Category: Teleradiology

18 Jan 2022

Eight point mantra for quality in teleradiology

Addressing to what Dr Sona said in her article on Challenges in teleradiology in India, Dr Arjun Kalyanpur, MD, CEO and Chief Radiologist, Teleradiology Solutions, Bangalore shares his insights on quality in teleradiology reporting

Teleradiology has become firmly established as a powerful clinical paradigm within healthcare delivery that permits radiology reporting to be performed rapidly and efficiently as well as providing access to radiologic expertise where/when it might otherwise not have been available, in an era of crippling radiologist shortages. However, for teleradiology to provide continuing benefit, it must be supported by quality reporting, or else its value proposition ceases to exist. How can teleradiology providers ensure that they deliver consistent quality to their clientele, and through them to their patients? And how can a hospital or imaging center that is looking for a teleradiology provider decide which service really and truly represents a quality performer? Here are eight key processes that define quality in teleradiology, and can/will distinguish the quality teleradiology provider from the rest.

Selection and training process: An important part of the growth of a teleradiology practice as new radiologists are added to the team, is to adhere to stringent recruitment processes that include not just vetting the CV but also conducting a baseline reporting quality check. Given that teleradiology presents a wide variety of reporting challenges such a process ensures that the aspirations of the radiologist are matched with the quality standards and processes of the teleradiology organisation.

Reporting standards and checklists: It is necessary for a teleradiology provider to develop clear internal standards, checklists and reporting templates to ensure that quality is maintained in day-to-day reporting. These should be available for each modality, and ensure an internal standard of reporting that forms the bedrock of teleradiology reporting operations.

Robust peer review: At the heart of any successful teleradiology practice is a strong peer review process. This essentially means review of both the examination and the report by an independent radiologist with a score assigned for error/discrepancy. Whether this is by way of external third party audit (as in the form of feedback from client radiologists) or internal peer review process, this is the true pulse check of quality and defines the organisation’s performance improvement, or lack thereof. The core philosophy behind such a process involves objectivising error evaluation (the American College of Radiology’s Radpeer scoring process is the current benchmark) and ensuring that the peer review process is consistently followed. It is all too easy in the midst of busy day to day work to let what may be perceived as “non-essential” processes slip or slide, and ensuring continuous focused attention on them is key to optimising teleradiology performance.

Rigorous data tracking mechanism: Coupled with peer review is the need for effective data collection from this process, which captures the information that is needed to provide the quality insights. The best way to ensure that steps 1 and 2 follow in sequence is to have a technology based solution for the same. In the case of our organisation, our teleradiology workflow platform Radspa also contains a robust quality assurance portal which allows for peer review to be assigned, performed and objectively scored. This data is continuously captured and subsequently extracted and sorted based on all the relevant parameters, namely based on error grade, referring client, radiologist etc etc.

Analytical approach: It is important to analyse the data effectively by asking the right questions that allow trends to be captured/identified. For an individual case, how could the error have been avoided? Is a particular member demonstrating a pattern of error on say, CT pulmonary embolism studies? Or is there a particular modality, such as CT angiography where the group as a whole has a higher error rate? Is the error pattern indicative of an individual performance issue or is there a systemic issue involved? Such trendspotting of error patterns can help to identify and address training or operational needs for the group, or to provide specific feedback to an individual. Here again, an effective online QA management and analytics portal such as Radspa can greatly help a teleradiology provider to detect and address such trends.

Couple the learnings from peer review analysis with teaching/training: As suggested by the previous step, the output from the data analysis is only effective if it is used to generate training material to benefit the individual radiologist as well as the entire group. It is necessary to capture the relevant images to illustrate the teaching point as well as to identify the specific learning insight that is gained from the retrospective analysis of the error. This process is key to transforming learning to teaching, which is at the heart of all quality improvement. The fundamental philosophy is (or should be) that the error of one should translate into a learning for all.

Learning philosophy: This last point is part of EQ or Emotional Quotient development. When a radiologist joins our group, in my initial interaction/orientation with them, my key message/request to them is to submerge individual ego in the larger purpose of learning and growth. For quality improvement to occur, it is important for the individual radiologist, however senior or experienced, to be receptive to feedback, to accept that everyone is capable of error and to be open to learning from it as well. I believe that my own greatest learnings have arisen out of my errors, and am candid in sharing my errors/misses with the rest of my colleagues, as I feel that quality assurance, to be effective, must be seniority-agnostic!

