4 reasons DICOM needs an upgrade

The Digital Imaging and Communications in Medicine (DICOM) standard for distributing and viewing any kind of medical image may not be the best method for Internet-based multi-organization exchange, according to testimony heard at a recent hearing of the Clinical Operations Workgroup of the Health IT Standards Committee.

According to a recent blog post from FierceHealthIT Advisory Board member John Halamka (pictured), co-chair of the committee and  chief information office at Beth Israel Deaconess Medical Center in Boston, two officials of LifeImage--CEO Hami Tabatabaie and CTO Michael Baglio--testified that image exchange should be divided into two categories: local and long distance.

While DICOM works quite well locally--for modality to PACS connectively within an enterprise--it struggles when used long distance. According to Halamka, the executives argued that  DICOM was "never designed for Internet-based cross organizational imaging sharing;" DICOM images are so large that they weren't designed to work with the firewalls, load balances and security appliances that are now in use.

According to Halamka, Tabatabaie and Baglio also pointed out that:

  • Current imaging standards don't include privacy metadata and that security isn't built in; they suggested future imaging sharing standards should enable applications to restrict image flows according to patient consent and preferences.
  • There should be a web-friendly method to visualize images that isn't operating system specific, so that users can see the images on the device of their choosing without happing to download a special application.
  • EHRs, HIEs and VNA's could eventually replace radiology information systems and PACS if those systems facilitate scheduling, image viewing, report construction, and image and report exchange.

Halamka has long taken a similar stance on DICOM.

"It's refreshing to hear from someone doing the hard work of high volume image sharing that current standards not ideal," Halamka said. " We need new approaches to move payloads efficiently on the internet, view images via web-browsers, facilitate easy searching, support security, and enable multiple provider/patient/group sharing use cases."

To learn more:
- see Halamka's post

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