emergency teleradiology ser 2015

Emergency Teleradiology

Arjun Kalyanpur MD, DABRChief Radiologist

Teleradiology Solutions

Outline

• Background• Clinical Role and Benefits• Technology and Operations• Quality and Peer Review• Regulation and Accreditation• Challenges

Background• Radiologist shortages – not getting better

– Emergencies (night shift) most affected– Remote/rural hospitals most affected– Global phenomenon

Radiologist to Population (per mill)Bangladesh 1India 10Japan 30England 48 Singapore 50Germany 92 USA 100Spain 112 France 130 •14 countries in sub Saharan Africa have no radiologist (Source: WHO)

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

Emergency Teleradiology 24 x 7 x 365 access – instant reporting

Time Advantage – work follows the sun “Nighthawk”Improved radiologist lifestyle

International Model

• Day-night time difference allows for• Better performance – biorhythms• Increased productivity• Enhanced service levels • Better accessibility

Global Teleradiology

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

Trauma- role of Teleradiology

1. Immediate detection improves patient outcomes – aortic injury, burst fracture, vascular injuries

2. Staff support at residency programs3. Decrease need for patient transport

from rural centers (Emerg Med J 2007;24(8):550-552)

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.

Mobile

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

Teleradiology Benefits• Improved Communication

– Immediate accessibility to ER doctor/specialist – Support for Technologist – protocols, rescans

• Radiologist Productivity, Efficiency, Lifestyle

• Cost benefit – economy of scale

Teleradiology Technology• Connectivity: Highspeed broadband network• VPN• Datacenter• Cloud

Teleradiology Technology• Teleradiology Workflow Platform • Intelligent assignment of cases• Inter-radiologist consultation• Analysis of performance

• Goal – to promote efficiency and productivity

Teleradiology Operations• Communications center

Calls for additional clinical info or images Critical values communication SMS alerts•Coordination between sites and radiologists•Complex scheduling

QA and Peer ReviewThe need:• Low margin for error in emergencies• High risk• Potential poor outcome

The Process: • Intense internal and External peer review• Training and CME - online

QA Analysis/tracking

Continuous peer reviewDetailed Analysis of trendsCorrective 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 3Grade 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

Not Rev

iewed

Grade 0

Grade 1

Grade 2

Grade 2/

3

Grade 3

Grade 3

/4

Grade 4

Grade 5

Total

QAs

Total

Cases

Teleradiology Research

Continuing Education and Training

Necessary in telerad environment

Continuous quality improvement

Knowledge update

Stimulate research

Online education portal : Radguru

Internal trainingTeaching 800 DNB PGs across the country

Regulation and Accreditation

• Radiologist • Certification/Licensing• Insurance

• Organizational – JC, MOH, KLAS

• Technical – FDA, CE, HIPAA

Challenges in Teleradiology• Insufficient Clinical Data – access to HIS/EMR

• Large Image Datasets – Routers

• Outages - redundancy in infrastructure

• Evolving client expectations – mindset changes

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

The future• More international utilization of emergency teleradiology

• Evolution towards subspecialization

• Increased focus on quality standards and metrics

• Integration with other telemedicine consultations

Email: info@telradsol.com

THANK YOU FOR YOUR ATTENTION

www.telradsol.com KLAS® rates Teleradiology Solutions the No. 1 National Teleradiology Provider in the US (2011)

www.teleradfoundation.orgTS 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 24hour multispecialty clinic

http://www.imagecorelab.comClinical Trials Imaging

www.healtheminds.comTele counselling