Images crossing borders: image and workflow sharing on multiple levels

Peeter Ross,Hanna Pohjonen

doi:10.1007/s13244-010-0059-y

Peeter Ross, Hanna Pohjonen

Open Access

https://doi.org/10.1007/s13244-010-0059-y

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Abstract

Digitalisation of medical data makes it possible to share images and workflows between related parties. In addition to linear data flow where healthcare professionals or patients are the information carriers, a new type of matrix of many-to-many connections is emerging. Implementation of shared workflow brings challenges of interoperability and legal clarity. Sharing images or workflows can be implemented on different levels with different challenges: inside the organisation, between organisations, across country borders, or between healthcare institutions and citizens. Interoperability issues vary according to the level of sharing and are either technical or semantic, including language. Legal uncertainty increases when crossing national borders. Teleradiology is regulated by multiple European Union (EU) directives and legal documents, which makes interpretation of the legal system complex. To achieve wider use of eHealth and teleradiology several strategic documents were published recently by the EU. Despite EU activities, responsibility for organising, providing and funding healthcare systems remains with the Member States. Therefore, the implementation of new solutions requires strong co-operation between radiologists, societies of radiology, healthcare administrators, politicians and relevant EU authorities. The aim of this article is to describe different dimensions of image and workflow sharing and to analyse legal acts concerning teleradiology in the EU.

Highlights

The sharing of medical images, relevant clinical data and reports between healthcare organisations or between healthcare organisations and the citizen is changing dramatically: in addition to linear point-to-point connections, the matrix type of many-to-many connections is emerging
In addition to the need for the new models of management of imaging workflow described in the inter-organisational setting the international cross-border setting needs a reliable solution for translating reports, which is currently not commercially available in teleradiology [6]
Sharing of images or workflows can be done on different levels—inside the organisation, between organisations inside the country or across the country borders, and with citizens

Summary

Introduction

The sharing of medical images, relevant clinical data and reports between healthcare organisations or between healthcare organisations and the citizen is changing dramatically: in addition to linear point-to-point connections, the matrix type of many-to-many connections is emerging. Sharing images between the healthcare organisations creates new challenges regarding quality control, trust, workflow management, legal issues, reimbursement and interoperability of electronic patient records (EPR), radiology information systems (RIS) and PACS. The complex legal environment, the need for multiple contracts in the case of point-to-point connections and resource demanding integration of EPR, RIS and PACS has made an inter-organisational shared workflow a demanding task—even despite the availability of internationally agreed IHE standards like XDS or XDS-I. In addition to the need for the new models of management of imaging workflow described in the inter-organisational setting the international cross-border setting needs a reliable solution for translating reports, which is currently not commercially available in teleradiology [6]. This will be obligatory to achieve the anticipated benefits of new data-sharing models in healthcare

Discussion

28. European Commission