Communication and accountability: A teleradiology provider must audit itself not just on the quality of its reports but on metrics such as report turnaround time, and equally important, the level of communication on any critical finding of acute clinical significance. Ultimately in radiology, diagnosis is only 50 per cent and the other 50 per cent is clear communication. Therefore tracking of such communication is important to ensure that the organisation is compliant with protocols. Further, sharing of all such metrics in an open and transparent manner with the client is in the interest of building trust and ensures that any issues that arise are discussed and addressed to mutual satisfaction, on an ongoing basis.

Teleradiology, given its outsourced nature, has traditionally been held to a higher quality standard than in-hospital radiology. And in a competitive industry such as teleradiology represents, the differentiator must be quality and not cost. The hallmark of true quality is introspection and insight, and any teleradiology provider of substance must be willing to go the extra mile and spend the extra hours needed to gain the meaningful insights that can genuinely facilitate improved quality of performance. Hence the critical importance of a structured quality assurance program/process for a teleradiology service provider. The ultimate goal is to learn from one’s errors in order to prevent further such incidents. In teleradiology no less than anywhere else, as the aphorism goes, an ounce of prevention is far better than a ton of cure.

29 Mar 2021

Benefits of Teleradiology

Telemedicine is the application of information technology and telecommunications networks for the purpose of medical diagnosis and therapy from remote locations. A host of recent technology innovations have made it possible for telemedicine to expand its reach across every medical speciality– its usage in radiology is called “Teleradiology.”

Radiology incorporates the diverse methods used in medical science to capture images of the internal body structure and function (eg. x-rays, MRIs, ultrasounds), to assist in the process of medical diagnosis or treatment.
Teleradiology is the capability to acquire these medical images in one location and facilitate their transmission over a range so that they can be viewed and interpreted for diagnostic or consultative purposes by a radiologist.

This practice is becoming widely adopted by hospitals, urgent care clinics, and diagnostic imaging centers. The factor responsible for its rapidly growing implementation is due to the fact that it addresses the inadequacy of appropriately skilled personnel to provide radiological analysis and the lack of practitioners of this specialty.

The process of teleradiology, in essence, is based on a fundamental triad; an image sending station, a transmission network, and a image retrieval station that should have a high-quality display screen. Additional more recent technology innovations include the incorporation of cloud for redundancy and cost reduction, mobile technologies for greater access and sophisticated teleradiology workflow that enhances radiologist productivity, provide performance metrics and track quality. .

Teleradiology improves client care by enabling radiologists to supply their expertise without necessarily being at the same location as the patient. This is especially essential when radiologist subspecialists (e.g. MRI radiologists, pediatric radiologists, neuro-radiologists) are required, because these specialists are few in number and typically located in metropolitan cities. Teleradiology therefore enhances the quality of radiology reporting by bringing the images of a patient in a small town to the most specialized radiologist who is best qualified to interpret the particular radiologic scan..

On the other hand, smaller sized healthcare facilities in rural areas might use only one radiologist or none at all. In such situations, it is virtually impossible for the radiologist to be available 24 x7 x 365. Having the support of a teleradiology reporting service can both improve the quality of life of the solo radiologist as well as improve the quality of care that might be potentially diminished by radiologist overwork..

Teleradiology can be a means through which physicians can collaborate when they are not in direct contact. For example an emergency doctor at a rural urgent care center can gain obtain a radiology consultation from a specialist urban radiologist and discuss the case telephonically while simultaneously viewing his or her patient’s images. (e.g. they are in remote places). This can be extremely valuable from the perspective of enhancing patient care and improving outcomes.

Using the services of outsourcing companies or radiology groups to supply and maintain the needed radiology coverage, smaller medical facilities are able to make better usage of their own on-site specialists and enable them to maintain their regular working hours.

This can likewise be economical for the medical facility as the outsourcing institution need only spend based on utilization, and is spared the significant fixed cost of having a radiologist on site at a small institution where they may not be fully utilized . The arrangement of these expert services to manage inpatients at small hospitals without experts on site has been revealed to be a reliable way of providing high quality care that would otherwise be unavailable.

In summary, the benefits of teleradiology are related to affording access to specialist radiologist expertise where or when none exists, to the appropriate utilization of radiologist time and energy, and to the overall enhancement of patient care, while at the same time reducing healthcare costs!

