The Push for Portals

Tech-savvy patients are embracing hi-tech tools to access their imaging scans. Providers say there are multiple benefits

By Aine Cryts

“There’s a ‘wow factor’” to a 4D ultrasound fetus image,” said Cristine Kao, global healthcare IT marketing director at Carestream Health, Rochester, NY. “While the expectant mother and father might not know exactly what they’re seeing, the image itself brings the future bundle of joy to life for the future parents’ Facebook friends and others in their immediate circle.”

While it’s likely that neither RSNA nor the ACR had Facebook updates top-of-mind when both organizations prioritized patient engagement, the reality is that patients today are more mobile and tech savvy—and that’s the reality across generations.

Need for Patient Engagement Driving Innovation

Enabling patient engagement is the driving force behind RSNA Image Share, which is headed up by David Mendelson, MD, chief of clinical informatics at Mt. Sinai Medical Center, New York. His team’s approach has been to create a solution that’s housed in the cloud and accessible to patients via a secure personal health record (PHR).

Here’s how that works for patients: They find out about the image-sharing portal at their radiologist’s office, then they receive information about getting an image-enabled PHR account, from which they can export exams and reports from the local radiology environment into the cloud.

“Our clearinghouse [holds onto the images for] patients to retrieve. The patient has full control of viewing and distribution of their images. Anywhere there’s an Internet browser, patients can look at images and reports and show those to anyone ‘on the fly.’ We’re moving to smartphones as well. [This portal allows patients to] establish authentication of other people, and patients can provide and remove access privileges,” said Mendelson.

The last—though essential—piece, he says, is the ability for patients to download the entire original DICOM data set. This is important because “you can do a lot looking at JPEGs, but you can do a lot more with DICOM.”

Mendelson and his team are today working with three vendors that provide patients with access to free PHR services. RSNA Image Share has been in existence for about 5 years, and, today, four academic radiology departments and 10 radiology practices are participating, including Advanced Radiology Consultants of Shelton, Conn.

There is no cost to the patient, the provider, or the radiologist, says Mendelson, who notes that the National Institutes of Health has provided two rounds of funding for this venture. The ultimate goal, he says, is to continue to extend that network and hand off the network to a vendor after standards have been established. At that point, the cost should come down to something very reasonable, so the barriers to entry will be few.

Mendelson expects to “hit critical mass” over the next 2 to 3 years in terms of getting standards in place and signing up new patients—so far, about 8,000 patients have signed up. “This isn’t for all patients,” he said. “A good number will embrace this, and standards are important. With everything living on the same infrastructure, we can drive down the cost [of image sharing].”

A Homegrown Solution

Alan Kaye, MD, president and practicing radiologist at Advanced Radiology Consultants, worked with a variety of external consultants and in-house technology experts to create a homegrown imaging portal to serve his practice’s patients. The user name and password-driven imaging portal took about 2 years to develop, is funded by Meaningful Use incentives received from the government, and has signed up at least 1,000 patients a month since providing access to images in February 2014, according to Kaye, who notes that his practice is also involved in RSNA Image Share.

Patients have largely embraced the portal, as have referring physicians, says Kaye. The only concern voiced by referring physicians is that a patient might not show up for their appointment if they see a negative result on a test.

Kaye believes that as healthcare becomes more transparent, metrics and quality are going to become increasingly important to patients. “Patients will have more say in where they go,” said Kaye. “We want our patients to think about how smart their [referring] doctor is in sending them to Advanced Radiology Consultants. To the extent that we engage with patients, they feel better about their referring physician, and both will look to us for the value we provide as radiologists.”

For practices interested in developing their own homegrown imaging portal for patients, Kaye advises that they first consider that radiology is in the business of providing information. “Our job is to take certain kinds of information and make it available for the care of patients. The expeditious flow of accurate and relevant information is probably the most important part of healthcare,” he said.

His practice undertook a gap analysis in order to determine the right way to proceed in the development of their imaging portal—but he also notes that it’s just as important to know that your practice has the in-house talent, direction, and culture that drive this type of technology innovation.                                       

Patients’ Perceptions of Portal Technology

It sounds worthwhile for vendors and others to create technologies for sharing images, but will patients access these image portals? That’s one of the fundamental questions Carestream was trying to answer with a study the company commissioned with IDR Medical, an international marketing consultancy serving the healthcare industry.

In March 2013, IDR Medical conducted an online study of 1,000 patients to determine patient opinions about patient portal technology, in general, and Carestream’s MyVue imaging portal, specifically. The primary focus of the study was to determine how many patients would use MyVue, how they would interact with it, and their satisfaction level with the service.

