Teleradiology - Using Information Technology to Provide Medical Diagnosis to Remote Locations

Arjun Kalyanpur, Founder, Teleradiology Solutions

The Teleradiology market is ex­pected to grow steadily in the coming years. Radiologist short­age is the main factor driving the growth of the market. At the same time the utilization of radiology within clinical medicine is increas­ing as new technologies and applications are developed and lifestyle diseases such as cardio­ vascular disease and stroke increase in preva­lence. Consequently the amount of image data generated by imaging departments is rising exponentially increasing the workload of the available radiologists. The immediate solution involves the use of technology to distribute the workload among the radiologists that are avail­able in the workforce. Teleradiology workflow platforms incorporate efficiency and productiv­ity tools that augment radiologist productivity, allowing for shortening of report turnaround times.

The Indian Scenario

In India the investment environment in health­care has resulted in profusion in growth of im­aging centres and hospitals. The main users of Teleradiology are diagnostic imaging centers in small towns in the periphery where radiolo­gist availability on site is limited. The radiolo­gist may only visit the center for a few hours a day. Emergency scans and X-rays performed at other times would potentially have their re­porting delayed. Today, with the implementa­tion of Teleradiology, immediate reporting by a radiologist in another location is made possible. Hence, the acceptance of teleradiology is high as it results in greater patient satisfaction and improved patient care due to increased access to high quality radiologic diagnosis, including subspecialist radiology reporting.

"Today, with the implementation of Teleradiology, immediate reporting by a radiologist in another location is made possible"

Highlighting the Benefits

Hospitals and medical institutes that fail to adopt Teleradiology face the risk of potential coverage breakdown during emergency after hour’s coverage. In a manpower shortage en­vironment it is the night shift that is affected the most. It is also expensive for a hospital sys­tem to have a radiologist in-house at each of its individual hospitals overnight. It makes better financial sense to deploy a single radiologist re­porting for all the sites at night via Teleradiol­ ogy, or alternatively to outsource the reporting to an established Teleradi­ology provider of demonstrated qual­ity. Further as radiology has become more specialized, it is beneficial for a small medical institution to have access to a larger pool or group of radiologists with subspecialty exper­tise to enhance reporting quality for complex scans.

Best Practices around Teleradiology

The best practices in the teleradiol­ogy environment are as follows:

a) Ultra-short turnaround: Teleradi­ology facilitates immediate reporting and contributes greatly to emergency setting, particularly in conditions such as a stroke.

b) High reporting quality: Using teleradiology, scan images can be transmitted to the radiologist with the highest level of expertise in the subspecialty allowing highest pos­sible reporting standards to be met.

c) Communication: In the teleradiol­ogy environment, the level of com­munication between referring physi­cian and radiologist is kept at a level commensurate with that of the in-hospital radiologist.

d) Security and patient confidentiali­ty: Teleradiology practices need to be compliant with HIPAA or equivalent security standards.

e) Robust Quality Assurance Pro­gram: Having high level analytic process for error detection, review and feedback is critical.

f) Integration – Through interfaces such as HL-7, the teleradiology work­flow platform can integrate with and seamlessly exchange information with other information systems such as HIS, EMR etc, which benefits patient care and improves disease outcomes.

Addressing the Loop Holes

There are loopholes in the Telera­diology market that need to be ad­dressed. These include: IT infra­structure challenges, medico legal requirements, and business con­siderations such as equipment and system costs. The technology indus­try can also help address these gaps which pose a threat to the growth in the adoption of Teleradiology.

Remote areas tend to have chal­lenges of connectivity. It is pertinent for telecom providers to continuously innovate to bring high level connec­tivity to remote peripheral locations with reliable uptimes and low cost. Imaging companies in the industry can focus on developing low cost imaging equip­ment that can be easily deployed and installed in remote locations, with reliable after-sales sup­port and service.

From a regulatory perspective, Teleradiol­ogy is governed by strict standards of security, such as HIPAA in the United States (Health Insurance Portability and Accountability Act) which requires a high level of com­pliance. Using high-level encryption ensures a high de­gree patient confidentiality. Further, radiologists practicing Teleradiology need to demonstrate appropriate reg­istration, insurance and licensure. Measures such as accreditation by a standard organization such as the US Joint Commission also add value in the teleradiology scenario.

Current and Future Scenario

In keeping with Moore’s law, the cost of telecommunication as well as the storage and processing capacity of the computer/server hardware needed, are constantly evolving and improv­ing. The internet cloud has also facili­tated a drop in costs. Therefore, for a hospital or radiologist group, there is no longer a reason to purchase ad­ditional expensive storage/archival in­frastructure, making the deployment of teleradiology inexpensive and prac­tical.

The future of teleradiology is bright, as it is today an essential part of healthcare delivery. There is a strong clinical need based on im­balance between imaging utilization and radiologist availability. Telecom­munication and IT innovation are ongoing technical drivers that fa­cilitate its growth. Above all, there is a strong value addition in terms of improved quality of patient care that makes the most profound argument for the growth of teleradiology in the future.