international teleradiology experience in developing vs developed world dr ashish dhawad coo,...
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International Teleradiology
Experience in Developing vs Developed World
International Teleradiology
Experience in Developing vs Developed World
Dr Ashish Dhawad
COO, TeleDiagnosys
CEO, Medsynaptic
Africa Telehealth Conference 2010
Cairo, Egypt
Definition of TeleradiologyDefinition of Teleradiology
DefinitionDefinition
Needs no introduction
Teleradiology is a means of electronically transmitting radiographic patient images and consultative text from one location to another*
Teleradiology is the most mature of Telemedicine areas
Source: http://www.radiology.uiowa.edu/MoreRAD/Teleradiology/Tele.html
History of TeleradiologyHistory of Teleradiology
BeginningBeginning
Alexander Graham Bell
Mr Watson, Come here, I
want you
In 1876, simultaneous beginning of telephone and telemedicine
Early AdoptionEarly Adoption
1930 – Queen Mary ocean liner used the ship radio for medical consultations with onshore experts
Middle AgesMiddle Ages
1960-1970 – Closed circuit and broadcast Television used for medical consultations
EvolutionEvolution
1980 – Computer usage began for telemedicine
MaturityMaturity1990 – Internet becomes popular
21st Century – Modern Teleradiology using High speed Internet and mobiles
iphone
Concept of TeleradiologyConcept of Teleradiology
Conceptually simpleConceptually simple
Imaging data acquired at one site
Network transmits images to a server or receiving station
Data is reviewed and interpreted at the remote site
Report generated and transmitted electronically back to the parent site
Teleradiology: ComponentsTeleradiology: Components
1. An image sending station
2. A transmission network
3. A receiving/image review station
Sending Station: The Source
Sending Station: The Source
What can be sent? Anything!
– Non-digital (conventional) films can be digitized using scanners
– Most studies are now digital from the start: Computed Radiography, Digital Radiography CT Ultrasound MRI Nuclear Scans Mammography
Sending Station: The Source
Sending Station: The Source
Connection can be directly from the equipment (CT scanner, etc.) or from a PACS (Picture Archiving System) or a Workstation
Requires adherence to the Digital Imaging and Communication in Medicine (DICOM) lossless compression standard.
DICOM gateway is required between the source and the transmission network.
Sending Station: The Source
Sending Station: The Source
CT Scanner
DR/CR
MRI Scanner
Mammography Nuclear Scans
Ultrasound
DIFFERENT IMAGING MODALITIES
Sending Station: The Source
Sending Station: The Source
A virtual private network (VPN) is required to assure compliance with the Health Insurance Portability and Accountability Act (HIPAA)
VPN’s can be software or hardware based
Transmission Network Transmission Network
Wire
Fiber optics
Microwave
Internet
Receiving/Image Review Station Receiving/Image Review Station
Consists of:
1. Network interface
2. Personal computer with storage medium (e.g. hard disk drive)
3. One or more Medical monitors
4. Optional hard copy device printer
Receiving/Image Review StationReceiving/Image Review Station
What is the need of TeleradiologyWhat is the need of Teleradiology
Increase in radiology workloads worldwide
Shortage of radiologists is a worldwide phenomenon
More and more imaging procedures being done
Radiologist compensation getting higher increasing costs
Inefficient operations, declining stability of radiology staff
Faster services required by patients
Advantages To CustomersAdvantages To Customers Reduced Costs and increased profits
Quality Service
Access to quick opinion from experts speeding up treatment and enhancing patient care
24 X 7 X 365 Service
Faster Reporting in critical cases
Higher Levels of Patient Satisfaction
Higher Cash flows to remote centers due to patient retention
No worries about shortage of radiologists
Requirements to Setup Requirements to Setup
Space
Finance
Technology
Manpower
Clients!!!
