Personally Controlled Sharing of Medical Images in the Rural and Urban Southeast

医疗成像是医疗保健的一个重要和昂贵的组成部分，每年每人花费1000亿美元或350美元。卫生信息技术（HIT）被提议作为一种手段，通过更有效和协调的服务来降低成本和改善健康。在卫生需求未得到满足的社区，收益将最大;然而，这些社区提出了独特的HIT挑战。我们提出了一个在美国东南部农村和城市的临床成像数据共享示范项目。 个人健康记录（PHR）的方法是有前途的，作为一个有效的框架，共享医疗信息，然而，成像提出了独特的挑战。现有的方法包括一个集中的存储库，如果扩展到医疗成像，将需要大量的档案和网络基础设施。目前，大多数社区，特别是农村和服务不足的社区都没有这些资源，造成后勤和财政障碍。 我们提出了一种新的方法，我们命名为“个人控制访问密钥注册表”或PCARE。PCARE解决了将大量成像数据从成像提供商移动到集中存档的根本问题。在PCARE范例中，成像数据作为主存档保留在执行成像的提供者处，直到授权的医疗保健提供者需要为止。PCARE是一个安全加密电子“密钥”的中央储存库，取代了PHR档案。这些电子“钥匙”由患者或授权代表直接控制。无论患者、图像或提供者的物理位置如何，患者都可以授予和撤销提供者对其数据的访问权限。成像数据从执行设施直接传送到患者选择的任何提供者可以以选择性和及时的方式发生。该创新充分利用了PHR范例的患者控制性质，并克服了集中式健康记录方法在成像方面的许多缺陷。 其广泛的长期目标是通过改善医疗成像数据的共享来改善医疗保健。有效的共享可以改善诊断，减少不必要的测试和控制成本。具体目标是：（1）分析美国东南部农村和城市的患者、提供者和医疗机构之间医学图像共享的需求、能力和障碍，作为服务不足社区的国家模式。(2)使用PCARE开发用于医学图像共享的患者控制平台，旨在与参与提供者的电子健康记录无缝集成。(3)在农村和城市社区的各种设施中部署PCARE原型系统，用于图像共享，以证明可行性并衡量患者，提供者和其他利益相关者的接受程度。这一概念可以很容易地扩展到电子健康记录的其他组成部分。 公共卫生相关性：医学成像是主要的医疗保健成本，并且当前在提供者之间共享图像数据的策略是不充分的，并且对患者造成更高的成本和负面的健康后果。我们将开发和测试一种新的方法，用于在美国东南部的农村和城市使用个人健康记录（PHR）方法共享医学图像数据，这是一个多样化的地区，有着既定的未满足的医疗保健需求。

DESCRIPTION (provided by applicant): Medical imaging is a critical and expensive component of health care with a cost of $100 billion or $350 per person per year. Health information technology (HIT) is proposed as a means to reduce costs and improve health through more efficient and coordinated services. The gains will be greatest in communities with unmet health needs; however, these communities present unique HIT challenges. We propose a demonstration project of clinical imaging data sharing in the rural and urban southeastern U.S. Personal health record (PHR) approaches are promising as an effective framework for sharing medical information; however, imaging poses unique challenges. Existing approaches include a centralized repository, which if expanded to medical imaging would require substantial archive and network infrastructure. These resources do not currently exist in most communities, especially rural and underserved communities, presenting logistical and financial barriers. We propose a new approach that we have named "Personally Controlled Access key REgistry" or PCARE. PCARE addresses the fundamental problem of moving large amounts of imaging data from imaging providers to a centralized archive. In the PCARE paradigm the imaging data remains at the performing imaging provider as the primary archive until needed by an authorized health care provider. In place of the PHR archive, the PCARE is a central repository of secure encrypted electronic "keys". These electronic "keys" are under the direct control of the patient or authorized representative. The patient can grant and revoke access to providers to their data irrespective of the physical location of the patient, images or provider. The transfer of the imaging data from the performing facility directly to any provider of the patient's choosing can occur in a selective and timely manner. This innovation takes full advantage of the patient controlled nature of the PHR paradigm and overcomes many of the pitfalls of a centralized health record approach in regards to imaging. The broad, long-term objective is to improve health care through improved sharing of medical imaging data. Effective sharing can improve diagnosis, reduce unnecessary testing and contain costs. The specific aims are: (1) to analyze the needs, capabilities, and obstacles for medical image sharing across the spectrum of patients, providers, and medical facilities in rural and urban Southeastern U.S. as a national model for underserved communities. (2) to develop a patient controlled platform for medical image sharing using PCARE, designed to integrate seamlessly with electronic health records of participating providers. (3) to deploy a prototype PCARE system for image sharing in diverse types of facilities located in rural and urban communities to demonstrate the feasibility and measure the acceptance of patients, providers and other stakeholders. The concept could be easily expanded to additional components of the electronic health record. PUBLIC HEALTH RELEVANCE: Medical imaging is a major health care cost and current strategies to share image data between providers are inadequate and cause higher costs and negative health consequences to patients. We will develop and test a novel approach for sharing medical image data using a Personal Health Record (PHR) approach in rural and urban southeastern U.S., a diverse region with established unmet health care needs.