Is it feasible to bring the instantaneous responsiveness of platforms like Instagram to the realm of radiology? Dive into the challenges and innovative solutions that could transform global medical imaging.
In the rapidly evolving digital age, the healthcare sector, particularly radiology, faces the challenge of adapting decades-old technology to meet contemporary standards. The idea of a global medical imaging application that combines the ease of use and instant access of social media platforms like Instagram with the stringent requirements of medical data is compelling. And when I say this, I don't mean just another JPG-based mobile app, pretending to do real clinical work, but actually the real thing including full medical image data and viewing capabilities on medical formats such as DICOM.
But is such a leap technologically and legally possible? This blog post explores the hurdles and potential solutions that could make this vision a reality.
The Challenge
Radiology's transition to a global digital platform comes with a unique set of challenges that must be addressed to ensure success. Key success factors include:
Data Ownership: Users and institutions must maintain control over their medical imaging data, knowing exactly where it is stored, and processed and who has access to it.
Instant Accessibility: The ability to access imaging data instantly from anywhere in the world is crucial to evolving the field by enabling a true Global Medical Imaging experience.
ALCOA+ Compliance: Every access and manipulation of data must be traceable and auditable to comply with stringent regulatory standards from the perspectives of patient safety, clinical performance and data security and privacy.
Flexible Data Management: Depending on the use case, the medical imaging data may need to be anonymous, pseudonymous, de-identified, or fully identified, requiring adaptable configuration and processing at the point where the data leaves the hospital and later on inside the cloud solution.
The Technical Hurdles
Developing a system that can deliver radiology images with the speed and simplicity of Instagram globally involves overcoming significant technical barriers:
Cloud-Native Challenges: Many state-of-the-art medical imaging viewers are not designed for cloud environments. These solutions, whilst providing the very best of clinical functionality, are likely to put sticks in the wheels of an application aspiring to scale to a global presence. However, rewriting this software from scratch would most likely mean a multi-year activity that may never catch up with the leaders.
Handling DICOM Data: The DICOM standard, while pivotal in radiology, does not align well with technologies that accelerate global data access like CDNs and caching because of its large data volumes and sensitivity. Significant architectural and domain-driven work is required to overcome simplistically the frontier between the two worlds.
Security Concerns: DICOM's security features are outdated when considering it as a networking protocol, and while incremental improvements exist such as DICOMweb, they are inconsistently supported across the industry and cannot be fully depended on as a "catch-all" solution.
Edge Infrastructure Requirements: Inevitably, anyone setting out to overcome this challenge, will end up realizing that a hospital edge gateway will be required to take care of the many privacy and data sensitivity-driven concerns. Modern hospitals often rely on local VMware clusters that are optimized for local-scale applications. This becomes the available deployment environment for the edge gateway node which must be designed to be efficiently managed, monitored, and maintained within this ecosystem.
The Legal Obstacles
Adhering to privacy laws such as GDPR and HIPAA introduces legal complexities that must be navigated carefully. From the perspective of a person with deep insight to how modern web applications are built, some of the actual rulings from the courts such as the ECJ, make very little sense. We nevertheless have to live with these boundaries and design our application in such a way that we can explain very clearly and simplistically how we achieve compliance with the law.
Defining Data Transfer: Legal precedents vary, but some interpretations suggest that viewing content on the web does not constitute personal data transfer, whereas others, like CDN caching, definitely do. In these legal/technical muddy waters, we have to define a clean and explainable architecture we can simplistically explain and also wholeheartedly stand behind as we believe it's the right thing to do.
Design Considerations: The application's architecture must therefore separate the concerns of data persistence and processing from viewing to be able to comply with the strictest privacy laws and still achieve its overarching target of becoming a true Global Medical Imaging platform.
Wrapping Up: Instagram for Radiology?
While the hurdles are significant, the potential benefits of a globally accessible, Instagram-like platform for radiology could be transformative. We can enhance clinical, educational, and research capabilities across borders by simplifying access to imaging data. The journey towards this vision is already underway, and the possibilities are boundless.
Let’s embark on this exciting journey together and witness the transformation of medical imaging firsthand. Join us to see the progress and be part of this revolutionary change firsthand!
Pär Kragsterman, CTO and Co-Founder of Collective Minds Radiology
