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Emergency Teleradiology SER 2015

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Teleradiology Benefits :
Improved Communication
Immediate accessibility to ER doctor/specialist
Support for Technologist – protocols, rescans

Radiologist Productivity, Efficiency, Lifestyle

Cost benefit – economy of scale

Published in: Healthcare
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Emergency Teleradiology SER 2015

  1. 1. Emergency Teleradiology Arjun Kalyanpur MD, DABR Chief Radiologist Teleradiology Solutions
  2. 2. Outline • Background • Clinical Role and Benefits • Technology and Operations • Quality and Peer Review • Regulation and Accreditation • Challenges
  3. 3. Background • Radiologist shortages – not getting better – Emergencies (night shift) most affected – Remote/rural hospitals most affected – Global phenomenon
  4. 4. Radiologist to Population (per mill) Bangladesh 1 India 10 Japan 30 England 48 Singapore 50 Germany 92 USA 100 Spain 112 France 130 •14 countries in sub Saharan Africa have no radiologist (Source: WHO)
  5. 5. Emergency Teleradiology Evolution • Increase in emergency imaging utilization – Dependence on imaging as a triage tool – Rapid advances in CT technology – CT primary modality – trauma, vascular • Increasing need for immediate reporting • Technology – Broadband, DICOM, PACS/RIS • CJEM 2013;15(3):161-166
  6. 6. Emergency Teleradiology 24 x 7 x 365 access – instant reporting Time Advantage – work follows the sun “Nighthawk” Improved radiologist lifestyle
  7. 7. International Model • Day-night time difference allows for • Better performance – biorhythms • Increased productivity • Enhanced service levels • Better accessibility
  8. 8. Global Teleradiology
  9. 9. Clinical Applications • Trauma • Stroke • Acute Abdomen- stone, diverticulitis, volvulus • Acute Thorax – PE, Aortic dissection • Sonography – RUQ, Early pregnancy, Torsion • Nuclear Medicine - VQ, GI bleed • Pediatric Emergencies – intusussception, appendicitis
  10. 10. Trauma- role of Teleradiology 1. Immediate detection improves patient outcomes – aortic injury, burst fracture, vascular injuries 2. Staff support at residency programs 3. Decrease need for patient transport from rural centers (Emerg Med J 2007;24(8):550-552)
  11. 11. Stroke – role of Teleradiology •Teleradiology can shorten the time to thrombolysis •Early diagnosis – dense MCA, insular ribbon •Immediate detection of contraindication for thrombolysis – bleed, aneurysm, mass •Early detection of complications – herniation, hemorrhagic conversion of infarct.
  12. 12. Mobile
  13. 13. Role of Emergency Teleradiology • Immediate report • High report quality by emergency radiologist – Comfort level with all imaging modalities – Experience in all emergent scenarios – Speak the same language as the ER doctor/trauma surgeon – These translate to better patient outcomes
  14. 14. Teleradiology Benefits • Improved Communication – Immediate accessibility to ER doctor/specialist – Support for Technologist – protocols, rescans • Radiologist Productivity, Efficiency, Lifestyle • Cost benefit – economy of scale
  15. 15. Teleradiology Technology • Connectivity: Highspeed broadband network • VPN • Datacenter • Cloud
  16. 16. Teleradiology Technology • Teleradiology Workflow Platform • Intelligent assignment of cases • Inter-radiologist consultation • Analysis of performance • Goal – to promote efficiency and productivity
  17. 17. Teleradiology Operations • Communications center Calls for additional clinical info or images Critical values communication SMS alerts •Coordination between sites and radiologists •Complex scheduling
  18. 18. QA and Peer Review The need: • Low margin for error in emergencies • High risk • Potential poor outcome The Process: • Intense internal and External peer review • Training and CME - online
  19. 19. QA Analysis/tracking Continuous peer review Detailed Analysis of trends Corrective measures Overall QA Grades 2008 23% 4% 23% 2% 31% 0% 0%11% 3% 3% Grade 0 Grade 1 Grade 2 Grade 2/3 Grade 3 Grade 3/4 Grade 4 Grade 4/5 Grade 5 Not Reviewed Rad X QA Grades for 2008 0 15 0 0 8 2 15 3 3 46 20083 1 10 100 1000 10000 100000 N otR eview ed G rade 0 G rade 1 G rade 2 G rade 2/3 G rade 3 G rade 3/4 G rade 4 G rade 5 TotalQ A sTotalC ases
  20. 20. Teleradiology Research
  21. 21. Continuing Education and Training Necessary in telerad environment Continuous quality improvement Knowledge update Stimulate research
  22. 22. Online education portal : Radguru Internal training Teaching 800 DNB PGs across the country
  23. 23. Regulation and Accreditation • Radiologist • Certification/Licensing • Insurance • Organizational – JC, MOH, KLAS • Technical – FDA, CE, HIPAA
  24. 24. Challenges in Teleradiology • Insufficient Clinical Data – access to HIS/EMR • Large Image Datasets – Routers • Outages - redundancy in infrastructure • Evolving client expectations – mindset changes
  25. 25. How does Teleradiology benefit Emergency Radiology? • Teleradiology is now an integral part of emergency radiology coverage • The greatest impact of Teleradiology has been in the emergency radiology space • The increasing adoption of teleradiology worldwide benefits the subspecialty of emergency radiology
  26. 26. The future • More international utilization of emergency teleradiology • Evolution towards subspecialization • Increased focus on quality standards and metrics • Integration with other telemedicine consultations
  27. 27. Email: info@telradsol.com THANK YOU FOR YOUR ATTENTION
  28. 28. www.telradsol.com KLAS® rates Teleradiology Solutions the No. 1 National Teleradiology Provider in the US (2011) www.teleradfoundation.org TS gives back www.radguru.net Training Radiologists globally http://www.teleradtech.com RADSpa-a teleradiology platform for the world www.rxdx.in RXDX-Whitefield's premier 24 hour multispecialty clinic http://www.imagecorelab.com Clinical Trials Imaging www.healtheminds.com Tele counselling

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