Social and Economic Isues in Imaging| Volume 23, ISSUE 2, P237-244, February 2016

Patient-directed Internet-based Medical Image Exchange:

Experience from an Initial Multicenter Implementation
Published:November 25, 2015DOI:

      Rationale and Objectives

      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.

      Materials and 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.


      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).


      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.

      Key Words


      PHI (protected health information), CD (compact disc), PHR (personal health record), ISN (Image Share Network)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mendelson D.S.
        • Bak P.R.
        • Menschik E.
        • et al.
        Informatics in radiology: image exchange: IHE and the evolution of image sharing.
        Radiographics. 2008; 28 (Epub 2008/09/06): 1817-1833
        • Bodenheimer T.
        Coordinating care—a perilous journey through the health care system.
        N Engl J Med. 2008; 358 (Epub 2008/03/07.): 1064-1071
        • Kuperman G.J.
        Health-information exchange: why are we doing it, and what are we doing?.
        J Am Med Inform Assoc. 2011; 18 (Epub 2011/06/17): 678-682
        • Orszag P.R.
        Evidence on the costs and benefits of health information technology.
        (Statement of the Director of the Congressional Budget Office)2008
        • Ge Y.
        • Ahn D.K.
        • Unde B.
        • et al.
        Patient-controlled sharing of medical imaging data across unaffiliated healthcare organizations.
        J Am Med Inform Assoc. 2013; 20 (Epub 2012/08/14): 157-163
        • Hagiwara H.
        • Nemoto A.
        • Inoue T.
        Burden on university hospitals of handling Portable Data for Imaging (PDI) media.
        Appl Clin Inform. 2014; : 46-57
        • Erickson B.J.
        Experience with importation of electronic images into the medical record from physical media.
        J Digit Imaging. 2011; 24 (Epub 2011/02/03): 694-699
        • Mendelson D.S.
        • Rubin D.L.
        Imaging informatics: essential tools for the delivery of imaging services.
        Academic radiology. 2013; 20 (Epub 2013/09/14): 1195-1212
        • Kaelber D.C.
        • Jha A.K.
        • Johnston D.
        • et al.
        A research agenda for personal health records (PHRs).
        J Am Med Inform Assoc. 2008; 15 (Epub 2008/08/30): 729-736
        • Gadd C.S.
        • Ho Y.-X.
        • Cala C.M.
        • et al.
        User perspectives on the usability of a regional health information exchange.
        J Am Med Inform Assoc. 2011; 18: 711-716
        • Langer S.G.
        • Tellis W.
        • Carr C.
        • et al.
        The RSNA image sharing network.
        J Digit Imaging. 2014; 28 (Epub 2014/07/20): 53-61
        • Blumenthal D.
        • Tavenner M.
        The “meaningful use” regulation for electronic health records.
        N Engl J Med. 2010; 363 (Epub 2010/07/22): 501-504
        • Flanders A.E.
        Medical image and data sharing: are we there yet?.
        Radiographics. 2009; 29 (Epub 2009/09/17): 1247-1251
        • Mandl K.D.
        • Szolovits P.
        • Kohane I.S.
        Public standards and patients' control: how to keep electronic medical records accessible but private.
        BMJ. 2001; 322 (Epub 2001/02/07): 283-287
        • Johnson A.J.
        • Frankel R.M.
        • Williams L.S.
        • et al.
        Patient access to radiology reports: what do physicians think?.
        J Am Coll Radiol. 2010; 7 (Epub 2010/04/07): 281-289
        • Keselman A.
        • Slaughter L.
        • Smith C.A.
        • et al.
        Towards consumer-friendly PHRs: patients' experience with reviewing their health records.
        AMIA Ann Symp Proceed. 2007; (Epub 2008/08/13): 399-403
        • Wen K.Y.
        • Kreps G.
        • Zhu F.
        • et al.
        Consumers' perceptions about and use of the internet for personal health records and health information exchange: analysis of the 2007 Health Information National Trends Survey.
        J Med Internet Res. 2010; 12 (Epub 2010/12/21): e73
        • Tang P.C.
        • Lansky D.
        The missing link: bridging the patient-provider health information gap.
        Health Aff (Millwood). 2005; 24 (Epub 2005/09/16): 1290-1295
        • Johnson A.J.
        • Easterling D.
        • Williams L.S.
        • et al.
        Insight from patients for radiologists: improving our reporting systems.
        J Am Coll Radiol. 2009; 6 (Epub 2009/11/03): 786-794
        • Ball M.J.
        • Costin M.Y.
        • Lehmann C.
        The personal health record: consumers banking on their health.
        Stud Health Technol Inform. 2008; 134 (Epub 2008/04/01): 35-46
        • Delbanco T.
        • Berwick D.M.
        • Boufford J.I.
        • et al.
        Healthcare in a land called PeoplePower: nothing about me without me.
        Health Expect. 2001; 4 (Epub 2001/08/09): 144-150
        • Whiddett R.
        • Hunter I.
        • Engelbrecht J.
        • et al.
        Patients' attitudes towards sharing their health information.
        Int J Med Inform. 2006; 75 (Epub 2005/10/04): 530-541
        • Tang P.C.
        • Ash J.S.
        • Bates D.W.
        • et al.
        Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption.
        J Am Med Inform Assoc. 2006; 13 (Epub 2005/12/17): 121-126
        • Yamin C.K.
        • Emani S.
        • Williams D.H.
        • et al.
        The digital divide in adoption and use of a personal health record.
        Arch Intern Med. 2011; 171 (Epub 2011/03/30): 568-574
        • Wyatt E.
        Most of U.S. is wired, but millions aren't plugged in.
        New York Times. 2013 (2013 August 19)