John Halamka, CIO of Beth Israel Deaconess Medical Center (BIDMC) in Boston, had a personal experience recently that showed why the Digital Imaging and Communications in Medicine (DICOM) standard for transmission of medical images is not sufficient when it comes to cross-organization information exchange.
In a recent blog post, Halamka explains that his wife Kathy needed a follow-up visit following a breast cancer exam, and wanted to send her mammogram from her local hospital to BIDMC. It turned out that the only way to do it was to pick up a CD that contained the mammogram and the correct viewer and physically take it to BIDMC herself.
Halamka says that DICOM was created to move images across radiology systems within an organization. However, he said, "It is not sufficient for a healthcare information exchange world that uses the Direct implementation guide ... for content exchange among organizations. The fact that vendors such as LifeImage, Accelarad, and Merge Healthcare have created their own image sharing networks suggests that more standards work is needed to create an open ecosystem of image sharing among organizations."
Here's what would be required to create a true image-sharing capability that would eliminate physical transportation of storage media, according to Halamka:
- A DICOM implementation guide to mandate vendor-neutral content in imaging messages--including a basic set of metadata that would work with any viewer (Siemens, Afga, Philips, GE, Kodak, etc.).
- That vendor-specific/proprietary data be stored separately from vendor-neutral content, so that proprietary extensions of DICOM would not impede generic viewers.
- EHRs with vendor-neutral DICOM viewers being all that a clinician needs to receive and view images. No organization should be required to have a Picture Archiving and Communications System (PACS) for clinicians to view images sent by another organization.
Halamka promises that the Healthcare IT Standards Committee, a federal advisory body, will take up DICOM standards in its spring session. Of course, he can carry out that commitment, since he's co-chair of the committee.