I spent an entire morning a few weeks ago shuttling CDs between my father’s cardiologists as his care was being transferred from one hospital to another.
Like many others in the so-called “sandwich generation,” I’m caring for an aging parent as well as my children. It’s a lot for anyone to manage, even a physician like me who knows (as much as it’s knowable) how the health system works. My father has had one cardiac surgery and is now preparing for another. He has had numerous radiology and cardiology imaging studies, and it has fallen on me to play courier, carrying the antiquated disks containing my father’s scans back and forth between providers.
Scenes like this play out thousands of times a day in our nation’s health systems, subjecting patients to what a recent Mayo Clinic paper described as an unnecessary and under-appreciated “burden of treatment” alongside the already heavy burden of illness. Where healthcare interoperability has seen steady progress in recent years, imaging still lags dangerously behind.
Providers routinely produce duplicate x-rays, ultrasounds -- even costly MRIs and CTs -- due to lack of timely access to prior films that are often walled off in Picture Archiving and Communication Systems (PACS). As much as 9% of all medical imaging has been estimated to be unnecessary or redundant. With medical imaging accounting for 10% ($100 billion) of all US healthcare spending, repeat imaging adds significant cost to our already overtaxed system. Beyond the cost and patient burden there’s the impact on patient care and safety. In cases of trauma, it’s been shown that efforts to transfer and upload images between facilities can cause a delay of up to 25 minutes, a life or death difference in some cases.
Fortunately, a growing movement is picking up steam to #DitchtheDisk and drag medical imaging (kicking and screaming) into the 21st century. The #DitchtheDisk Task Force brings together the American College of Radiology and the Radiology Society of North America (RSNA) to advance two key components of medical image sharing: provider-to-provider and patient-mediated exchange.
On the provider-to-provider front, more health systems are embracing Vendor Neutral Archiving and cloud based image management, which allows providers to view, share and store images originating in different systems, breaking down silos and opening up real-time access across clinical networks. The shift to value-based care and payment models is adding new urgency and tailwinds to this effort. With the technology and incentives in place, the next challenge is around defining shared data standards for image exchange. As recently announced, RSNA has teamed up with Carequality and The Sequoia Project to develop improved technical standards for the sharing of medical images. Imaging vendors Ambra Health, Life Image and Philips Healthcare should be commended for leading the charge and adopting these standards into their solutions.
Ironically, on the very same day I was shuttling CDs between my father’s doctors, my newsfeed was lighting up with commentary on the ONC’s recent mandate to give patients digital access to their data. As this important conversation moves forward, we must not forget about imaging. With appropriate privacy measures in place, patients should have easy digital access to view and share their medical images, whether through online portals, a shareable link, or through an App. As Elise Sweeney Anthony, Director of the Office of Policy for the ONC has stated, “If a patient requests their record, and it’s not given to them electronically and for free, that’s information blocking.” The same principle must apply to images. It’s time to #DitchtheDisk.
Ashwini Zenooz, MD is an Abdominal Radiologist and Chief Medical Officer at Salesforce. She leads the #DitchtheDisk Task Force which was established by the American College of Radiology Informatics Commission in conjunction with RSNA in 2018. To participate in the conversation, please share your thoughts using the hashtag #DitchtheDisk on social media.