SpaceSpace
Assume 5 Workstations
Thumb rule - 200 Sqft per person
Total required – 1200 – 1500 sqft
Includes space for reception, radiologists, executives, Server / IT room, Conference room
FinanceFinance
Self funded
Angel / VC
Debt
Finance required variable on location
IT Requirements to StartIT Requirements to Start
Server with Backup PACS/Teleradiology Software Storage – SAN, NAS Radiologist Workstations Medical Displays Internet with Backup Transcription hardware Routers/LAN Fax, VOIP, Telephones, Email
PACS/Teleradiology Software
PACS/Teleradiology Software
Web based
vs Point to Point
Point to PointPoint to Point
Sending Station
Receiving Station
Transmission Network
Older technology
Less flexibility
Sample ArchitectureSample Architecture
Sending Station
Receiving Stations
Web BasedWeb Based Sending Station
Central Server
Transmission Network
Multiple workstations can be connected to the Central Server
More manageable and flexible
Allows access from anywhere in the world
Sample ArchitectureSample Architecture
Sending StationCentral Server
Radiologist WS
StorageStorage
Medical Imaging generates large data– Eg: 64 slice CT Scans generate 1 GB per scan
Need to store images online for access
Prior studies are sometimes required by radiologists
Storage solutions like SAN or NAS can be considered
Storage policy needs to be in place
Radiologist WorkstationsRadiologist Workstations
Need to have better configuration than standard computers
Used for Image processing & Interpretation by radiologists
Handles large data
Good Graphics card helpful
Connected to Medical Displays
Medical DisplaysMedical Displays Different models available
Grayscale/Color option
Single Head/Dual Head
5 MP – Used for Mammography– Approx cost $ 15000
3 MP – DR/CR/CT/MR– Approx Dual Head cost – $ 5000 (Color) – $ 10000 (B& W)
2 MP – CR/MR/CT– Approx Dual Head cost – $ 5000 (Color) – $ 8000 (B& W)
Leading vendors are Barco, Planar, Totoku, Eizo, NEC etc
InternetInternet
Bandwidth requirements depends on the study volume
Option of Wired/Wireless
Needs to be fast and reliable
Take a backup connection – preferably from another provider
TranscriptionTranscription
Inhouse or outsourced
Speech Recognition
Keep control of Quality
Routers/LANRouters/LAN
LAN– CAT 5– CAT 6– Wireless
Gigabit Routers
VPN Routers
Other RequirementsOther Requirements VOIP phones
Fax
Telephones
Toll Free numbers
Ergonomic Furniture
Printers
ProcessesProcesses
Training
QA process
JCI/JCAHO
ISO
TrainingTraining
Radiologists need to be trained on PACS
Staff needs to know the defined protocols for reporting– STATs– How to handle client questions– Error reporting– Rereads
Quality PolicyQuality Policy
Should make all efforts to follows guidelines issued by organizations like HIPAA, ACR, ESR etc
Clearly defined Quality assurance policy
Regulatory requirementsRegulatory requirements
License
Credentialing
Insurance
Data Security
Legal
StandardsStandards
ACR – American College of Radiology
ESR – European Society of Radiology
CAR – Canadian Association of Radiology
UK – Royal College of Radiology
Market HotspotsMarket Hotspots USA Canada UK Africa Singapore India Australia China Europe
– Germany– Spain– Sweden– Norway
Marketsize - 2010Marketsize - 2010
More than 1 billion imaging procedures performed worldwide every year (X Ray, US, CT, MRI, Nuclear)
More than 300 million in US alone !– 200 million X Rays– 35 million MRIs– 75 million CTs– 35 million Ultrasounds– 18 million Nuclear scans
Europe performing more than 150 million procedures
Potential MarketPotential Market
Potential Market anywhere between 2.5 to 5 billion USD
Increasing by atleast 10 % per year as imaging volumes grow
Not enough radiologists being trained every year
Creating a opportunity for service providers
Developing vs Developed World
Developing vs Developed World
Infrastructure– Variable from country to country– Urban areas in Developing world as good as Developed world
Manpower– Advantage for developing world
Regulations– Missing in developing countries
Licensing & Liability– Major barrier in developed world
Marketsize– Large in developed world– Moving towards subspecialist services
Barriers to SuccessBarriers to Success
RegulationsRegulations
No uniformity or Teleradiology license
Every country has different standards
Need to follow regulations for each country
May not be possible to provide services to certain sectors like government insurance
LanguageLanguage
Majority of the market does not pose challenge as English accepted
More prevalent in Europe
Many countries require reports in local language
Translation costly and prone to errors
ExpertiseExpertise
Getting the right manpower may be difficult
Radiologists with required skillsets unavailable– Training, subspeciality– Licensing– Language– Time schedules– Relocation trouble
Good IT support crucial
SummarySummarySummarySummary
Teleradiology is an excellent empowering technology Teleradiology is an excellent empowering technology which enhances patient carewhich enhances patient care
Legal issues on teleradiology are still vagueLegal issues on teleradiology are still vague A safe strategy is the best strategyA safe strategy is the best strategy
– Do not compromise patient care Do not compromise patient care
– Appropriately qualified radiologistsAppropriately qualified radiologists
– Clear contracts and insurance a must to cover Clear contracts and insurance a must to cover liability issues liability issues
– Efficient communication in a clinical settingEfficient communication in a clinical setting
– Quality assurance programmeQuality assurance programme
– A very friendly lawyer!A very friendly lawyer!
The world is becoming a Global VillageThe world is becoming a Global Village
For any questions please contactFor any questions please contact
Dr Ashish Dhawad
Tel: +91-9823041375
Email: [email protected]