By Kurt Woock
The future for Hamid Tabatabaie, lifeIMAGE’s CEO, is clear. “We think the final frontier is a network where any physician using any medical record can look up a patient’s imaging history online, no matter where that imaging took place.” Although a possibility, Tabatabaie says that final frontier is still far from reality. “Imaging exams are kept in relative silos in the facility they’ve been captured in.” With lifeIMAGE, a Web-based solution that facilitates image sharing, Tabatabaie hopes to level the silos and build bridges, connecting facilities across the country.
Making a Better Exchange Environment
The traditional methods of image delivery, CDs and virtual private networks (VPNs), don’t cut it, he says. CDs can be defective, they can be in only one place at one time, and they can be hard to ingest into the facility’s medical record. The VPN approach can be time-consuming for those on the receiving end. Tabatabaie calls these strategies “fire-and-forget.” “They produce images, and then it’s ‘good luck to the recipient!’”
Getting the entire imaging community to run on a seamless online platform is a big goal, Tabatabaie says, but far from impossible. “We’re not delusional,” he said. “There’s a precedent. We went through this with prescriptions. In 2002, less than 50 million electronic prescriptions were online. In 2011, we approached 600 million.”
Tabatabaie says the move to the online prescription model had three distinct purposes. First, the prescribing physician can be informed by the patient history. Second, electronic decision support helps identify any conflict with medication the patient is currently taking. Third, it can act as a fulfillment method. “There’s no reason to think that imaging can’t benefit from the same capabilities,” he said.
Such a system in radiology would have multiple benefits. “If I’m an ordering physician, I can see the type of imaging exams patients have had, which informs my decision of what to order,” Tabatabaie said. “The system will stop me from ordering duplicate exams if one has already been performed in a timeframe that is reasonable. Finally, it allows the orders to go through, perhaps to the destination of an imaging center.”
So why haven’t these systems taken root in radiology as in other fields? “Historically, there has been a business deficit to a network like this,” Tabatabaie said. “That is, radiologists make money on duplicate and unnecessary exams just as if they were original and necessary. There was no reason to submit themselves to a network like this. But now, the winds have changed. They are changing from fee-for-service to value-based. As a result, radiologists, too, have to change and adopt the new approach. The business reasons to avoid a network are going away.” Tabatabaie calls lifeIMAGE a new platform for that new business model.
The lifeIMAGE Solution
Connections, which debuted in November and was released at the end of March, is the lifeIMAGE directory that provides customers access to any other lifeIMAGE customers as well as to noncustomers. “If you’re a hospital that signs up for our services, you simply have a directory where others have made themselves available for image exchange,” Tabatabaie said. “The system works somewhat like LinkedIn. You and I are both on the directory. I ping you to see if you are available. If you approve, we can exchange imaging information.” The difference between lifeIMAGE and LinkedIn is that Connections allows users to ingest the data into their own local systems’ PACS, EMR, or RIS.
The Web-based lifeIMAGE looks like Gmail or Outlook, Tabatabaie says. “It’s not a brand-new look and feel.” Users can choose their viewer or preferred workstation. “It fits within any other application you want to use; lifeIMAGE doesn’t have to be the face of the application. We can simply be the image inside. We are deployed with various EMRs that embed us and various order entry programs. It’s radiology meeting the next-generation of IT for the new business model in radiology.” More than 25,000 users are using the network, and they have exchanged 1.5 million exams. Those who aren’t signed on for lifeIMAGE’s service still can use it—universal access is fundamental to its philosophy. Users with the service can simply create guest presences for people or organizations. Guests can see and download all the data.
A system such as lifeIMAGE relies on a high level of openness in order to achieve the flexibility and usefulness that makes it effective. But because the information is sensitive, it uses a number of security measures. First, lifeIMAGE corroborates the identities of persons and organizations that sign up. Second, lifeIMAGE encrypts the data with a unique key for each transaction. “If you managed to intrude upon one exam, you couldn’t do that with other exams,” Tabatabaie said.
Easing the flow of communications has a direct patient benefit. Patients transferred under trauma settings will benefit when physicians have quick, reliable access to images. The number of redundant exams will be reduced, lowering unnecessary radiation doses. Patients can get second opinions immediately. Patients in rural areas can cut down on unneeded travel time.
Without a doubt, the work at lifeIMAGE is a technical endeavor, but patient care is at the heart of the mission. “We were founded and stay true to our aspirations to make sure imaging exams are not duplicated or ordered unnecessarily,” Tabatabaie said. Whether the consequences of duplicate and unnecessary imaging are counted in radiation dose or wasted labor, everyone—from patients to radiologists to administrators—stands to benefit from reducing these situations.