"Many hospitals are using tablet computers today - at the bedside, in the emergency room, and the physicians are carrying them," says Long. "I think the iPad is the next generation. The risk is- at what point is the information too much information? Information with no context is in many cases worse than no information."

Even now there are applications to view diagnostic images via compact mobile devices such as the iPhone or iPad. To date, these technologies are not to be used to make clinical decisions, but one day that may change.


"It's very conceivable that these mobile devices and platforms that are getting smarter, but are not full computers, have the capacity to actually provide a diagnostic quality image," says Kulbago. "There are going to have to be people that make that determination."

Health information exchanges

Developers are not only working to get health information to more handheld technologies, but they are deploying technologies that enable images to be moved easily across vast health information exchanges between medical facilities. This is where concepts like cloud computing and zero-download, zero-client, and thin client technologies really take off. This applies to many departments within the hospital.

"Our IMPACS data center is a medical imaging repository for images that are created in all kinds of diagnostic and clinical imaging departments, such as ophthalmology, dermatology, pathology and cardiology and every other 'ology," says Reznick. "There's no software download required now to view the images - we don't send the images; we use Web 2.0 technologies to stream data to users."

The engine behind health information exchanges, whether between disparate systems within the same facility, or between institutions, is a painstakingly developed set of standards profiles agreed upon by member organizations and vendors within the industry. These standards make very complex information exchange possible by establishing a language that is recognized by all players. The people behind the IHE, aka Integrating the Healthcare Enterprise, call this process "testing the interoperability."

"One of the most public ways, and the way that a lot of big hospitals do it, is through the IHE profiles and the XDS - the standards-based interchanges," says Kulbago. "They hook up their HIS system to their RIS and their PACS system and they are all using HL7 to talk to each other."

Cross Document Sharing, or XDS, is a profile of the IHE, and HL7, aka Health Level Seven International, the international authority on health information system interoperability, with members from more than 55 countries. Another standard that has become synonymous with imaging and PACS is DICOM, which stands for Digital Imaging and Communications in Medicine. As the industry and its technology evolves, so too will the standards.

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