What happens when a patient wants a copy of their medical imaging?
Years ago, when PACS became the standard, hospitals began downloading digital images unto CDs instead of printing physical films.
As we dive into the digital age, we are beginning to “Ditch the Disk”
Burning a CD is time consuming and requires a physical token (the CD) to be physically transported from institution A to institution B. A courier may be used to transport the CDs. The CD may be handed to the patient who will have to take it with them to their next appointment. Or the CD could be mailed. The CD in itself requires a hospital staff member to burn the physical CD. There are costs associated with this work as well as maintenance of the hardware that creates the CDs. Not to mention the costs of the CDs themselves. Quite frankly it’s expensive. The “Ditch the Disk” initiative becomes clear.
The advent of technology now leans in the direction of transferring images from one institution to another digitally. Greater bandwidth allows an institution to encrypt and send imaging data to another institution.
There are multiple ways to do this
VPN
Hospital A can send to Hospital B by establishing a VPN connection. A virtual private network can ensure the study is sent over a secure connection. A VPN can provide encryption by “tunneling” a secure connection from point 1 to 2 through the internet. This connection will require IT support from both hospitals to establish. If there is a Hospital C that wants to connect with Hospital A, a separate connection will have to be configured. The VPN connection process will need to be configured for each respective Hospital.
Gateway
Hospital A can send to Hospital B directly over secure port 443. This will require hospital A to have a server in the DMZ. This may also require the receiving institution to also receive the images in a DMZ server. DMZ, like demilitarized zone is the middle ground between the hospital’s internal network and the public internet. The DMZ provides security to the internal network. By having an external facing server in the DMZ, a hospital can reduce it’s exposure to attacks from the public internet. A gateway server from Hospital A will need to be installed in Hospital B’s DMZ. The gateway allows Hospital A to send images to Hospital B’s gateway. This connection will require IT support from both hospitals to establish. A server will need to be stood up at Hospital B. Both parties will need to install and configure the gateway connection. Hospital A IT staff will have to support image transfers from the internal network to the DMZ. Then from the DMZ over the internet to hospital B. In addition, Hospital A may be required to support the gateway in Hospital B. This can lead to cumbersome calls and meetings to troubleshoot simple issues since Hospital A may not be given direct network access to the gateway.
Vendor-provided Image Sharing Platform
Hospital A and Hospital B can subscribe to a vendor-supported cloud image sharing service. If Hospital A wants to share with Hospital B, they will send their images from their DMZ to the vendor cloud on port 443. The vendor is responsible for sending that image down to Hospital B into their DMZ. Hospital A is only responsible for sending images to the cloud. The vendor will take care of the rest. This introduces scalability. If a Hospital C or D want to connect with Hospital A, there is no need to configure a connection directly to those hospitals. If Hospital C has the same cloud platform, Hospital A will simply send to the cloud. The vendor cloud will send to Hospital C. To achieve this functionality a vendor-provided gateway can be installed at each site. The gateway from each Hospital will typical be a connection from the Hospital DMZ to the cloud. Each Hospital will be responsible for supporting their own gateway. The Image Sharing vendor will be responsible for getting the images from Hospital A to B within their cloud.