Some key findings from the study include:

• 68% of respondents were likely to use a patient portal
• 90% of those with children under the age of 18 (31%) would use a patient portal to access their children’s images—even more so than they would to access their own images (83%)
• 87% of respondents perceive value in the ability to access medical images and associated reports.

Somewhat surprisingly, there was enthusiasm across virtually all age groups for the imaging portal use. According to a report¹ published by IDR Medical, “Respondents from 18-60 years of age were consistently high in their ranking of the likelihood of use while results showed that respondents 60+ years of age might be slightly less inclined to use a portal.

However, as younger generations mature and continue to incorporate new technologies into their daily lives, it should be expected that likelihood of use of a patient portal will increase across all age groups. Medical providers should take note of this,” concludes the report.

Based on feedback from the survey, patients seem to be saying that the technology is intuitive and they will continue to use it. As patients accumulate more medical imaging studies within their PHRs, it’s likely that they will start to have concerns about ongoing access to the data, says Kao of Carestream, which sponsored the IDR Medical study.

“Do I own this data? What can I do with this information? Can I send it to my specialists for a second opinion?,” said Kao, who notes that patients are already starting to ask these questions about the best way to leverage image access.

According to this sponsored research with IDR Medical, only 17% of respondents were concerned about security related to the imaging portal. Kao believes that there is doubt among some patients about the use of data within healthcare—she points to “scares” during the 2013 Christmas shopping season with Target and other retailers.

That said, she has found that patients “don’t treat healthcare information as preciously as their money,” and patients need to recognize the importance of protecting that information with safely protected user names and passwords.

Connecting with the Customer

“My highly mobile patients are using Carestream’s MyVue portal to view and share their images,” said Randall Stenoien, MD, CEO and a practicing radiologist at Houston Medical Imaging, who notes that patients are increasingly interested in their diagnostic images, whereas physicians are more interested in their patients’ reports. Approximately 60% of those patients offered access to the patient portal sign up for access, according to Stenoien.

While he isn’t able to quantify this, Stenoien believes that by having access to Carestream’s MyVue patient portal, his patients are more engaged. “They are certainly better informed in the way that they manage their health,” he said. “[These patients] have knowledge of what’s going on in terms of radiation exposure.”

Something he also can’t quantify is the feeling that patients should have—an intangible —that because Houston Medical Imaging provides access to high-quality technology those patients will then feel more confident about the practice, and they’ll be “more likely to come back and see us because they can be online and engaged [with my practice].”

What’s Next?

While his goal was to provide excellent service to patients, Stenoien quickly realized that Houston Medical Imaging also could realize substantial savings with MyVue—to the tune of tens of thousands of dollars during its first few months on the platform and even more over time.

“At some point, we’re going to hit a critical mass when patients expect to get their images and reports using MyVue,” said Stenoien. “When that happens, we’re going to see tremendous cost savings. It just surprised me that we’ve already begun to see some of those costs savings, which I hadn’t expected or budgeted for.”

In terms of what’s lacking with imaging portal technology today, Kao believes the greatest challenge is adoption. “That’s why you see CMS putting a 10% requirement for patient adoption in order to make it work.” She cites the example of the Blue Button Initiative, which encourages patients to understand why their healthcare information should be kept secure and why that information should be accessible to patients.

Over the last 6 months, Carestream has seen more and more patients embracing the company’s imaging platform—and about 50% of those patients are sharing their images, which means the company is well exceeding the CMS average of 10%, according to Kao.

Kao attributes this level of patient adoption to the mature technology and ongoing education of technologists, front-desk personnel, and others who are at the front line when communicating with patients. Patients really want to hear from physicians, says Kao.

“Today, the radiology experience is as follows: Patient goes into an outpatient setting, they get a CT done. They don’t really hear from the practice ever again,” said Kao. She projects that the vast majority of patients who sign up for an image-enabled PHR account will likely return to that practice or hospital, which is critical for the practice of radiology.

“Radiologists are recognizing that collaboration is a huge part of where radiology is going. The ACR is talking about Imaging 3.0, and patient interaction is a huge part of that,” she concluded.

It appears that Mendelson would concur, since the goal of the RSNA Image Share program is to have millions of patients using it. From his perspective, the groundwork needs to be laid, standards established, and then vendors must be secured to further develop and monetize the technology. “This can have the impact that DICOM had 15 years ago,” said Mendelson, who notes that the “next great thing is interoperability.”

What will be truly meaningful for patients is when they have access to their images outside of their geographic area, he notes. Mendelson is excited about the possibilities associated with the development of health information exchanges that are image-enabled—in essence, providing a “national highway” for images and reports across the country. “That’s the long-term goal here,” he said.

Aine Cryts is a contributing writer for Axis Imaging News.

Reference

1. Patient attitudes regarding use and utility of a new patient portal platform. IDR Medical GmbH