Volume 192 - Issue 12
Bridging the communication gap between public and private radiology services
Authors: Nicholas J Ferris, Philip J Dubois, Christopher Lindop, Vincent B McCauley and Peter A MacIsaac
Med J Aust 2010; 192 (12): 723. || doi: 10.5694/j.1326-5377.2010.tb03717.x
Published online: 21 June 2010
Published online: 21 June 2010
To the Editor: The recent clinical update by Chakera and colleagues highlights the problems and adverse patient outcomes that occur when current and prior diagnostic images are not accessible during the clinical care process.1 While the article describes a locally crafted, tactical, information technology (IT) solution, it fails to mention that much work has been done internationally to create a standards-based, scalable architecture for image and document exchange.
This work has been done by Integrating the Healthcare Enterprise (IHE) (http://www.ihe.net), a global collaboration between health care equipment suppliers, IT experts and clinicians. The aim of the collaboration is “to improve the way computer systems in healthcare share information”. The profile for cross-enterprise document and image sharing is known as XDS-I. XDS-I defines how to use established health care and IT standards (eg, the Digital Imaging and Communications in Medicine [DICOM] and Health Level 7 [HL7] standards2,3) to facilitate secure exchange of health care information, including images, between health care institutions.
Information exchange is independent of the hardware and software in place at the participating institutions, and system integration using XDS-I supports user needs, including security and privacy, while streamlining workflow. Using a single technical approach, implemented at a regional or state level, diagnostic images can be exchanged, along with documents such as radiology and laboratory reports, discharge summaries, and even general practitioner care plans. Providers can, with patient permission at the time of care, access such documents via secure internet connections.
The solution developed by Chakera and colleagues covers Western Australian public hospitals and parts of the private sector. XDS-I is a platform that also allows image sharing between the public and private sectors, regardless of the picture archiving and communication system adopted by participating practices or hospitals. Many of the operational problems identified in the article by Chakera and colleagues (consent, staff time costs and manual processes) have been addressed in the IHE XDS-I profile.
While projects such as the pilot program by Chakera and colleagues are useful learning exercises, locally crafted single-vendor solutions (even those using industry standards) are rarely scalable to broader usage. We strongly commend the IHE XDS-I model to everyone considering image exchange systems in Australia.
Competing interests
Christopher Lindop is Co-Chair of IHE Radiology Planning Committee and IHE Technical Committee. Vincent McCauley is Chair of IHE Australia, Treasurer of the Medical Software Industry Association, a volunteer for HL7 Australia, and a consultant for the National eHealth Transition Authority. Peter MacIsaac is Secretary of IHE Australia.
References
- Chakera T, Nagree Y, Song S, Jones P. Bridging the communication gap between public and private radiology services. Med J Aust 2009; 191: 558-560. 0_CACJDFIE
- National Electrical Manufacturers Association. Digital imaging and communications in medicine (DICOM). Rosslyn: NEMA, 2009. ftp://medical.nema.org/medical/dicom (accessed Mar 2010).
- HL7 organisation. Health Level 7, a standard for electronic messaging in healthcare. http://www.hl7.org/implement/standards/index.cfm (accessed Mar 2010).