Implementation methods of medical image sharing for collaborative health care based on IHE XDS-I profile

Abstract

IHE XDS-I profile proposes an architecture model for cross-enterprise medical image sharing, but there are only a few clinical implementations reported. Here, we investigate three pilot studies based on the IHE XDS-I profile to see whether we can use this architecture as a foundation for image sharing solutions in a variety of health-care settings. The first pilot study was image sharing for cross-enterprise health care with federated integration, which was implemented in Huadong Hospital and Shanghai Sixth People's Hospital within the Shanghai Shen-Kang Hospital Management Center; the second pilot study was XDS-I-based patient-controlled image sharing solution, which was implemented by the Radiological Society of North America (RSNA) team in the USA; and the third pilot study was collaborative imaging diagnosis with electronic health-care record integration in regional health care, which was implemented in two districts in Shanghai. In order to support these pilot studies, we designed and developed new image access methods, components, and data models such as RAD-69/WADO hybrid image retrieval, RSNA clearinghouse, and extension of metadata definitions in both the submission set and the cross-enterprise document sharing (XDS) registry. We identified several key issues that impact the implementation of XDS-I in practical applications, and conclude that the IHE XDS-I profile is a theoretically good architecture and a useful foundation for medical image sharing solutions across multiple regional health-care providers.

Keywords: IHE XDS-I profile; picture archiving and communication system; regional health-care services; solutions for image sharing and exchange.

Fig. 1

The diagram of actors (boxes) and transactions (lines) used in the XDS-I.b profile.

Fig. 2

The architecture, major components and work flows of an XDS-I–based iEHR for image sharing with federated integration.

Fig. 3

Protocols and data flows for: (a) online sharing model in edge appliance, and (b) near-line sharing model in edge appliance.

Fig. 4

Performance comparison of online and near-line sharing models. The time intervals (s) represented by vertical axes (time unit: s) for appearance of the first image of different data series after issuing an ITI-43 request in the IHE X-DS-I–based image sharing platform.

Fig. 5

The architecture, major components, and data flows of the RSNA image sharing network solution.

Fig. 6

The architecture of the grid-based XDS-I image sharing system for regional imaging collaborative diagnosis, integrated with an existing electronic health-care record (EHR) system. There are two service groups (#1 and #2) in this diagram. The collaborating relationship in service group #1 is that hospitals A and C are the requesting hospitals for imaging diagnosis, and hospital B is the responding hospital to perform the final diagnosis. It is the same in service group #2, in which hospital K is the requesting hospital for imaging diagnosis, and hospital F is the responding hospital to perform the final diagnosis. The radiologists in hospitals B and F perform the final reporting. The image manager is the central storage archive, which provides image archiving functions to all hospitals in one district.

Fig. 7

The data models for the cross-enterprise document sharing (XDS) provide and register document set-b. The models are related to submitting the preliminary and final reporting datasets.

Fig. 8

The two new communication services in the interface integration between the grid-based XDS-I image sharing system and the existing EHR system. (a) The image readiness notification allows information to flow from the XDS registry to an existing EHR system. (b) Different mechanisms are shown for a Web-based EHR portal client to access published images from the grid-based XDS-I image sharing system, which is integrated with an existing EHR system.

Fig. 9

Monthly statistical chart of numbers of imaging studies generated in 18 community hospitals in Xuhui district and the number of studies sent to a remote central hospital for both preliminary and final reporting through the iEHR system from January to December in 2014.