An Interview with Dr Chaturica Athukorala

Winner of an AIIA 2022 iAward

Congratulations, you recently won Start-Up of the Year at the Australian Information Industry Association (AIIA) 2022 National iAwards for the development of Aurabox, a cloud-based, medical imaging storage, viewing and collaboration platform for doctors and patients.

Can you tell us more about the benefits Aurabox offers to clinical radiologists and radiation oncologists and other clinicians?

I developed Aurabox with my team to solve a problem that radiologists face multiple times a day—the inability to access a patient’s complete imaging history in one place. I spend a considerable amount of time attempting to locate and view previous imaging to accurately interpret the imaging that I am reporting, and generate a clinically meaningful report. We have all received requests to “assess progress” of abnormalities for which we have no previous imaging or found an abnormality that we are 99 per cent sure is benign but have no previous imaging to confirm stability. In these cases, the accuracy and relevance of our reports is affected and in some cases we have no choice but to recommend potentially unnecessary repeat or followup imaging, which can be detrimental to the patient and does not necessarily improve their outcomes.

Colleagues in other specialties including radiation oncology experience the same frustration when attempting to access patient imaging, particularly when caring for complex patients who require multi-modality and serial imaging for diagnosis and monitoring.

We conducted a survey of these specialists and found that the majority were unable to access necessary patient imaging for at least one patient every day. One hundred per cent of specialists that we surveyed indicated that the inability to efficiently access patient imaging caused delays in their day-today practice.

Aurabox solves this problem by allowing a patient’s complete imaging history to be accessed in one place, regardless of how many medical imaging practices they visit. Because it is cloud-based and aggregates imaging from providers, Aurabox allows doctors to share patient profiles containing complete imaging histories with their colleagues quickly and easily. The Aurabox multidisciplinary team (MDT) function allows an MDT meeting to be run from a single platform, negating the need for the MDT radiologist to access multiple, disparate imaging platforms during the meeting which is time consuming and can make comparison of imaging performed at different practices difficult and inaccurate. Aurabox is also beneficial for doctors conducting research involving imaging protocols across multiple sites as it facilitates collaborative collation and a single point of access for all researchers without geographic constraint.

And to patients? How can patients be involved in management of their care? How does it improve their care journey? What is the ideal— clinician input into Aurabox or patient input?

We conducted a quality improvement pilot study at the Canberra Region Cancer Centre earlier this year and received positive feedback from several of the enrolled patients on how Aurabox improved their care journey.

One patient had a newly diagnosed brain tumour and had imaging performed at four different medical imaging practices outside of Canberra for his work up. Prior to trial enrolment, several of his imaging studies had to be copied to USB and posted to Canberra for his specialist to access them. This delayed his treatment planning and caused him considerable stress.

Following his initial surgery and radiation, he decided to undergo chemotherapy in Sweden and his Aurabox profile containing his complete imaging history was able to be shared with his Swedish oncologist within minutes. This allowed her to review his imaging and formulate a treatment plan prior to his arrival without placing any unnecessary burden on the patient.

He was able to compare his experience pre- and post-Aurabox and credited Aurabox for making the process of sharing his imaging with his overseas specialist seamless and stress free.

Another patient with metastatic melanoma found it useful to be able to view her complete medical imaging history and reports within her Aurabox profile so she could better understand the chronology of her condition. She developed adrenal metastases during the trial period and found Aurabox to be of “immense value” at that time as she was able to provide access to her complete medical imaging history to her radiation oncologist at Canberra Hospital, radiation oncologist at Prince of Wales Hospital in Sydney and her surgeon at Canberra Hospital who performed her adrenalectomy.

What is the ideal—clinician input into Aurabox or patient input?

Both! Both patients and doctors can upload, store and share medical imaging within patient profiles on the Aurabox platform. This caters for patients who want to be more involved in their care as well as those with limited digital literacy. Aurabox also offers a concierge service to both doctors and patients to assist them to use the platform.

How widely might it be used in the future? Are there any constraints for uptake? How scalable is the innovation?

Currently, Aurabox is targeted at patients with complex medical imaging requirements such as oncology patients. However, we know that there is benefit for almost every patient, so the potential reach is very wide. If you look at the kinds of organisations which are currently using or considering Aurabox, there is a very diverse range, including healthcare providers, cancer hospitals, research organisations, as well as individual specialists.

We can scale Aurabox as far as required to make it work for users across the healthcare system. Modern software development makes it relatively easy to build systems that can scale without the overheads of traditional software. Aurabox has been designed and built from the beginning as a flexible system that can be scaled to meet demand elastically. For example, the service we built to power our viewer uses technology known as “serverless” to deliver imaging at the maximum speed available to the user, regardless of how many users we have. We can deliver a complete PET scan to the viewer in less than two minutes, for every user. Images in our viewer are displayed in full quality DICOM as opposed to the lossy, non-diagnostic JPEG format, which is displayed by other cloud-based viewers on the market.

Currently our focus is medical imaging however we plan to add other patient assets to patient profiles including pathology and correspondence between doctors in their care team.

Where is your main focus now? In Australia? Or can Aurabox go global?

Australia is the perfect place to kickstart the platform. We have issues with accessing imaging across jurisdictions and health systems, between public and private providers, and in remote and regional areas. Aurabox can help to solve all these challenges, by providing a central place to aggregate and view imaging from private and public imaging practices and crossing state and territory borders.

But no matter where you go in the world, most countries have similar issues, and because DICOM has been standardised since the 1980s Aurabox can effectively drop in anywhere and be compatible with local systems from day one. So, we do see ourselves expanding to other countries in the future. The challenge for us will be scaling it in a way that does not reduce the quality of the service that we provide and continue to deliver on our mission of helping doctors deliver better care for patients.

Can you identify any other areas that could benefit from innovation to improve communication and efficiencies in sharing information between clinicians, between different specialties, in health care in Australia and New Zealand? And beyond our jurisdictions?

The status quo for accessing patient data means that a considerable amount of time is wasted performing unnecessary administrative tasks. I am sure we all agree that we can improve efficiency across the board, whether that be accessing clinical notes, medical imaging, pathology, referral letters or making referrals to our colleagues. The sub-specialty nature of medicine means that most patients have more than one doctor in their care team. The inefficiencies that we face become exponentially worse as each member of the care team attempts to access the patient data they require and collaborate with colleagues in other specialties.

I believe the cause of the problem is the organisation-centred approach that we currently have for storing healthcare data for patients. This results in multiple, siloed storage systems which do not communicate with each other. This is highly problematic because each silo contains critical patient information that needs to be evaluated concurrently with other information held in a disparate silo to optimise patient care.

A collective approach is key to solving this problem. Existing databases need to be integrated in a patient-centric manner in addition to the development of new, innovative solutions like Aurabox. A further critical ingredient for success is the involvement of us, the end-users, when developing solutions. We all have fantastic ideas for how our day-to-day workflow can be optimised and I would strongly encourage you to become involved in the development of solutions where you can.