The technologies today are mature and evolved, and the outsourced model wherein images are routed to a teleradiology reporting service is an established and tested one which affords significant value, especially to small rural and community hospitals. Startup costs, as well as running costs, are reasonable and affordable and the process is smooth and streamlined.

Sounds like a pretty compelling value proposition? Try it and find out for yourself!!.

13 Oct 2020
Transforming Radiology Technology

The Transformation of Radiology using Technology

Radiology has indeed come a long way since 1895, the year of the spectacular discovery of X-rays by German physicist Wilhelm Roentgen. It now plays an inherently crucial role in improved and better diagnosis and patient care.

The past few decades have seen the limits of imaging informatics being pushed beyond traditional boundaries thanks to several major changes in computer and communication technology. With the advent of new technologies, such as the World Wide Web, wireless connectivity, and, now, the ever-present social networks, momentous advancement has been made in the way radiological services can be delivered. The Internet has become a crucial gateway for electronic transmission and sharing of health-related data, something we today know as “e-Health”. Many types of e-Health are currently becoming available. In many hospitals, the electronic health record (EHR) is being introduced, which allows a complete electronic record of the patient’s health information. This EHR should not only automate and streamline the physician’s workflow but also allow patients to gain control over their health data through online portals.

The move from an analog to a digital working milieu put the radiologists at the front line of producing and distributing digital images. New dedicated software products were developed. One of the most important shifts being adopted by many healthcare institutions across the globe is a paper-free environment and the Picture Archive and Communication System (PACS) and Radiology Information System (RIS). These are truly remarkable steps in this direction. Radiologists employ the PACS to store myriads of image files which can be easily retrieved at any time in the patient management. Making lives extremely convenient, the entire database of images of all patients across all modalities is just a click away. It not just saves time but with the help of software solutions like RIS, it is now possible to keep a track record of every patient from scheduling appointments to diagnosis and treatment.

Transformative new technologies, many powered by cloud-based RIS-PACS, Artificial Intelligence (AI) and machine learning, promise to redefine the practice of radiology in ways that will considerably improve productivity, diagnostic quality, and medical treatment. Today, cloud-based computing in the imaging market has evolved from a service that provided cost-effective disaster recovery for archived data to fully featured PACS. It’s vendor neutral archiving services can address the needs of healthcare providers of all sizes, on the go.

Taking a look at AI, we need to identify AI’s strengths in analyzing visual images. Researchers train the algorithms to better detect potentially dangerous abnormalities, generating faster and more accurate insights to help guide clinicians’ treatment decisions. AI adoption is sure to ease the overwhelming workloads impeding the profession, facilitating radiologists to do what they’re best at and perform them better.

Going further ahead, we can examine Workflow orchestration technology too. This promises to boost efficiency and alleviate bottlenecks. By directing cases to the right recipient in the correct order, this technology optimizes the effectiveness of the read, especially in teleradiology settings. With the profession’s ever-increasing need for solutions that match demand with supply, a lot of organizations provide solutions that facilitate better collaboration across facilities for effective workflow orchestration.

Teleradiology is another field that is assisting well where streamlining workloads is concerned. Remote radiologic coverage and reliable telecom infrastructures means more radiologic analysis is being performed online to take care of workloads between hospitals. And as the field becomes progressively digitized, apprehensions regarding the security of radiology data accentuate the need for robust solutions that will not just prevent breaches but at the same time also safeguard patient information while complying with regulatory requirements.

Diagnostic images captured at the right place and at the right time give physicians, surgeons, and care centers an important tool to help provide better patient care and at a reasonable cost. For this reason, Telerad Tech has been building out solutions since 2009.

Telerad Tech was established with the goal of optimizing radiology productivity and improving patient outcome delivery through transformational medical imaging software solutions. Today, it is amongst the market leaders in providing integrated RIS-PACS software solutions for teleradiology, medical imaging centres, and hospitals of all sizes globally. Telerad Tech’s solutions cater to workflows needs across departments, including Radiology, Cardiology, Podiatry, Orthopedic, Chiropractic, Oncology and Veterinary.

We are today amongst the market leaders in providing RIS with integrated PACS with significant installations in both cloud and enterprise environment across 1500 facilities in 24 countries.

