J Am Med Inform Assoc doi:10.1136/amiajnl-2012-001146
  • Research and applications

Patient-controlled sharing of medical imaging data across unaffiliated healthcare organizations

  1. J Jeffrey Carr2
  1. 1Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Yaorong Ge, Department of Biomedical Engineering, Wake Forest School of Medicine, 2nd Floor MRI Building, Medical Center Blvd, Winston-Salem, NC 27157, USA;yge{at}
  1. Contributors YG and JJC were responsible for all aspects of this work, including conceptualization, design, and data analysis and interpretation. DKA and BU performed design, implementation, testing, and data acquisition. HDG focused on data acquisition, analysis, and interpretation. All authors participated in the writing and editing of the manuscript.

  • Received 6 June 2012
  • Accepted 21 July 2012
  • Published Online First 11 August 2012


Background Current image sharing is carried out by manual transportation of CDs by patients or organization-coordinated sharing networks. The former places a significant burden on patients and providers. The latter faces challenges to patient privacy.

Objective To allow healthcare providers efficient access to medical imaging data acquired at other unaffiliated healthcare facilities while ensuring strong protection of patient privacy and minimizing burden on patients, providers, and the information technology infrastructure.

Methods An image sharing framework is described that involves patients as an integral part of, and with full control of, the image sharing process. Central to this framework is the Patient Controlled Access-key REgistry (PCARE) which manages the access keys issued by image source facilities. When digitally signed by patients, the access keys are used by any requesting facility to retrieve the associated imaging data from the source facility. A centralized patient portal, called a PCARE patient control portal, allows patients to manage all the access keys in PCARE.

Results A prototype of the PCARE framework has been developed by extending open-source technology. The results for feasibility, performance, and user assessments are encouraging and demonstrate the benefits of patient-controlled image sharing.

Discussion The PCARE framework is effective in many important clinical cases of image sharing and can be used to integrate organization-coordinated sharing networks. The same framework can also be used to realize a longitudinal virtual electronic health record.

Conclusion The PCARE framework allows prior imaging data to be shared among unaffiliated healthcare facilities while protecting patient privacy with minimal burden on patients, providers, and infrastructure. A prototype has been implemented to demonstrate the feasibility and benefits of this approach.


  • Funding This work was supported by the NIH/NIBIB grant 5 RC2 EB011406.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Wake Forest institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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