Faced with an aging population, a shortage of clinicians, and the need to balance radiologist workload across different locations, the Health Region Waldviertel in Lower Austria has found success from adopting Internet-based technologies to enhance the practice of teleradiology.
Thanks to tools such as a Web-based multisite radiology reporting platform, the region's initiative has enabled radiologists to directly access images at other institutions without having to leave their own viewing environment, even between public and private facilities.
"Enabling connected health is a promising approach to provide [the] best-possible care in this environment," said Alexander Bernegger of Landesklinikum Horn in Austria. "Radiologists virtually 'zoom' into all other sites' systems and work there without having to leave their own local application."
Encompassing 27 hospitals and 20,000 employees in Austria, the Health Region Waldviertel is dealing with a number of challenges that require ongoing development of new strategies in order to provide the best care to their patients, Bernegger said. The Waldviertel region features relatively low population density, with long distances in between hospitals and an aging population that leads to more patients presenting with multiple morbidities. There's also a shortage of clinicians and a need to balance radiologist workload across different locations and to provide off-hours, emergency radiology coverage 24/7.
"Night shifts and weekend coverage are offered only at one institute in the region at a given time, so we need to ensure that the emergency patients can receive the best and fastest care," he said.
New IT tools
As a result, Health Region Waldviertel wanted to provide IT tools for radiologists -- regardless of the location -- to be able to interpret imaging studies in support of primary care teams at all of the region's hospitals, said Bernegger, who outlined the organization's experiences during a session at the recent ECR 2015 in Vienna. The goal was to provide an independent imaging management system with new Web-based technologies that could serve as an additional layer from local hospital systems, enabling easy and direct access to images stored at other institutions and also to connect both public and private diagnostic care providers.
They also wanted to comply with the European Society of Radiology's (ESR) white paper on teleradiology, which offers best-practice guidelines such as providing images without loss in quality during transmission or display; inclusion of clinical referral information such as the referring letter or request card; providing access to all relevant prior images; and furnishing access to clinical information such as blood results, pathology reports, and clinical correspondence.
Because at the time no vendor in the market could implement this type of system off-the-shelf, a task force was formed and called for industry partners who would be willing to implement it. The region partnered with GE Healthcare on the initiative to develop a multisite radiology reporting platform.
Cross-enterprise radiology reporting
Seamlessly integrated into GE's eRadCockpit radiologist's reporting platform, GE's xSite worklist serves as a global worklist and provides radiologists with access to images across the enterprise, he said. After launching the worklist and selecting a case, the radiologist is redirected to the RIS/PACS of the practice where the patient is being treated and is able to use the same Web-based reporting platform to view the studies, according to Bernegger. Images are not pushed to the requesting location.
"Virtualizing the whole toolbox makes it easy for a remote radiologist to get exactly the same working environment as one would use on site," he noted.
As part of the collaboration, nine associate private outpatient centers have been connected with four hospitals.
"Multisite viewing with streaming technology in one single FDA-approved application is improving the ease of accessing relevant prior images, building a longitudinal, real-time patient record across hospitals [and managing imaging] without loss in quality during transmission or display," he said. "The quality of radiological reports and services delivered by teleradiology should be no less than those of local radiologists."
