Taking Control

Personal health record technology is ready, but are patients willing?

My friend is a highly capable, sophisticated, busy, urban professional. Yet she refuses to use online banking or the check-in kiosk at the airport. If you tell her these technologies are designed so she can quickly and efficiently manage her banking and boarding on her own, she’ll tell you she already has enough to “manage.” It’s not so much the technology that bothers her, it’s that she prefers service. She’d rather have a teller or an airline attendant handle her transaction. Clearly, my friend is not going to be among the early adopters of a personal health record (PHR) account.

Image sharing was among the hot topics at this year’s Society for Imaging Informatics in Medicine (SIIM) event in Orlando. I talked with vendors about a variety of specific solutions for health care providers, but I also had conversations with several experts about how image sharing is extending directly to the patient. The pilot program that is leading the way is RSNA’s Image Share project. The objective is to give patients access to and ownership of their diagnostic images and empower them to distribute them as they see fit.

Five major institutions, including the University of California-San Francisco Medical Center, University of Chicago Medical Center, Mayo Clinic, University of Maryland Medical Center, and The Mount Sinai Medical Center, are participating in the image sharing project. Mount Sinai was the first site to go live in August 2011 and has enrolled 220 patients to date. As of now, a total of more than 1,000 patients are enrolled across all the sites, according to David S. Mendelson, MD, FACR, Chief of Clinical Informatics at The Mount Sinai Medical Center and Chief Clinical Investigator for RSNA Image Share.

How does the whole thing work? Cloud technology is the key. Images are stored in the cloud, and to use RSNA Image Share, patients create an account and password and then are given access to import their images and reports into the personal health record. One vendor currently providing PHRs for RSNA Image Share is lifeIMAGE. With a lifeIMAGE Network Cloud Service account—or a LINCS account—patients can instantly access and share their exams with doctors they choose as well as anyone else important to their care plan. Sounds good. No phone tag with the physician’s office trying to track down your imaging exams. No CDs that can easily get lost or damaged.

But how likely is it that the average patient will adopt a personal health record account? Many will be concerned about privacy issues, although vendors insist their networks are highly secure and point to the confidentiality of online banking. Then there are the matters of demographics and personality types. While younger patients and the technologically savvy may embrace the PHR, it is unlikely that most seniors or technologically challenged types will welcome it. Finally, there are busy people like my friend who simply do not want to “manage” another account—of any kind. She sees it as just another laborious task and would prefer the physician’s assistant to handle the sharing of her imaging exams.

But perhaps Dr Mendelson has identified the true early adopters. He says the highest use of Image Share is among patients who have a current or life-threatening medical need such as cancer and therefore need to share their images with multiple physicians at multiple locations. It makes sense. When you have a critical diagnosis, you are acutely aware of time and you feel little is in your control. But taking control and speeding those images along to the right physician just might save your life.