Hammering the final imaging interoperability nail.

  While the rest of the medical world suffers a lack of EMR interoperability because there is no standard for the export of complete patient information (!), we, in imaging, are hampered by more mundane matters. As has been true for the past 30-odd years, Medical Imaging is way ahead in the development of interoperability standards (DICOM) and technical frameworks (IHE).

  Intraoperability of imaging within an enterprise is very mature. Transferring images between providers and enterprises via a patient transported CDROM and its subsequent importation into the destination system has been available for decades. Technical frameworks for the direct, electronic interoperability of imaging studies across enterprises have existed for many years. There are ongoing, multi-institution, multi-vendor demonstrations of this interoperability.

  BUT, in the real world, outside the demonstration, commercial, direct, electronic image sharing across enterprises does not occur. None of the commercial medical image sharing vendors, large or small, federate with each other despite the fact that they may do so as part of the demonstration project. Shame on them. When we write checks to one another or otherwise transfer money, our individual banks are federated to each other and through clearing houses to make the transaction work. Similarly, when EMR systems place e-prescriptions, these transactions go through clearing houses to reach the pharmacy of your choice. If these institutions have identified the business model that facilitates these exchanges, then why haven't our vendors done similarly? As I have written before, this is because of market driven engineering. Vendors will only implement that for which their customers demand. So when you go out to subscribe to an image sharing vendor's service, insist on federated (IHE XDS-i.b) exchange. If only there were a national office to coordinate health care IT that could coordinate this nail into place.