November 2009 | | Issue 11

Too Big to be Shared

Clinical image information, such as EEGs, X-rays and echocardiograms, now speeds from distributed organizations to specialists.

According to David Boyer, Clarian's video architect, one of the reasons Clarian sought a secure file-transfer solution was to provide its rural partners greater access to pediatric neurologists located in Indianapolis.

Collaboration and sharing of patient data between physicians and clinicians is common practice for most healthcare organizations. At Clarian, a private, non-profit organization in Indiana offering a broad base of tertiary services, specialized pediatric care and a level-one trauma center, it is the driving force behind the organization's aggressive telemedicine program. Yet, with clinical information - such as EEGs, X-rays, echocardiograms and sleep studies - producing digitized images ranging in size from 40 MB to 100 MB, these files were too big to be shared via e-mail. As a result, patients had to drive long distances (sometimes up to four hours) to see a specialist, or wait for the medical information to be copied to a CD or DVD and mailed. The process was inconvenient for patients and physicians, and delayed treatment.

David Boyer, Clarian's video architect in charge of identifying and implementing tools that allow for collaboration of digital data, knew there had to be a better way. Following a meeting with the telemedicine team, he set out to find a solution that would offer a more-efficient way for physicians and clinicians in various locations to securely share large clinical files in near real time.

Dr. Omkar Markand, emeritus professor of neurology at Indiana University in Indianapolis, says, "As soon as I see the EEG, I review the report and render a diagnosis in less than an hour."

"A physician's priority is very simple: patients," explains Boyer. "They do not have the time or inclination to deal with complex technology. Therefore, finding a solution that was easy to use, met Clarian's strict security requirements and had tracking and reporting capabilities to meet government mandates was a top priority."

Advances in technology are paving the way for healthcare organizations to remove geographic boundaries restricting patient care. For geographically dispersed organizations such as Clarian, the ability to securely share large digital images and confidential patient data in near real time has improved how staff cares for patients, according to Boyer.

Boyer set out to find the ideal file-transfer solution for his customers. Through a basic Internet search, Boyer was able to narrow down his options, with only the Accellion Managed File Transfer solution able to meet all of his criteria. In 2007, Boyer rolled out the Accellion solution to Clarian's telemedicine team.

One of the reasons Clarian sought a secure file-transfer solution was to provide its rural partners greater access to pediatric neurologists located in Indianapolis. Prior to implementing Accellion, physicians and technicians in rural areas had to burn an EEG onto a CD or DVD, package it and physically ship it to specialists in Indianapolis. The entire process, from when the EEG was originally administered to when neurologists had it loaded and ready to read, took upward of three days.

According to Dr. Omkar Markand, emeritus professor of neurology at Indiana University in Indianapolis, "For a patient, waiting three days for a diagnosis seems like an eternity, especially when dealing with an emergency situation - like a seizure or other abnormal behavior - where an EEG is typically required."

Using Accellion file transfer, an EEG is sent in a matter of minutes. "As soon as I see the EEG, I review the report and render a diagnosis in less than an hour," Markand continues.

"We recently had a child from Deaconess who was admitted because of a possible seizure at night," he says. "The EEG was sent via Accellion file transfer. I saw a spike focus in the Rolandic region and quickly called the child's physician to alert him to the abnormal EEG. We were able to put the child on the appropriate medication immediately."

Dr. Charles Lewis, professor of clinical dermatology at Indiana University, has also seen success since deploying the Accellion solution. Accellion allows him to provide patients in rural areas with the level of specialty care they otherwise were unable to receive, unless they took the day off work to travel into Indianapolis.

"The Accellion solution has also enabled us to provide better, more-convenient healthcare to patients who were otherwise limited by their insurance," says Lewis.

Today, nurses from Clarian's partner hospitals are able to send high-resolution, macro-setting digital images of skin conditions directly to Lewis for review. Once the file is received, he has the ability to zoom in on suspicious areas and render a diagnosis without requiring unnecessary patient visits. If a diagnosis requires additional care, patients are referred to a local surgeon or they have the option to travel to Lewis for treatment.

