Reports and FEM to ingest or not to ingest!

At today's DI JIG meeting we had a long discussion about the risk and impact of ingesting reports along with images in the foreign PACS.
Situation: Foreign Exam Management as defined in the XDS Implementation Guide is triggered by a request from Site B (either a order triggering a prefetch or an adhoc request.) If site A who created the images and the report makes a change to either the images or report the update will flow to the DI-r but not to Site B. We mitigate the risk of images being out of sync by purging the images from Site B. Some PACS vendors do not have the ability to purge the report. Some sites are ingesting the reports as DICOM Structured Reports that are purged with the images.
Some questions for discussion:
1. Who owns the report?
2. Does the originating site or the DI-r have any responsibility to make sure that any amended reports reach everyone who viewed the original report? What is Site B's responsibility to ensure they are providing end users the corrected report?
3. Does the fact that we are now in an electronic world change the situation from the past when we mailed reports and the addendum was distributed to the physicians of record but we didn't worry about if anyone who had viewed the report actually received the addendum.
4. When you send CDs is there a disclaimer that talks about data quality and version control? ie: the information on this CD may not be the latest version of the information on file at the "source of truth".........
5. Has anyone who provides reports that are not purged got a legal opinion on the risk. is it a shared risk between Site A, Site B and the DI-r who facilitated the move? Who at the site is at risk? The Radiologist who authored the report? The employee who allowed the reports to be shared knowing that currency was a risk? The poor caregiver at site B who had no idea they were acting on an outdated report?
Section 5.1 Image and Report Change Management of the XDS Implementation Guide speaks to data quality and report and image Change Management. Link to the guide infocentral.infoway-inforoute.ca/2_Standards/1_pan-Canadian_Standards/Messaging/e_Diagnostic_Imaging/Current_Releases/XDS-i_-_Diagnostic_Imaging
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