Fierce Q&A: Image sharing project takes time ... and trust

Maine's health information exchange, HealthInfoNet, decided in 2009 not to include medical images because, at an average of 50 megabytes each, they would slow the system to a crawl.

Now it's working through a five-month pilot to create a statewide medical imaging archive, which it says will be a nationwide first. HealthInfoNet, vendor Dell and the pilot group of healthcare organizations will work together over the summer to confirm the system design and integrate the service with existing PACs systems and the exchange. HealthInfoNet expects to expand the service statewide by 2013, as FierceHealthIT recently reported.

In an exclusive interview with FierceHealthIT, Todd Rogow (pictured), director of information technology at HealthInfoNet, discussed the process.

FierceHealthIT: Do you have the right level of participation to make this image exchange truly effective?

Rogow: We hope we do. We have worked for two years to get the major stakeholders on board with the health exchange system. We have the four main hospital systems that account for 1.4 million of the 1.8 million images produced each year in the state.

FHIT: What about private physicians? Do they do their own imaging? Are they involved?

Rogow: Most private physicians send their patients to imaging centers run by the hospital groups. A few of the larger physician practices do their own imaging and we hope to enlist them. But there aren't many.

FHIT: How have you solved the problem that daunts so many image-sharing projects--the massive file size of medical images?

Rogow: There have been improvements in compression and storage. The files themselves are a bit smaller and compression is better, so it's basically just improvements in technology. Plus, the images are going to be stored separately from the clinical decision support network--200 terabytes of storage to begin with for the pilot--so they won't be slowing down the main system. Even if an image is called over for viewing, it won't be stored there. It will be stored in the archive.

FHIT: What other technical issues have come up?

Rogow: We've undergone a two-year process in which we've worked through issues through a rigorous request for information request for proposal process with the member hospital systems involved because they're going to be clients of this vendor, too. We worked through a list of vendors and finally selected Dell.

The images will be hosted in the cloud by Dell, which has data centers in several states. There's a redundancy, so we can tell the hospital systems that even if the system goes down, it won't be down more than 15 minutes.

There's the issue of integration with the various PACS (picture archiving and communications systems) and with the main clinical decision support system. And with EHRs. They're all different, but they're all similar.

Frankly, though, the technical issues are not what worries me most. This system has to save the member hospitals money. We've done significant ROI projections to ensure that it does.

FHIT: What cultural or workflow issues have come up?

Rogow: Because this is simply a back-end system, there really are no workflow issues on the front end. But because providers will no longer have to copy files to CD for patients to carry to another provider, we're estimating significant savings there.

It should allow providers to put the focus on the patient. It should save them from having repeat tests; there's a real health risk from radiation exposure for tests that are unnecessary. And providers can give better care when they have the patient's full history. 

In selecting Dell, we're bringing in a new vendor to us and to the member organizations. There's a level of trust that has to be there, so this pilot is important--not just going statewide right away. It's a time to kick the tires, so to speak, to make sure it works and to build up that trust.

FHIT: What advice would you give to other states or organizations considering such a project?

Rogow: I don't know that I'd do anything differently. I would like for it to go faster, but it's a process that takes time. We've spent two years on this. But you have to bring in all the stakeholders and put in the time to do the due diligence to make sure it's going to work for everyone.

You have to put in the time that takes.

Overall, there has to be a sense of readiness to share data. People have to understand that competing isn't the answer. They're still competing, but on the quality of service they provide, not competing over data.

Editor's note: This interview has been edited for length and clarity.