In a recent note, I proposed the idea of developing cloud-based central repositories to store radiology reports and images as a way to avoid redundant testing. Before new studies were ordered for patients, at least in theory, such repositories could be queried to search for prior studies. My note was prompted by a comment to a previous note discussing the increasing cost of imaging studies in the U.S. Mark Cox, an astute observer of the global LIS industry who works for Sysmex in New Zealand, responded to my second note with the following comment:
In NZ this is a key focus and justification for a number of projects. Have a look at http://www.testsafe.co.nz/ & http://www.testsafe.co.nz/
images/testsafe_diagram_ webready.png This is a system set up that contains all pathology (hospital and community), and radiology [reports] for a region. In this case Auckland with a population of 1M. Soon to be added is community Pharmacy dispensing which will have all drugs ordered by a GP and dispensed at the local pharmacy. One of the key justifications for this project was retesting when patients moved from one hospital to another or from secondary to primary care....[T]his is one of the big advantages of living in a socialised environment where the government can invest in regional clinical data repositories.
Here is summary of the New Zealand TestSafe central repository copied from his first link:
TestSafe is part of a regional initiative by the three Auckland DHBs [District Health Boards]...to improve information sharing among community and hospital healthcare providers for the benefit of patients. TestSafe gives healthcare providers access to diagnostic results and reports for their patients. It brings together results from DHB facilities and community laboratories and work is underway to include medications dispensed by community pharmacists. TestSafe helps healthcare providers 'complete the picture' so they provide the best care to their patients.
When I previously raised the topic of centralized health data repositories, I purposely avoided a discussion of exactly who (i.e., what authority or organization) would provide such a service. Although the federal government in the U.S. would seem to be a likely choice, this seems to be highly unlikely to me. Firstly, the government will have its hands full for at a decade or more delivering on its promise of guaranteed healthcare for a wider swath of the population . Secondly, I am not sure that a large percentage of our population would feel comfortable with the government holding their health records, although I personally think that it would be a more reliable steward than certain health insurance companies. At least one of the latter does not have an enviable record of being a good steward of such data. I don't know to what extent we can learn from the New Zealand experience. The country had a total population of only 4,143,279 in 2006 -- fewer people than live in some of our major cities. One promising sign of progress in this area is that there is a large and growing literature in radiology about image exchange.