Category: Teleradiology

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.

05 Sep 2020
Teleradiology software for practice

How To Pick The Best Teleradiology Solution For Your Practice?

With a plethora of vendors offering a RIS/PACS solution and claiming to do everything under the sun, it is not surprising that most buyers are confused and overwhelmed. Even for a discerning user, it is difficult to separate the wheat from the chaff and arrive at a short list of vendors who meet both the technical and the financial criteria. If you are managing a radiology imaging facility, then you are probably walking a tightrope between investing in technology for your radiologists and improving the bottom line for the organization. This has become a lot easier with the advent of cloud technology. The right Teleradiology software for you depends on your needs and the size of your practice. It is the 80/20 rule. 80% of the features are nice to have, but the 20% features impact the bottom line and should be considered as must haves.

Some Teleradiology providers offer an extensive range of Teleradiology software solutions with many extra features that you might not need – and will end up paying more than you actually need. Do you really want an integrated billing system? Marketing services? Do you need a Teleradiology solution bundled with contracted radiologists?

On the other hand, if you are based in a bigger health ecosystem and you need a wide range of services, you will prefer a Teleradiology software that offers an all-in-one solution.

Minimal set-up

When it comes to adopting a new Teleradiology software and then training the staff it will require a ton of resources and time. If possible, look for a web-based solution, or opt for a user-friendly Teleradiology software and simple implementation. Consider a product which has no capital investments, no maintenance costs and you can still keep your Radiology reading team excited and productive!

RIS and EMR integration

If you want to archive any transmitted medical images and radiology consults, how will you? How will these files be incorporated into your patient records? Check with the teleradiology software provider whether they offer EMR integration or compatible radiology information systems (RIS). If you are looking to archive the studies and the reports you need to make sure that they are stored in a VNA. You must be able to get out of the relationship with the vendor and move out with all your data and take it elsewhere. You need to be assured that the data is not stored in any proprietary format and is stored in standard DICOM. Check if the vendor complies with HL7 standards and HIPAA guidelines.

Patient portal

Will you be sharing medical images with your patients? Check if the Teleradiology solution provides a patient portal that allows them to share images with the patients in a hassle free manner without the printing, and couriering the media costs.

Mobile solutions

Based on your need for mobile devices, in your practice, you may want to explore teleradiology software that is mobile compatible.

That way, providers can retrieve and enhance medical images and radiology consults on their devices while on the go.

Cost

A Teleradiology solution can be an effective way to expand radiology services while saving money. However, one has to evaluate all the associated costs. Ask the Teleradiology software provider for a detailed pricing quote, in writing. Consider the below questions when doing the ROI.

How can operational efficiency and the productivity of my team improve? Can I shoot for a goal of 30% improvement or more?

How can I reduce the maintenance cost of my system that I purchase?
How can I spend more time on my business rather than on the system related stuff?
How reliable and stable is the company who is offering this product?
Can I have a full feature trial of the system before I decide to buy?
What is my monthly cash outflow with this system?
Can I get an obligation free consultancy with an expert and discuss my needs?
How can my team benefit from the use of the system?
Support: This is one of the important criteria for selection. Question to be asked are

Does your company provide 24x7x365 support?
Can I see your Service Level Agreement (SLA)?
Do you support multiple languages in your software?
Do you have local support people?
What happens when a feature of the system does not work? How soon can I expect a response? Is there a way to replace the system? If so how quickly can it be replaced? (This is a challenge especially in an ONSITE solution and a cloud-based solution has advantages here!)
Security

Teleradiology software needs to be HIPAA compliant. If you don’t have the IT resources to configure a secure virtual private network (VPN) and set-up a DICOM router, you may want to ask a Teleradiology provider if they will help get you set-up.

While the vendors are constantly working to improve their product offerings, the end user also has to do their due diligence before the purchase. All this happens all the time in the industry but it helps to have a check-list and go through it so you don’t lose track of any specific item! Teleradiology Solution can be an effective way for small to large health systems to expand their radiology services and offer 24/7 access. Find the right Teleradiology solution now.

