title: Patient-directed Internet-based Medical Image Exchange: Experience from an Initial Multicenter Implementation.
abstract: OBJECTIVE
  Inefficient transfer of personal health records among providers negatively impacts quality of health care and increases cost. This multicenter study evaluates the implementation of the first Internet-based image-sharing system that gives patients ownership and control of their imaging exams, including assessment of patient satisfaction.
  
  
  METHODS
  Patients receiving any medical imaging exams in four academic centers were eligible to have images uploaded into an online, Internet-based personal health record. Satisfaction surveys were provided during recruitment with questions on ease of use, privacy and security, and timeliness of access to images. Responses were rated on a five-point scale and compared using logistic regression and McNemar's test.
  
  
  RESULTS
  A total of 2562 patients enrolled from July 2012 to August 2013. The median number of imaging exams uploaded per patient was 5. Most commonly, exams were plain X-rays (34.7%), computed tomography (25.7%), and magnetic resonance imaging (16.1%). Of 502 (19.6%) patient surveys returned, 448 indicated the method of image sharing (Internet, compact discs [CDs], both, other). Nearly all patients (96.5%) responded favorably to having direct access to images, and 78% reported viewing their medical images independently. There was no difference between Internet and CD users in satisfaction with privacy and security and timeliness of access to medical images. A greater percentage of Internet users compared to CD users reported access without difficulty (88.3% vs. 77.5%, P < 0.0001).
  
  
  CONCLUSIONS
  A patient-directed, interoperable, Internet-based image-sharing system is feasible and surpasses the use of CDs with respect to accessibility of imaging exams while generating similar satisfaction with respect to privacy.
authors.affiliation: Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029. Electronic address: giampaolo.greco@mountsinai.org.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Greco
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California 94107.
authors.forename: Anand S
authors.initials: AS
authors.lastname: Patel
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York 10029.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Lewis
authors.affiliation: Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029.
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029.
authors.forename: Rehana
authors.initials: R
authors.lastname: Rasul
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California 94107.
authors.forename: Mary
authors.initials: M
authors.lastname: Torosyan
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota 55902.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595.
authors.forename: Atheeth
authors.initials: A
authors.lastname: Hiremath
authors.affiliation: Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Moskowitz
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California 94107.
authors.forename: Wyatt M
authors.initials: WM
authors.lastname: Tellis
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595.
authors.forename: Eliot L
authors.initials: EL
authors.lastname: Siegel
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California 94107.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Arenson
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York 10029.
authors.forename: David S
authors.initials: DS
authors.lastname: Mendelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002648:Child; D016250:Compact Disks; D016494:Computer Security; D003219:Confidentiality; D003952:Diagnostic Imaging; D005240:Feasibility Studies; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D033181:Information Dissemination; D020407:Internet; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D017060:Patient Satisfaction; D018907:Privacy; D011859:Radiography; D011873:Radiology Information Systems; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Image sharing; Integrating the healthcare enterprise; Internet; Personal health record