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6/20/2011
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How Cloud Can Improve Medical Image Sharing

One Texas health system transfers thousands of diagnostic-quality images to caregivers daily, using a secure, high-speed system that meets HIPAA requirements.

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Houston-based Memorial Hermann Healthcare System, has effectively set up a medical imaging exchange in the cloud that helps assure diagnostic-quality images are available at any time throughout the health system.

The Memorial Hermann Image Gateway connects the picture archiving and communications systems (PACS) at all 11 hospitals and 28 imaging centers in Texas' largest integrated delivery network, including the level 1 trauma center at the flagship Texas Medical Center. The platform, a major component of the Memorial Hermann Information Exchange (MHiE), can distribute and manage medical images on behalf of independent physicians and other referring hospitals in southeast Texas.

"It creates a PACS-to-PACS connection by way of the cloud," said Memorial Hermann IS director Robert Weeks.

The network, hosted by DICOM Grid, a Phoenix-based cloud platform founded by neuroradiologists, went live in April at Memorial Hermann hospitals at Texas Medical Center, in suburban The Woodlands, and at more distant facilities in Beaumont and Huntsville, Texas. It has since been rolled out to other facilities, automatically feeding images into the GE Healthcare PACS at each location.

According to Weeks, Memorial Hermann chose the cloud after DICOM Grid demonstrated that it could send huge PACS files at high speeds with adequate security. "From a technology perspective, we were very skeptical about going to the cloud," Weeks told InformationWeek Healthcare. "A DICOM image is infused with PHI," Weeks said, referring to the Digital Imaging and Communications in Medicine standard and to protected health information as defined under HIPAA regulations.

But Weeks said he was sold on DICOM Grid's patented "split-merge" technology that encrypts then strips PHI from medical imaging data before an image goes out over the Internet, then decrypts and re-matches patient identifiers when the image gets forwarded to an authorized viewer. The system also maintains diagnostic quality of images even as files are compressed for faster transmission, Weeks said.

Just as a video on DVD is of good quality but short of high definition, a radiological study on a CD is not diagnostic quality. The Memorial Hermann Image Gateway improves on the practice of saving medical images to CD by keeping the high resolution needed for diagnostic purposes and by making images available on demand at multiple sites, according to Weeks. "We can actually have our radiologists and imaging technicians read from the cloud," he said.

Since the system has been online, Memorial Hermann has been uploading 6,500 studies a night to the cloud, Weeks reported, including 1,500 to 1,800 new images and thousands of historical images, now going back about a year. The huge health system has 50 digital imaging modalities--MRI, CT, X-ray, and other devices--in its emergency departments, all linked to the Memorial Hermann Image Gateway, and the 28 imaging centers produce upwards of 100,000 studies a month, according to Weeks.

Weeks said that the image gateway proved its worth with the very first case it handled. A 10-year-old girl came to Memorial Hermann Beaumont Baptist Hospital, about 90 miles east of Houston, in the middle of the night with a broken hip. It was determined that she needed to be transferred by air to the trauma center at Memorial Hermann Texas Medical Center. Images taken at the Beaumont ER were automatically routed to the trauma center's PACS.

"Prior to [the patient's] arrival, we were able to examine the studies and plan our plan of care," Weeks said. "We were ready when she arrived." Having the images from the referring site also eliminated the need to perform duplicate tests and saved the young patient from receiving unnecessary extra radiation, according to Weeks.

Trauma transfers are the first of three use cases for Memorial Hermann's cloud-based imaging. The others include any referral involving imaging and as a real-time backup to any PACS installation in the health system, Weeks said.

Future plans call for making the network available to outside organizations via the MHiE. Weeks envisions any healthcare provider with proper credentials being able to access to the imaging exchange directly from a PACS or through a Memorial Hermann Web portal.

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.

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