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Emergency Teleradiology SER 2015
The document discusses emergency teleradiology, focusing on its background, clinical roles, technology, and associated challenges. It highlights the growing need for immediate imaging reporting due to radiologist shortages and the importance of teleradiology in improving patient outcomes in emergency situations. Additionally, it emphasizes the benefits of improved communication, productivity, and operational efficiency in emergency care through teleradiology practices.
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Emergency Teleradiology SER 2015
- 1. Emergency Teleradiology Arjun KalyanpurMD, DABR Chief Radiologist Teleradiology Solutions
- 2. Outline • Background • ClinicalRole and Benefits • Technology and Operations • Quality and Peer Review • Regulation and Accreditation • Challenges
- 3. Background • Radiologist shortages– not getting better – Emergencies (night shift) most affected – Remote/rural hospitals most affected – Global phenomenon
- 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. 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. Emergency Teleradiology 24 x7 x 365 access – instant reporting Time Advantage – work follows the sun “Nighthawk” Improved radiologist lifestyle
- 7. International Model • Day-nighttime difference allows for • Better performance – biorhythms • Increased productivity • Enhanced service levels • Better accessibility
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- 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. Trauma- role ofTeleradiology 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. Stroke – roleof 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.
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- 13. Role of EmergencyTeleradiology • 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. Teleradiology Benefits • ImprovedCommunication – Immediate accessibility to ER doctor/specialist – Support for Technologist – protocols, rescans • Radiologist Productivity, Efficiency, Lifestyle • Cost benefit – economy of scale
- 15. Teleradiology Technology • Connectivity:Highspeed broadband network • VPN • Datacenter • Cloud
- 16. Teleradiology Technology • TeleradiologyWorkflow Platform • Intelligent assignment of cases • Inter-radiologist consultation • Analysis of performance • Goal – to promote efficiency and productivity
- 17. Teleradiology Operations • Communicationscenter Calls for additional clinical info or images Critical values communication SMS alerts •Coordination between sites and radiologists •Complex scheduling
- 18. QA and PeerReview 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. QA Analysis/tracking Continuous peerreview 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
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- 21. Continuing Education and Training Necessaryin telerad environment Continuous quality improvement Knowledge update Stimulate research
- 22. Online education portal: Radguru Internal training Teaching 800 DNB PGs across the country
- 23. Regulation and Accreditation •Radiologist • Certification/Licensing • Insurance • Organizational – JC, MOH, KLAS • Technical – FDA, CE, HIPAA
- 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. How does Teleradiologybenefit 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. The future • Moreinternational utilization of emergency teleradiology • Evolution towards subspecialization • Increased focus on quality standards and metrics • Integration with other telemedicine consultations
- 27. Email: info@telradsol.com THANK YOUFOR YOUR ATTENTION
- 28. www.telradsol.com KLAS® rates TeleradiologySolutions 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