Teleradiology in Europe is here to stay and its impact will increase, according to Dr. Erik Ranschaert, staff radiologist at the Jeroen Bosch Ziekenhuis teaching hospital in 's-Hertogenbosch, the Netherlands. Several key issues must be resolved, however, before teleradiology can be used more widely.
"First, there's the jurisdictional factor," he said. "The language issue is still there, and the integration and implementation of IHE (Integrating the Healthcare Enterprise) standards, quality assurance, and of course the financial part. And then the patient is in the middle of the whole process because we should also see this type of healthcare provision as a patient-centric model."
Dr. Erik Ranschaert, staff radiologist at the Jeroen Bosch Ziekenhuis teaching hospital in 's-Hertogenbosch, the Netherlands. All images provided by ESR.
A clear regulatory framework is required to ensure the quality of services to patients, enable the use of cross-border teleradiology, enhance collaboration between radiologists and institutions across Europe and beyond, and deal with legitimate concerns about quality, security, privacy, and liability. Acceptance and trust of teleradiology will only come with greater transparency in quality assessment and assurance, mutual recognition of qualifications within and even outside the EU, uniform accreditation system for teleradiology providers, secure data communication protocols and agreements, and transparent legislation within the EU and local support of EU regulations and directives, he said.
Increasingly, patients are managing their own images and can present them to any doctor or specialist. This trend is being hastened by the introduction of new services for patients offered via websites and applications, including second opinions in radiology, clarification of findings, and the "translation" of reports into easily understood language. Reference sites about diagnosis, possible treatments, and prognosis are popping up, and these developments are leading to more direct communication with radiologists, according to Ranschaert.
He presented the findings of a survey he conducted in autumn 2011, with support from the European Society of Radiology (ESR). Of the 368 respondents from 35 countries, 65% are using teleradiology. Of those using teleradiology, 53% are doing so at their institution, 32% at their homes, and 15% elsewhere. Overall, 80% of the sample had a strongly positive opinion about teleradiology, 46% thought its importance would grow, and 20% mentioned the need for further standardization and better financial and legal regulations.
Outsourcing with teleradiology is being used by 35% of respondents, mostly for night readings, second or expert opinions, and part of their regular workflow. In 52% of cases, the outsourcing takes place at a commercial provider within the respondent's own country. It occurs at a tertiary center in 31% of cases, and at a commercial provider within the EU in 13% of cases.
Prof. Osman Ratib, chair of the department of medical imaging and chief of the division of nuclear medicine and molecular imaging at the University Hospital of Geneva, Switzerland.
Teleradiology has a bright future because there is always likely to be a shortage of radiologists, a need for on-call readings, and a need for subspecialty advice, Ranschaert pointed out. Opportunities for further growth include services offering expert or second opinions, emergency and on-call services, services to support small practices and hospitals, and creation of collaborative networks.
By 2015, 30% of all smartphone users will be using mobile health products, whereas the current figure is 5%, he noted.
Within five years, half of European Congress of Radiology (ECR) speakers will simply plug in their own Apple iPad and use it to give their presentations, rather than using the congress organizer's system, predicted Prof. Osman Ratib, chair of the department of medical imaging and chief of the division of nuclear medicine and molecular imaging at the University Hospital of Geneva, Switzerland. Known widely as a trendsetter, he used his own iPad to give his talk during Sunday's session.
Ratib first addressed the topic of handheld devices at the 2001 RSNA congress, when he took part in a refresher course about new ergonomics in radiology. It's only during the past couple of years, however, that truly mobile hand held devices have become available, due to changes in the consumer market, he noted.
Web-based applications involving a browser or thin-client technology are an increasingly popular means of displaying images and transferring data. Loading applications onto mobile devices is another option.
"The situation is changing so fast. These tablets now have quite powerful CPUs (central processing units) on board so that you can load both the data and the program," he said. "Memory is growing, and every time you have bigger and bigger amounts of storage space, so they are becoming almost as powerful as a laptop computer."
The other possibility is to remotely share your computer and run it from a portable device.
"You can keep your computer up and running, and through a channel of connection, you can take control of your computer," Ratib remarked. "This is not commonly used, but it's actually quite attractive for some applications."
With mobile devices, it's particularly important to not let your standards slip, to keep essential documentation, and to respect patient confidentiality, warned Dr. Richard FitzGerald, consultant radiologist at the Royal Wolverhampton Hospitals NHS Trust, U.K. In general, checking your indemnity cover regularly, taking measures to guard against fatigue, and keeping a PACS audit trail can help reduce the possibility of medicolegal cases, he noted.
Originally published in ECR Today March 5, 2012.
Copyright © 2012 European Society of Radiology