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

描述(申请人提供)：医学成像是医疗保健的关键和昂贵的组成部分，费用为每人每年1000亿美元或350美元。健康信息技术(HIT)被提出作为一种通过更高效和更协调的服务来降低成本和改善健康的手段。在卫生需求未得到满足的社区，收益将是最大的；然而，这些社区面临着独特的冲击挑战。我们提出了一个在美国东南部农村和城市共享临床影像数据的示范项目。 个人健康记录(PHR)方法作为共享医疗信息的有效框架很有希望；然而，成像带来了独特的挑战。现有的方法包括一个集中的存储库，如果扩展到医学成像，将需要大量的档案和网络基础设施。这些资源目前在大多数社区都不存在，特别是农村和服务不足的社区，造成了后勤和财政上的障碍。 我们提出了一种新的方法，我们将其命名为“个人控制的访问密钥注册中心”(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，成像数据作为主要档案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取代了PHR档案，成为安全加密的电子“钥匙”的中央储存库。这些电子“钥匙”由患者或授权代表直接控制。无论患者、图像或提供商的物理位置如何，患者都可以向提供商授予和撤销对其数据的访问权限。将成像数据从执行设施直接传输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。这一创新充分利用了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陷阱。 广泛的、长期的目标是通过改善医学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、减少不必要的测试并控制成本。具体目标是：(1)分析美国东南部乡村和城市患者、提供者和医疗机构之间的医学图像共享的需求、能力和障碍，以此作为服务不足社区的全国样板。(2)使用PCARE开发患者控制的医学图像共享平台，设计与参与提供商的电子健康记录无缝集成。(3)在农村和城市社区的不同类型的设施中部署用于图像共享的PCARE原型系统，以演示其可行性并衡量患者、提供者和其他利益相关者的接受度。这一概念可以很容易地扩展到电子健康记录的其他组件。 公共卫生相关性：医学成像是一项主要的医疗保健成本，目前在提供者之间共享图像数据的策略不足，并导致更高的成本和对患者的负面健康后果。我们将在美国东南部的农村和城市开发和测试一种使用个人健康记录(PHR)方法共享医疗图像数据的新方法，该地区是一个多元化地区，有既定的未得到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.