A Web-based application can successfully manage a multi-institutional teleradiology service for after-hours reading from emergency departments, according to researchers from Kaiser Permanente Southern California in Los Angeles.
"We've had a high degree of satisfaction from the ED departments," said Kaiser's Bruce Horn. He spoke during a session at the 2004 RSNA meeting in Chicago.
Kaiser Permanente Southern California comprises 11 medical centers and associated medical offices in five counties. Radiology departments are based in each of the medical centers, with about 150 radiologists across the locations, Horn said.
Historically, on-call radiologists at each center have provided emergency after-hours radiology services. In early 2002, however, Kaiser began designing a teleradiology program that would provide support to emergency departments from 7 p.m. to 7 a.m., seven days a week.
The program did engender some workflow challenges along the way, including handling the changing locations of the teleradiologists, Horn said.
"Rather than them being in the same location every night, they would go to their old medical center, which was their natural location and environment that they were used to," he said. "So (the location of the teleradiologists) varies day to day."
The workload also needed to be divided among the medical centers and the multiple teleradiologists, he said. Additional clinical sites and teleradiologists needed to be accommodated in the future, and various departments and clinicians needed to access findings, he said.
Teleradiologist performance had to be monitored, and teleradiology service stats needed to be compiled on a periodic basis, Horn said.
In the teleradiology exam workflow, the requesting department (primarily the emergency department) requests the exam. Next the request goes to the radiology department to perform the procedure. The study is sent on to a teleradiologist at a remote site for wet read. The ED then gets to see the result.
Kaiser built a Web-based tool that follows that workflow, Horn said.
Information collected on the ED Web request form includes patient ID, reason for exam, exam type, special instructions, the referring department, and referring physician's contact information. The ED can then monitor the study's status using the application, although each medical center can only access its own patient information.
The radiology department performs the requested exam, making use of the information provided by the ED, and the technologist adds any pertinent information and comments on the study, Horn said.
The teleradiologist then has access to all the information previously entered in the process, and provides a preliminary interpretation, he said. At that point, the ED now can see that the exam status has been changed, and can view the findings.
QA
Kaiser also placed emphasis on quality assurance (QA) in developing the teleradiology program. Any exam that was done as a wet read is read the following day by the local radiology department from where it originated, Horn said.
"We use that radiologist's final report to (indicate) whether they believe there was a significant difference between their findings and the preliminary read of the teleradiologist, blinded to who the teleradiologist was," he said. "If they think that there was a significant clinical difference, (the exam) goes to a local QA radiologist for that department, who also determines whether they believe there was a significant clinical difference. And then finally, it goes to a regional QA group, which consists of four radiologists, that meets on a quarterly basis to review everything, all exams that have been deemed significant clinically by the local QA across the region, and make their comments."
Report cards are compiled for the teleradiologists, detailing whether there were any significant clinical findings for them, Horn said.
In use since August 2002, the teleradiology system handles approximately 40,000 exams per year, with about 85% originating from the ED.
By Erik L. Ridley
AuntMinnie.com staff writer
January 31, 2005
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