In radiology, the exchange of electronic health records (EHR) translates to access to a patient’s prior imaging history being available to help improve the quality of the patient’s current diagnosis and/or treatment.
At RSNA 2006, the technology to share patient information and images is being demonstrated by vendors using the IHE integration profiles such as XDS-I (Cross-enterprise Document Sharing for Imaging). The profiles and technology utilize the DICOM and HL7 standards to transfer data as needed in the Affinity Domain, the network of care sites.
The actors of the Affinity Domain include a Patient Identifier Cross-reference (PIX) Manager, a Document Registry, a Document Repository, Document Consumer, and Document Source. A Source is able to post text, PDF, or KOS (Key Object Selection) documents to the Repository. The KOS document is a manifest that details the metadata needed to access the image from the Source. A Consumer can query the Repository for these documents.
In both cases, the actors must query the PIX Manager using the HL7 standard to retrieve the Domain’s global patient ID. The Source actor would use this patient ID as a part of the document(s) to be posted. For the Consumer, the next step is to query the Registry to retrieve a list of all the documents associated to the global patient ID. This list would include the location of the document in the Repository. With the needed location information, the Consumer can then query the Repository for the documents. For KOS documents, consumers use the metadata in the document to initiate the image retrieval from the Source, using standard DICOM or DICOM-WADO.
The technology is ramping up; however, the political and financial hurdles need to be overcome. As with any regional health information organizations (RHIO), provider sites wanting to participate will need to establish agreements for various aspects of the Domain. These aspects include HIPAA related issues as well as access, authentication, and audit trails. On the financial end, the parties must find the resources to fund the efforts which would include purchasing an EMPI (Enterprise Master Patient Index), a registry or registries, and a central repository plus their on-going maintenance.
With these types of RHIO implementations that utilize the IHE profiles, the vision of a national EHR will eventually be reality.