Setting up a distributed teleradiology network is readily achievable today with technology currently available in the market. But IT isn't the only factor to focus on when building collaborative teleradiology networks, according to Dr. Jan Schillebeeckx, a healthcare consultant in Bonheiden, Belgium.
Workflow optimization must also be utilized to achieve efficiency and success, said Schillebeeckx, who is also a radiologist at Imelda Hospital Bonheiden. He discussed teleradiology workflow management issues during a session at the 2011 European Congress of Radiology (ECR), held earlier this month in Vienna.
Today, there is a shortage of radiologists in some countries and regions around the world, Schillebeeckx said. And imaging utilization is on the rise due to an aging population and an increase in chronic disease. Imaging technology has also improved.
"Diagnosis is becoming more and more complex and requires new visualization tools, and there is more and more demand for subspecialization," he said.
The 8% increase in imaging volume is expected to be greater than the 2% increase in the number of radiologists, according to Schillebeeckx. In addition, patients have growing expectations for radiology services.
"They don't want to wait a long time to have an examination, and they want the result as fast as possible," he said.
Healthcare technology research firm KLAS has reported that hospitals and clinics today hold close to 40% of teleradiology contracts; the firm expects that percentage to increase to 80% in the coming years, Schillebeeckx said.
"Therefore, I believe that it's very important that we try to organize ourselves and create amongst us regional or countrywide ... collaborative networks for radiology," he said.
The most important challenges to this teleradiology vision are to ensure that it develops in a manner that benefits patient care, ensures overall patient safety, and does not in any way reduce the quality of radiology services provided to the citizen, he said.
Not just IT
Collaborative teleradiology networks require more than just IT infrastructure with IT support; they also require workflow management.
"And if you work with several hospitals, you need to have administrative and management support that provides all the stakeholders with operational, analytical, and statistical [quality assurance] reports," he said.
These networks cannot work well without workflow to provide organization, however. There needs to be some form of central management, but it isn't relevant whether it's a commercial company, an academic hospital, or a general hospital, as long as personnel have the IT skills and human resources to organize this, he said.
All participating radiology departments and hospitals need to be linked, with access to clinical information and images. And studies -- along with relevant clinical information -- should be immediately sent to the right specialist.
If different hospitals work together, a contract should be drawn up to spell out who will be participating in the network and who will do what, he said. Participating radiologists will also need to be trained on the system.
Planning should be performed to account for resource control, being aware of which radiologists are available and what types of examinations they can read, according to Schillebeeckx. All of the relevant information should also be available before the study goes on the worklist.
Results need to be sent back to referring physicians, and reports should be provided in the language of the patient, he said. Billing support should also be included.
In addition, radiologists also need to be able to answer clinical requests, he said.
"It is very important that a radiologist in hospital A can communicate with the referring physician in hospital B, and potentially with the patient," he said.
Technology platform
Setting up this kind of collaborative teleradiology network requires more than just having a PACS, Schillebeeckx said.
"You need to have an environment that hosts applications that support user management, security, system administration, backup, [etc.]," he said. "And you need to have applications that support functionality required for modern teleradiology and the electronic health record. I believe that you need to have access, if possible, to the electronic patient record, or it's preferable that you not do teleradiology."
A Web-based 3D-capable PACS should be used, allowing for radiologists to read all types of imaging studies. RIS and speech recognition systems should be available, and the system must be able to function in low-bandwidth environments, he said.
The technology platform needs an interoperability layer that supports communication between hosted applications and existing legacy systems on customer premises. It should also support the implementation of software that spans different applications on other networks, allowing for matching of patient IDs that may not be the same on different systems.
A clinical viewer should be available to provide referring physicians with access to images.
Process management and business intelligence tools are also needed to maximize overall efficiency in the healthcare organization, to ensure consistent and maximum performance from healthcare professionals and departments, to increase medical quality, to enhance billing processes, and to support evidence-based management, according to Schillebeeckx.
"You need to have an organization -- you can call it the centrally operated hub -- so that the radiology workflow is optimized to ensure throughput of cases, involving all the radiologists in the network with the difference that only the services are provided by the hub to the network and not the medical acts," he said. "It is important that the medical acts remain in our hands as radiologists."
