images presents a greater challenge than contacting another facility to fax documents such as discharge summaries or lab results.” The fact that Dr. Rosen has “…reached out to policymakers several times regarding the subject, with no response or further questions from the committee responsible” is puzzling. Just exactly what is motivating that committee?
If you have been paying any attention to the medical image market of late, you’ve probably noticed Image Sharing products and services popping up like mushrooms after the rain. Apparently a good many companies and Health Care Organizations believe that it is critically important to patient care to gain access to relevant medical image data, not just the associated reports. However, the statement in the article that hospitals and facilities already exchange DICOM images on CDs, which “demonstrate that the images are needed and the data standard works across sites” is a little misleading.
True, the fact that there is a such an effort to exchange images demonstrates the importance of the image data to the patient’s record, but the reason that there are so many new efforts to replace the use of CDs as the transfer mechanism is not because everyone is tired of handling CDs and the Image Sharing movement is simply the new, techno-sexy way to exchange data.
The real problem with the current methods of image exchange based on CD transfers is that they are based on the premise that one vendor’s DICOM is going to be compatible with another vendor’s DICOM. There are numerous real world examples that stand as evidence that this is not entirely true. I’ve written on that subject in this blog as well. The real objective of the new Image Sharing concept is to get the DICOM Image data created by one PACS into a neutral place, where it can be modified to meet the requirements of the recipient PACS. Image Sharing services or products that cannot perform this dynamic data manipulation will not likely be any more successful that the CD exchange methods.
I am very encouraged to see a call for the inclusion of images in the meaningful use discussion sooner rather than later, but I also encourage those proponents not to assume that image exchange is simply a matter of a secure internet connection facilitated by a service or a server. DICOM is not the rigid standard that many believe it to be. There is a lot of room for “interpretation” in the DICOM standard, and most Modality and PACS vendors have taken full advantage of this opportunity to be creative. The successful exchange application will have that something extra in the middle to make the data truly useful on the receiving end. If we succeed in getting image data moved up in the meaningful use schedule, let’s not blow it by overlooking the details.
Whether policymakers wake up and recognize the true importance of image exchange or not, the market already recognizes the value of meaningful image exchange, and the replacement of the CD exchange methodology is long overdue. Washington may not get it right, but the market always gets it right.