Our software solutions suite has been incubated, tested and perfected in a radiology ecosystem and are designed to address the unique needs of multiple care pathways across departments, including radiology, cardiology, dentistry, oncology, and veterinary. Our software has customizable workflow features, intelligent productivity tools & analytics and Vendor-Neutral Archive technology. It has strong patient security framework and integrates seamlessly with other systems for exchange and retrieval of electronic health information.

To enable physicians to consistently deliver optimal patient management and to augment the precious time of radiologists, Telerad Tech has also leveraged Artificial Intelligence (AI), for various radiology diagnostics.

We truly believe that the future is here

Technological development has undoubtedly prompted some anxiety among radiologists. But while tech adoption will inevitably alter the way radiologists work, technology’s clinical value will be in supplementing and adding to and not replacing or even displacing the professionals. Radiologists empowered by AI will only encounter a new, more efficient stage of radiology, helping to focus their time and attention on the most crucial elements of their job.

Also, we need to remember that image analysis is just one of the aspects of a radiologist’s job, other tasks, including discrepancy reviews, diagnostic reasoning, and patient-facing work such as invasive radiology, will still be performed by humans. Those tasks will simply be supported and enhanced by advancing technology.

The future of radiology is here, and the prediction clearly states that it will not only better health care but also the lives of all the stakeholders.

24 Sep 2020

What do you look for in a RIS/PACS for a Tele-radiology application

Let’s face it. Today a PACS is a commodity …has been for quite a while.
Most PACS and for that matter RIS on the market can do most everything………..at least that is what the brochures claim!

For a Tele-radiology application, these are some of the important requirements

  • What are the workflow features it supports?
  •  How easy is it for a Radiologist to set up a practice for himself or herself?
  •  How many reports can the Radiologist dictate in a day?
  •  What is the cost of ownership?

Let’s take the last one first!

Today, reducing reimbursements from insurance companies, increasing competition across the globe, and the need to provide quality care in spite of all the above – are forcing owners of imaging centers to question the cost of ownership.

This is where the cloud-based solution brings value to the table. With a cloud-based solution, the vendor is responsible for the high end redundant servers housed in class III or similar data center, disaster management solutions, archiving studies and reports for 7 years or more. This solution provides a very low or practically nil cost of ownership.

The Radiologist or the owner can focus on building the business, signing up new hospitals, and bringing the bacon home! The cloud based solution gives him a lot more flexibility and freedom to go after new prospects even if they are not in the same state or even the same country.

The number of reports a Radiologist can generate in a day translates to profits. The system must be simple to use and the reporting engine and viewer must allow him to dictate as quickly as possible. Interface with a Voice recognition system, easy content (text and audio) exchange between the Radiologist and transcriptionist, peer review with ABR codes, QA, real time collaboration between different stakeholders are some of the features to look for in a system. The Radiologist must be the last link in the chain and studies/images must reach him only when they are complete in all respects, thereby saving his valuable time. Some systems have the reconciliation feature that handles this part of the assignment. The system must support all DICOM modalities which can be added any time later with ease and also support non DICOM for use with legacy modalities.

The system must be simple to use and more importantly easy to install. The Radiologist must be able to start his business or add a new hospital within hours thereby generating confidence in his business. If the hospital or clinic that is sending studies provides a VPN -then the issue of encrypting, security, and safe transmission are taken care of and there is no need for any hardware purchase by the Radiologist. If not, a simple PC that can house the DICOM router software and route the studies fast and efficiently to the central server, is sufficient. The system must also be universal such that it should not need any proprietary hardware for viewing and should be able to log in from any browser. Viewing and distributing images on a mobile device is becoming ubiquitous today and helps the Radiologist to take instant decisions from an airport or a coffee shop!

Last but not least the workflow features are very important. It is indeed an irony that when you mention workflow, most people have the “deer caught in the headlights look”. The workflow is the most important factor which contributes to the productivity and thereby to the bottom line of the enterprise. Some systems provide a “soup to nuts” solution for the workflow from capture to archive while some provide certain modules. Here it is important to get a standard off-the-shelf software that can be customized -rather than develop one from scratch and make it proprietary, finding it difficult to change in the future. The workflow defines many conditions that improve overall efficiency.

