emergency teleradiology ser 2015
TRANSCRIPT
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
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