Technology is taking the distance out of medicine and there is no better example than teleradiology. With the assistance of revved-up computers and speedier telecommunication technology such as WANs (wide area networks), high-quality digital images are acquired, sent electronically to radiologists just about anywhere around the globe and integrated seamlessly into workflow for diagnosis. In many cases, completing an imaging report used to take days - now it takes minutes.
While landline and satellite-transmitted telehealth is far from a new concept, radiology has by far exceeded any of the other "teles" in medicine. "Teleradiology is probably the most developed of all the subsets of telemedicine," says Jeff Bauer, Ph.D., senior vice president of Superior Consulting Co.
Bauer attributes improved bandwidth to teleradiology's growth. "As bandwidth increased, T1 lines became more affordable and the government started providing subsidies for putting broadband linkages between rural and urban hospitals. Bandwidth started coming into rural America and it was more attractive for vendors to develop products for teleradiology," explains Bauer.
Teleradiology also is fully reimbursed, clinically proven and relatively inexpensive to implement and operate, says Jon Linkous, executive director of the American Telemedicine Association.
"There are services popping up now that provide hospitals after-hour services and they are done typically by teleradiology," explains Linkous. "At the same time, as hospitals do that, there are medical centers that are looking to outsource all of their imaging services and do it on a contracted basis to a vendor. Plus, looking at it on the reverse side, there are hospitals that have fairly sophisticated imaging centers that become [an expert] source for smaller clinics."
THE REVERSE SIDE
The University of Iowa Healthcare System, a 769-bed facility in Iowa City, supports eight rural community clinics in Iowa with no on-site radiologists. Providing coverage all day, every day, the institution employs 32 radiologists who can read images on eight separate workstations. Out of its 225,000 imaging exams read annually, 10 to 15 per day are sent from off-site CT (computed tomography) and ultrasound systems.
The bulk of the images are CT, says Brian Mullan, M.D., associate professor, vice chair of education and director of clinical PACS at the institution. "With ultrasound, who does the scan and how well they do it is critical to the images that are generated. Generally we'll have no idea who the tech is or what their level of skills are. If there is an emergency and they are looking for a very specific thing, we will do that, but we can only offer a limited report," explains Mullan.
Before a clinic signs on, Mullan says their equipment is examined for possible upgrades. "If we don't feel that the equipment is up to our standards - that we are not willing to interpret off of - then we have discussions with them to upgrade their equipment," clarifies Mullan. It also is mandated in the contract that a clinic must integrate their equipment with Iowa's system so that the images go directly in their archive. Teleradiology images blend into workflow and are presented in the exact same way as the studies from within the facility.
Previously, Iowa's radiologists read images on a separate monitor in another room. Disrupting workflow, Mullan says radiologists were more adept to finish the hospital's caseload before looking at the studies from the rural clinics. "Now, unless I look at the top and see the hospital identification number on it, I don't know where it came from," says Mullan.
Teleradiology's recent growth and acceptance has been fueled by the many companies that provide nighthawk coverage. Since staffing a radiology department at night is costly, and on-call hours are burdensome, these nighthawk companies "lessen the load" by providing off-site interpretation and consultation services. The trend has proven itself as a cost-effective alternative to leveraging the increasing volume of images and waning number of physicians - without jeopardizing diagnostic quality.
Improved bandwidth has recently allowed these companies to provide teleradiology services day and night. "The word 'tele' is almost an insult to the teleradiology system of today," says Sean Casey, M.D., president of Virtual Radiologic Consultants of Eden Prairie, Minn. "Probably a better word for [teleradiology] is remote networked radiology,"