Using Accellion, Markand, Lewis and their colleagues in Indianapolis are able to receive images from Bedford, Jasper, Deaconess and Evansville hospitals in near real time.

As other departments within the Clarian network learned about the successes the telemedicine team was achieving using Accellion file transfer, they began to adopt the solution for their own purposes. The human resources (HR) department, for example, needed a secure way to share large, confidential files that offered the necessary tracking and reporting capabilities to meet HIPAA mandates.

Clarian's HR department deals with large volumes of confidential patient and employee data. The sheer size of files and strict security requirements made sharing this information with outside vendors and government agencies a challenging process. The department now is able to quickly send and receive files in a format that meets Clarian's strict security and privacy requirements. The file-transfer system also provides tracking and reporting logs necessary to maintain HIPAA compliance.

Used by Other Departments

"In April, the HR department was safely sharing files as large as 2.4 GB. The ability to quickly and securely send that data is extremely helpful," Boyer says.

Clarian's marketing department also uses the solution to share prerelease marketing videos in a controlled manner. Collaboration among team members and other stakeholders is common practice during the developmental phase; yet, because the videos are still a work in progress, they need to be shared in a controlled manner to avoid exposure prior to receiving approvals.

Videos typically range from 50 MB to 100 MB, and often are larger. Traditional e-mail was not an option, as file sizes exceeded the allowed limit. Additionally, e-mail did not offer the level of control the department needed. As a result, staff often relied on CDs and thumb drives to share information, but security controls were lacking.

Using the file-transfer system, the marketing department can strictly control who is able to receive and make changes to the videos. The solution's authentication capabilities ensure that only the intended, preapproved recipients are able to view and edit the videos. It also offers a tracking mechanism to show when files are downloaded and by who.

From the Catalog

According to Accellion's managed file-transfer solution is designed to address the key requirements for on-demand and automated, multi-office enterprise, secure file transfer. The Accellion secure file-transfer system comprises a selection of components that, in combination, create a robust system for securely sending and receiving large files, and folders for ensuring data-leak prevention and demonstrating compliance. Accellion is designed for enterprise-managed file-transfer applications with installations comprising multiple appliances located around the globe at company offices and network hubs. Accellion can also be deployed as a standalone installation providing file-transfer capabilities for small to midsize healthcare organizations.

A Look Ahead

Clarian has begun plans to leverage Accellion's secure file-transfer technology to expand its global reach. The heart-surgery team at Clarian's Riley Hospital for Children and the Indiana University School of Medicine are part of an international outreach program, the Gift of Life. Through the program, physicians perform procedures to repair congenital heart defects on children from different countries, while training local health professionals. The program was developed through relationships with charitable foundations, physicians located in various regions and the U.S. military, which has found children throughout Iraq and Afghanistan in need of medical treatment.

A major challenge for the team is the ability to get accurate information, which is needed to assess the children in order to remotely determine if a repair is feasible. Clinical studies have been limited to snapshot views of a testing screen and basic written reports, both of which have the potential to inaccurately describe defects.

The Riley team is currently testing the use of downloading these important studies on pediatric cardiology patients in Iraq to the Clarian Accellion server for direct viewing and consultation with the U.S. military. Medical personnel stationed in Iraq will be able to collaborate with Clarian's pediatric cardiologists and surgeons on pre- and post-operative cases. The technology will provide a simple and secure means for military, as well as non-military cardiologists in Iraq (and soon, hopefully, Afghanistan, China, Jordan, Syria, Kenya and Uganda) to send information back to the Riley physicians.

Upon downloading and viewing echocardiograms, CT scans and other visual diagnostic studies, Clarian's heart team will have more-thorough information to consult on cases and the ability to render a more-accurate diagnosis and treatment strategy. The technology also provides a secondary benefit: the surgery team will be able to triage patients in advance of future trips to the international mission sites.

Clarian's long-term goal is to expand its pediatric cardiovascular-surgery global-outreach program to all U.S. military cardiologists located throughout the Middle East. The company also plans to connect regional medical centers and their specialists via telemedicine to Clarian's physicians and nurses in the Heart Center at Riley Hospital.

For more information on Accellion solutions: click here.