22 Jun 2020

Advances in the Teleradiology Sector

Dr Arjun Kalyanpur, MD, Chief Radiologist and CEO, Teleradiology Solutions, Bengaluru, India speaks about the trends and prospects that teleradiology brings to healthcare

The last decade has been a truly exciting one for the teleradiology sector, which in its currently established form is about two decades old, i.e. as old as the current millennium. The first decade of this millennium had teleradiology proving its credibility as a potentially transformational technology innovation that could provide much needed support to radiologist-starved hospitals and diagnostic centres, emergency departments and perhaps most importantly, to other overworked radiologists. Over the second decade 2010-2019, however, teleradiology has seen exponential scale and has evolved into an industry unto itself. The main advances and trends facilitating this growth of teleradiology, which we have witnessed through the perspective of our own global clinical teleradiology practice have been:

1. Increase in utilisation of teleradiology – Once the initial concerns and doubts about its efficacy and safety were addressed, the sheer need for teleradiology based on critical radiologist shortages and dramatic increases in utilisation of imaging have driven its explosive growth. In our practise we have seen that the growth has spanned all geographies from the most technologically advanced metropolitan cities of the United States to remote and backward parts of Africa and Asia where healthcare delivery is still primitive. Similarly, all modalities have been impacted by teleradiology from plain X-rays to PET-CTs. And market surveys which a decade ago tentatively hinted at teleradiology growing into a 1-billion-dollar industry today seem to confidently proclaim that it will soon cross 10 times that number.

2. Clinical applications driving the need for teleradiology – Driving the demand for teleradiology has been a profusion of clinical applications in which teleradiology makes significant impact.

a) A classic example is acute stroke. In our US clinical teleradiology practice we have seen a significant increase in both the number of centres accredited as stroke treatment centres and the corresponding number of stroke imaging scans being performed (now including CT angiography and perfusion imaging). This means that thousands of images per patient need to be interpreted in an ultrashort time frame, typically within 10 minutes. Further, trauma and emergency imaging in general are increasingly utilised. In the US it is estimated that CT imaging of the spine for trauma increased by 400 per cent from 2006-2016 and Vascular CT angiography by 300 per cent over the same time period. As after-hours radiologists are hard to find in the current environment, teleradiology steps in as the provider of choice.

b) At the opposite end of the urgency spectrum even screening examinations such as chest X-ray for TB, low dose screening CT for lung cancer detection and mammography are able to realise greater adoption when combined with teleradiology interpretation. In parallel, the radiologist shortages have become even more acute, despite efforts to train more personnel, which are thwarted by the challenge that today radiologists in many instances are too busy with clinical work to be able to dedicate sufficient time to train the next generation. Hence, more teleradiology utilisation (and online education to train radiologists, but that’s another story…).

3) Cloud technology promotes the growth of teleradiology – From a technology standpoint one of the transformational trends in teleradiology over the past decade has been the spread of cloud based technologies which allows doctors and medical centres to set up and use teleradiology without investing in expensive hardware. Thus, there is a cost reduction by reducing the need for high-end onsite servers. It has also led to greater saleability of teleradiology as the ability to add on server space incrementally, rather than in quantum mode, is facilitated by cloud technologies. Also as server and internet bandwidth costs have dropped, the ability to reliably archive data offsite has become a reality. Rapid/immediate deployment of teleradiology services – as in the pay-as-you-grow model, such as the one afforded by our technology workflow Radspa, wherein any radiologist wishing to practice teleradiology can sign up for and switch on instantly, has accelerated adoption.

4) Teleradiology increases radiologist efficiency with workflow tools, viewer embellishments – Over the past decade the focus of teleradiology has been on further improving the reporting efficiency of radiologists by using an amalgamation of efficient viewer design, structured reporting, voice recognition and radiology lexicons all of which are driven by the increased workloads and radiologist shortages, a challenging scenario in which teleradiology provides its greatest value. Teleradiology workflows focus on ensuring that every second of radiologist time is optimally utilised.

5) Teleradiology enables working from home, part time: New service and business models have emerged in the past decade due to the proliferation of teleradiology services. The number of radiologists working part-time from home offices has increased in geometric progression which allows for better utilisation of that exceptionally valuable resource, that is radiologist time. This has also allowed for segments of the workforce who were previously unproductive such as young mothers and those dealing with elder care issues to remain productive in the workforce and equally importantly to retain their radiology skills. Teleradiology also facilitates a per-read reimbursement model that translates into more efficiency and greater productivity in reporting than the traditional salaried reimbursement model.