For example:

  • Assignment of studies to a Radiologist depending upon various conditions
  • Workflow parameters like TAT, number of reads, work load, QA score for Radiologist
  • Auto assignment or through manual intervention by an Administrator
  • Monitoring TAT (Turn Around Time) and reassigning studies if TAT is not met
  • Collaboration between various stakeholders through work-list
  • Customizable work-list which enables the user to see what they want to see and hide the extraneous information.
  • Monitoring QA, reconciliation, Peer review to help improve the quality of care to the patient
  • Integration with existing front end or back end solutions using HL7 or web links
  • Accessing PRIORS and showing patient demographics to the Radiologist while reporting to enable faster and more accurate reporting
  • Enabling the patient to get hold of the report and studies through a secure patient portal.
  • Use of mobile devices and maybe a QR code to make it easy for the patient to receive the information.

These are just some of the important workflow features to look for. It is best to ask the vendor what they provide – to help you improve the productivity of the Tele-radiology center. An important characteristic the software should provide is the flexibility to customize the features to get the best bang for your buck.

Many vendors who are in this business should be getting constant feedback from their valued users and keep improving their product.

Make sure they provide 24x7x365 support otherwise all the above is not as attractive as it sounds!

07 Sep 2020

7 Signs That Diagnostic Centers Should Invest In Tele-Radiology

In today’s competitive healthcare environment, running a diagnostic imaging center is not easy. Apart from the high equipment cost at startup, operational and ongoing financial challenges abound. A technology innovation that can assist owners of diagnostic centers in optimizing their center’s performance is teleradiology. This article lists the typical scenarios in which owners of diagnostic centers can benefit from this pathbreaking healthcare innovation.

  1. A chain of new diagnostic imaging centers is being opened.

The best time to invest in teleradiology is at the time of expansion from a single center facility (either a diagnostic center or a nursing home or hospital) to a multicenter practice setup. This is when teleradiology will bring you maximum benefits, as it will allow you to utilize your existing radiologist staffing more efficiently. One radiologist at one of the sites can potentially report Xray and CT/MRI scans for all the centers. An onsite radiologist will be required at each site for performing ultrasounds and procedures.

  1. Scans are not getting reported on time and the patients and referring doctors are complaining.

Implementing teleradiology is a highly effective way to improve your report turnaround time. It brings the images to your radiologist and allows him/her to report them instantly, instead of your having to wait for the radiologist to show up at work. Furthermore, using an efficient teleradiology workflow platform (Radspa developed by TeleradTech is one such example) can significantly improve your radiologists’ reporting efficiency and thereby further shorten the reporting times.

  1. The diagnostic imaging center has started receiving injury cases at night that need immediate reporting.

Emergency Nighthawk/urgent care is where teleradiology makes its greatest impact. If your hospital or diagnostic center is open 24 hours and scans are being performed through the night then you can greatly benefit from teleradiology, either by allowing your own radiologist to report from his or her own home at night or if that is too taxing for them, by outsourcing your reporting to a teleradiology reporting center that provides 24 x 7 services. Remember though to check reporting quality standards and accreditations!

  1. The center is unable to find a radiologist to report the scans.

In the current scenario of radiologist shortages, this is not an uncommon situation and the radiologist staffing at any site can suddenly become a problem. Teleradiology can help by either allowing your radiologist to report the scans from wherever he or she may be, or by allowing you to outsource your radiology reporting to a teleradiology reporting center.

  1. The reporting radiologist is getting frustrated and burnt out with the increasing workload.

As your diagnostic center volumes increase it may become more difficult for your radiologist to cope with the workload. In such situations, teleradiology can be a helpful backup to direct your excess case workload to a teleradiology reporting service.

  1. The radiologist is excellent with reporting xrays and ultrasounds but not comfortable with CT and MRI.

Advanced imaging techniques such as CT and MRI are rapidly evolving and becoming more and more complex, not all radiologists may be comfortable reporting all types of exams especially pediatric, musculoskeletal or cardiovascular. In such cases, referring such complex examinations to a teleradiology reporting center can improve the quality of reporting by gaining access to a subspecialist radiologist with expertise in the specific type of examination.

  1. The center requires a backup of all the scans done without the hassle of maintaining it on site.

Using teleradiology allows one to maintain a remote archive of all of one’s scans and reports, on the cloud, with complete security. This can be a valuable backup archive for an imaging center, so that there is never any loss of patient information or images.

The above points are a brief synopsis of the many benefits that teleradiology can afford to the promoters of a diagnostic imaging center. To help unleash the full potential of an imaging center, teleradiology holds the key today.

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