Teleradiology can help solve workflow problems, but introducing it is not simply a case of "plug-and-play," according to two leading European experts.
A good technical infrastructure, including an integrated RIS/PACS and state-of-the-art diagnostic workstations, is a prerequisite. Radiologists and the teleradiology companies must have liability insurance in each client's home nation, and additional licenses or specialist registrations are still needed in some European countries, wrote Dr. Frits Barneveld Binkhuysen, past president of the Radiological Society of the Netherlands, and Dr. Erik Ranschaert, a radiologist at Jeroen Bosch Ziekenhuis, in 's-Hertogenbosch, the Netherlands, in the European Journal of Radiology.
Several commercial cross-border teleradiology centers have become active in Europe during the past decade, but the full potential of teleradiology to change paradigms of care is not yet known. Image courtesy of Dr. George McInnes, Telemedicine Clinic, Barcelona, Spain.Among the questions that must be addressed: How is clinical information transmitted and integrated? How are previous images/procedures and reports made available? How is quality assurance organized? Is single or double reading requested? What turnaround time is needed? What language is being used? What legislation is involved in the patient's country? What about privacy and integrity of data? How do referring physicians and radiologists communicate? How are these processes validated? What medicolegal aspects must be dealt with?
"All these issues are part of the so-called clinical governance code," they noted in the EJR's special edition on PACS, distributed in May (Vol. 78:2, pp. 205-209). "In the last decade, several commercial cross-border teleradiology centers have become active in Europe. These centers can develop an unmatched concentration of expertise and industry-level quality controls, e.g., by using double readings in every cross-sectional examination."
Market research firm Frost & Sullivan has estimated between 4% and 20% of worldwide imaging procedures will be reported remotely during 2011, and it cited Norway and the U.S. as two countries leading the way.
The growth of teleradiology has advantages, but also poses potential threats to the quality of care and to radiologists' interaction with their clinical colleagues, according to the authors. It is important that the quality of the service is high and those providing the service are properly trained, that they are registered with the appropriate authorities, and that they participate in continuing medical education. The ability to discuss cases with those reporting the studies must exist too.
Ten years ago, image quality, transmission speed, and image compression were the important issues, but now the focus is on clinical governance, medicolegal issues, and quality assessment. "The challenge today is to overcome the general inability to seamlessly integrate teleradiology systems with other [locally existing] healthcare information systems when data need to be transmitted between different institutions or to an outside provider," stated Barneveld Binkhuysen and Ranschaert.
Teleradiology cannot replace the role of the radiologist as a consultant or the direct interaction with the referring physician, they continued. One solution is to include the mobile phone number of the reporting radiologist on every report so the referring clinician can easily contact the reporting radiologist. Another solution is to appoint a "buddy" within the partnership or hospital hiring a teleradiology service, and this person is responsible for all communication with the teleradology company.
Furthermore, high-quality reports in terms of content and language are essential, and there should be regular clinical audits.
The referring hospital and the teleradiology service provider must ensure that patient confidentiality is secured in both the transmitting and receiving country. Therefore, transfer of patient data needs to be secured by VPN or HL7 connections. Access to patient data should be limited to a "need-to-know" basis, and patient records should not be stored longer than necessary, advised the authors.
In the future, the distinction between PACS and teleradiology will be blurred, and virtual organizations with distributed capabilities will become a reality, they added. The future teleradiology portfolio will consist of e-consultation and second opinion, e-image processing, analysis, and supporting services (e-archiving and e-training). The full potential of teleradiology to change the nature of healthcare is not yet known, however, and substantial experience is required to understand the possibilities.
"Will teleradiology profoundly change the way we practice our profession? Can radiology services almost completely be outsourced when we keep in mind that less than10% of the total radiology production, namely vascular and interventional radiology, is exempt from outsourcing?" they asked. "Theoretically yes, but more likely no."
