SBIR-STTR Award

Ubiquitous and secure access by physicians to a patient's medical records regardless of geographic location has tremendous potential to improve the delivery of medical care along multiple dimensions, yet the lack of a unique patient identifier between institutions remains a critical obstacle. While a national patient identifier was to have been established by the federal HIPAA legislation, opposition from privacy advocacy groups led to the suspension of a notice of proposed rulemaking. Probabilistic record linkage, however, represents a cross-disciplinary set of techniques that should permit reliable identification of patients across institutions in the absence of a unique identifier. Here we propose to study the feasibility of these techniques and quantify their reliability in the context of radiologic records, the only digital medical data for which there is a standard for electronic data interchange. In collaboration with the Hospital of the University of Pennsylvania (HUP), we propose to create a virtual patient "film jacket" across two unconnected picture archiving and communication systems (PACS). Adapting tools initially developed at the US Census Bureau, we will use probabilistic techniques to map unique patients between the two PACS based on the standard demographic data available in the DICOM headers of their imaging studies excluding the medical record number (MRN). We propose to compare this statistical approach to a benchmark of "true matches" represented by HUP's own MRN and use frequency analysis to determine appropriate cutoff values for probabilistic matches and evaluate the discriminatory power of the different DICOM attributes. We will also extend this analysis to additional demographic data stored in HUP's radiology information system (RIS) to evaluate the potential benefit of interfacing with both PACS and RIS and explore system performance as the number of records scales upwards. Phase II of the project, intended as a proof-of-concept to set the stage for commercialization, will involve applying our approach to a far more realistic test case - the creation of a virtual patient film jacket across two unaffiliated medical institutions. Commercialization of this technology will take the form of a radiology-specific global master patient index platform that will enable the creation of seamless, patient-centric virtual file jackets across arbitrary sets of institutions and PACWRIS installations. Such a product based upon non-proprietary, open standards would enable true and practical integration of care delivery between hospitals within an affiliated integrated delivery network or even between unaffiliated medical centers.

We propose to launch the first commercial service enabling physicians at unaffiliated hospitals to directly retrieve their patients' digital images and reports from each other on-demand. Despite significant societal need and market demand, US hospitals remain islands of mutually inaccessible data even as patients move between them. Even the most vulnerable patients remain burdened with carrying their own data from place to place. Radiologist interpretations are impaired without the benefit of historical images for side-by-side comparisons. Other physicians are faced with incomplete information to guide clinical decisions. The problem is only magnified for cancer patients who frequently seek care among multiple providers, inadvertently scattering their records across sites. Any one of such a patient's physicians can access only the subset of imaging data available from his/her island, blunting the impact of imaging on screening, diagnosis and management. In Phase I, we demonstrated the feasibility of a novel approach to clinical connectivity - a peer-to-peer network linking commercial imaging information systems from different vendors across three hospitals in a demanding clinical environment. Efforts to exchange data between hospitals over the last two decades have failed primarily due to their reliance on a central shared data repository. In contrast, our peer-to-peer approach satisfies the privacy, security, data stewardship, trust and independence requirements that competing health systems require to exchange digital clinical data with one another. In Phase II, we will launch the first-of-its-kind local healthcare information infrastructure (LHII), enabling five hospitals among three unaffiliated health systems to directly and securely access each other's digital imaging data. We will focus on the application of this technology to cancer screening, diagnosis and management in particular, and we will develop the additional components required to launch the first such non-proprietary clinical information service built on the basis of open standards. This service will have significant commercial and societal implications for the cost-effective delivery of high quality patient care while bringing to market the first commercial platform to support the federal government's recent call for establishing LHIIs around the country