The Evolution of Distributed Diagnosis: Teleradiology As a Case Study

As the limits of the healthcare enterprise expand so is the need to provide diagnoses across boundaries and disciplines. The definition of the healthcare enterprise has grown in such a way to encompass the diagnoses of images within individual hospital department to the sharing of images across the globe. From a single hospital the healthcare enterprise expands to a multi-center environment eventually creating the concept of the virtual healthcare enterprise where regardless of geographical boundaries and local site technical characteristics, sharing of patient information is possible. Based on a National Library of Medicine effort, this paper uses teleradiology as a case study to explore the concept of the expanding healthcare enterprise and identifies the technical issues associated with image sharing especially as they relate to middleware considerations including access control in a federated environment with grid computing as an enabling architecture