6) Recent governmental adoption and tendering process for teleradiology – A significant advance in teleradiology over the past decade has been a consequence of the realisation on the part of the government that it is unable to effectively address on its own the radiology needs of the community and its embracing public private partnership models which use teleradiology workflows to deliver valuable access to remote areas in a public health environment. Our work with the government of Tripura has illustrated the power of collaboration between the private sector and government using teleradiology as a bridge to provide radiologist access to district hospitals and community health centres to rural populations in remote parts of India.

7) 3D Teleradiology Lab – the use of outsourced 3D post-processing services for generation of high quality volume data that facilitates surgical planning is an important offshoot of teleradiology that has been firmly established over the past decade. Our work with the Harvard MGH 3D Lab providing after hours post-processing services to a luminary tertiary care metropolitan hospital site is an illustration of the value of this service. From the technology standpoint, the convergence of 3D workstations with teleradiology workflow is a new advance that increases and enhances the reach and value of both.

8) Teleradiology core lab facilitates drug discovery and clinical research – In the last decade, there has been a resurgence in drug discovery related research in the pharma and biotech sector in the country while the industry has only continued to grow at a global level. The use of teleradiology-driven Core Labs, such as our own Image Core Lab, by the pharma/biotech sector has significantly increased, as has the creation/adoption of teleradiology workflow such as Clinspa which are focussed on the unique requirements of clinical research-related radiology reporting such as dual read with adjudication, quantitative imaging and the use of objective reporting standards such as RECIST. Teleradiology has proven itself to be a major value addition in drug discovery and clinical research.

9) Teleradiology-driven education and second opinion sites- The increasing use of teleradiology for second opinions and subspecialty consultations especially through web-based services to which anyone can upload their imaging data marks another success story for teleradiology in recent times. And the growth in popularity of teleradiology-driven online education websites portals for radiology education parallels that of the Internet as the foremost source of information and learning today. We currently have users from all across the world logging on to our live e-lectures by luminary international guest speakers.

10) Teleradiology and AI, the next big thing – Of all these, by far the most exciting development in the teleradiology space has been the emergence and realisation of growing synergies between it and the new and precocious kid on the block, namely artificial intelligence and its conjoined twin, deep learning. Both teleradiology and AI thrive in the environment of clinical complexity, computational and networking technology and big data and both seek to solve the same fundamental challenge of too many images and not enough radiologists. Teleradiology provides an exceptional environment for the development, validation, testing and finally the deployment of deep learning algorithms. The integration of AI algorithms with teleradiology workflows can help make the radiologist more efficient and more accurate. For instance, we have deployed an AI tool that can auto detect a brain bleed into our ER teleradiology practice which enables stroke cases to be triaged immediately as positive or negative. This represents a pivotal moment in the evolution of the new age technology enhanced super-radiologist. AI is the catapult that will propel teleradiology into the new decade and beyond.

To summarise, from a teleradiology perspective, very exciting times lie ahead… and to paraphrase the old time jazz singer Al Jolson…. we ain’t seen nothing yet!

References:

1. https://www.mpo-mag.com/contents/view_breaking-news/2019-08-29/teleradiology-market-continues-to-grow/
2. https://www.auntminnie.com/ index.aspx?sec=rca&sub=rsna_2018&pag=dis&ItemID=123892
3. https://www.diagnosticimaging.com/ articles/cloud-computing-creates-climate-change-teleradiology
4. https://www.dicomstandard.org/wp-content/uploads/2018/10/Day3_S2-Bedi-Clinical-Teleradiology-Workflow.pdf
5. https://www.rcr.ac.uk/posts/nhs-does-not-have-enough-radiologists-keep-patients-safe-say-three-four-hospital-imaging
6. https://www.slideshare.net/ TeleradiologySolutio/teleradiology-in-the-northeast
7. https://health.economictimes.indiatimes.com/news/medical-devices/teleradiology-solutions-invests-300000-for-3d-imaging-facility-partners-with-massachusetts-general-hospital/54419957
8. https://radiologykey.com/evaluating-and-working-with-an-imaging-core-laboratory/
9. http://www.arjunkalyanpur.com/2018/10/elearning-from-very-best-in-world.html
10. https://www.researchgate.net/publication/333411163_Teleradiology_and_Artificial_Intelligence_-_Birds_of_the_Same_Feather

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