I was once an x-ray tech at Maine Medical Center. I didn’t have x-ray vision, but I was skilled at aiming a beam of radiation at the appropriate body part. When I first started my training, we developed the x-rays by hand. I still remember the smell of the chemicals in the darkroom. It was a big deal when we switched to automatic processing, but we’d still have to go into the darkroom to unload the film from the cassette and feed it into the processor. Patient’s x-rays were kept in large brown envelopes in the radiology department’s file room. When space got tight old films were carted off to a storeroom someplace else in the hospital. You can just imagine the storage nightmare.

When I read that HealthInfoNet was doing a pilot project to create a statewide archive for radiologic images, it caught my attention. The plan is that x-rays, MRIs, CT scans, mammograms, and other images taken at various facilities around the state will be stored in a single archive. Now that will be one huge file room!

A notable difference is that it will be an electronic file room, because the image files are now digital. We’ve come a long way since those days of hand developing x-rays! But considering that an estimated 1.8 million medical images are generated in Maine every year and that the files can be pretty big, storage space is still a huge problem.

What is HealthInfoNet?
HealthInfoNet is an independent, non-profit organization located in Portland, Maine. Since 2009, HealthInfoNet has managed Maine’s statewide health information (HIE) exchange. The exchange contains electronic medical records for more than one million patients. Right now 25 of the state’s 39 hospitals are connected, as well as 182 physician groups. More, along with behavioral health centers, long-term care facilities, and nursing home providers are signing up to participate. By logging into the HIE, medical providers who have been given access can view their patient’s medical records, including:

  • medication information
  • lab and test results
  • hospital discharge summaries
  • diagnoses
  • allergies
  • radiology reports

The radiology reports may be useful, but the missing link has been the images themselves.

How doctors view medical images these days
Many health care facilities and larger medical practices have their own electronic image archiving systems — they’re called picture archiving and communication systems or PACS. Digital image files are stored in the individual systems and medical providers who have been granted access can log in and view a patient’s images on the computer.

If you aren’t part of a particular system, you can’t access the images, which is an issue for someone like Dr. Shawn Laferriere, the chief radiologist at Cary Medical Center in Caribou. If a patient had images taken elsewhere in the state, he can’t just log in and look at them. It’s a problem, especially when he is trying to interpret new images taken at his hospital and has nothing to compare them to.

“Our job is to be clear and concise with our reports,” he told me over the phone, “but if you’ve got nothing to compare to, then the report can only describe today’s findings. If it’s something that’s a very subtle abnormality and you have no clue how it looked before … well, you don’t want to miss anything, you want to be able to recognize a change early.”

At the same time, he says a provider elsewhere in the state may not be able to access images that were taken at Cary, which can lead to duplicate exams and unnecessary exposure to radiation.

One solution is to burn the images onto a CD and give it to the patient to take to the doctor. Unfortunately, it doesn’t always work. “The rare person will come with a CD or with their films, but probably seven or eight times out of 10 the patient comes with no information at all,” says Dr. Laferriere. Even if the patient does bring a CD, he says it can be useless. “Not everyone’s software works the same on everyone’s computer. If you go to a hospital that is a Mac based institution versus PC you may not be able to open the CD. It might require software the doctors aren’t allowed to download on their computers. It’s not functional or the information you wanted isn’t on it. So sometimes CDs aren’t helpful. It’s a huge hassle.”

The pilot project
HealthInfoNet contracted with Dell, which manages one of the largest cloud-based unified clinical archive systems in the world, to build and operate Maine’s archive. Over the summer Cary Medical Center, Eastern Maine Medical Center in Bangor, and MaineGeneral Health in Augusta will participate in the pilot project to transfer images from all three facilities into the one archive.

Dave Silsbee, IT director at Cary says the first step is linking each hospital’s PACS to the statewide system so they’ll be able to talk to each other. One of the challenges is that not only do providers have their own systems, those systems were likely built by different vendors. Of course, that’s why they’re doing the pilot project — to figure out all the bugs and glitches and get them fixed before they roll it out statewide.

“We’ll have a full time connection to the archive,” says Silsbee. “When our system generates an order for a patient here at Cary, say a CT scan for Dave Silsbee, that message is going to go down to the statewide archive — Cary Hospital just ordered a CT scan. Do you have anything else on Dave Silsbee that might be relevant to that CT that should be pulled back up to Cary’s PACS system for the radiologist to see? If there is, that process will start as soon as the study is ordered.”

Not only will Maine’s health care providers have easy access to images, Todd Rogow, director of IT at HealthInfoNet, says a statewide image archive could save them an estimated $6 million dollars over a seven year period. “The cost savings are on two fronts,” he explains. “One is not having to pay for individual storage and servers to store the images on individual PACS. The second is the handling of the CDs — transferring of images across organizations won’t be necessary once you have people connected to one central repository.”

If all goes as planned, the pilot will end this fall and the new system will be rolled out statewide sometime in 2013. HealthInfoNet believes it will be the first statewide medical image archive in the nation.