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Emergency Teleradiology
Arjun Kalyanpur MD, DABR
Chief 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 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)
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 programs
3. 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 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
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
Teleradiology Research
Continuing Education and
Training
Necessary in telerad environment
Continuous quality improvement
Knowledge update
Stimulate research
Online education portal : Radguru
Internal training
Teaching 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.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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Emergency Teleradiology SER 2015

  • 1. Emergency Teleradiology Arjun Kalyanpur MD, DABR Chief Radiologist Teleradiology Solutions
  • 2. Outline • Background • Clinical Role 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 x 7 x 365 access – instant reporting Time Advantage – work follows the sun “Nighthawk” Improved radiologist lifestyle
  • 7. International Model • Day-night time difference allows for • Better performance – biorhythms • Increased productivity • Enhanced service levels • Better accessibility
  • 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 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. 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.
  • 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. 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. Teleradiology Technology • Connectivity: Highspeed broadband network • VPN • Datacenter • Cloud
  • 16. Teleradiology Technology • Teleradiology Workflow Platform • Intelligent assignment of cases • Inter-radiologist consultation • Analysis of performance • Goal – to promote efficiency and productivity
  • 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. 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. 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
  • 21. Continuing Education and Training Necessary in 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 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. The future • More international utilization of emergency teleradiology • Evolution towards subspecialization • Increased focus on quality standards and metrics • Integration with other telemedicine consultations
  • 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