When telemedicine does deliver!

Lluís Donoso-Bach, Barcelona/ES

Professional Organisation Committee Chairman and ESR Executive Council member

Information Systems

Information Systems and

clinical information processing

Connectivity, interoperability,

telemedicineSecurity

• Telemedicine applications:

• Telediagnosis (27 centers)

• Radiology

• Pathology

• Others

• Teleconsultation (20 centers)

• Dermatology

• Cardiology

• Pediatrics

• Telemonitoring of chronics (8 centers)

• Diabetes

• HTA

• EPOC

Our vision

66,7%

12,5%

20,8%

43,8%

18,8%

12,5%

37,5%

25,0%

12,5%

The ICT situation in Catalonia

• Teleradiology has a number of well-defined benefits which have already become established and recognised .

• There are however many potential pitfalls, especially if teleradiology moves from its present highly specific role to a general method of service delivery.

Benefits• For those communities which lie at a considerable

distance from a major centre and where there is insufficient work to justify the appointment of local radiologists.

• Images of complex problems can be transmitted to major tertiary centres for evaluation and advice.

• Tertiary centres can decide whether a patient needs transfer from the smaller hospital to the tertiary centre for treatment without unnecessary discomfort and disruption for the patient.

Benefits

• To provide emergency reports on images where the local centre does not have sufficient radiologists to provide a 24hour cover.

• Improved continuing professional development.

• Permits users to view images in different locations simultaneously for the purpose of discussions.

Real and Potential Problems

Communication

• Clinic-radiological communication• Team Working• Linguistic Problems• Wording of report and clinical impact

Access to Previous Examinations

Real and Potential Problems

Downstream Costs

Quality Control: • Learning from mistakes through

participation in radiological discrepancy/error meetings

• It is difficult for teleradiology services to have a proper feedback of the outcome and undertake satisfactory audit of their reports.

Real and Potential Problems Legal issues:

• The registration of the reporting doctors.

• Appropriate CME

• Properly trained

• Abide EU Health and Safety legislation

• Medico-legal liability

• Consent

• Jurisdiction

• Patient Confidentiality

• To comply with Euratom directive

Telemedicine Communication

COMMUNICATION FROM THE COMMISSION TO THE

EUROPEAN PARLIAMENT, THE COUNCIL,

THE EUROPEAN ECONOMIC AND SOCIAL

COMMITTEE AND THE COMMITTEE OF THE REGIONS

on telemedicine for the benefit of patients, healthcare

systems and society

Brussels, 4.11.2008

COM(2008)689 final

Aims of Telemedicine Communication:

• Bringing legal clarity

• Solving technical issues and facilitating

market development

• Building confidence in and acceptance

of telemedicine services

Telemedicine Communication

ESR Position:

• Teleradiology is a medical act in its own right

• Establish accreditation criteria for teleradiologyproviders that are homogenous throughout the EU

• Emphasis on the importance of delivering high-quality healthcare to the patient

• Cost savings must not come at the expense of quality or safety – international standards needed – careful monitoring of service providers

Telemedicine Communication

ESR Position:

• The regulation of telemedicine and teleradiologyshould be the responsibility of the member state where the patient undergoes the imaging procedure or telemedical referral

• Legal clarity

• Full information of patients & informed consent

• Importance of interoperability and standardisation

Telemedicine Communication

Development of teleradiology

LEGAL:

ESR stresses the importance of bringing clarity.

A legal framework related to teleradiology and common to all Member States would pave the way to the trusted development of teleradiology as a medicalpractice

TECHNOLOGY:

Having the relevant ICT infrastructures (e.g. broadband availability for all) with consistent attention to the implementation of measures aimed at ensuring respect for the right to protection of personal data.

Development of teleradiology

ORGANISATION:

The introduction of teleradiology into clinical practice requires re-engineering of clinical pathways, medical protocols and management of human resources, with a noticeable impact on the overall healthcare-delivering system (both public and private).

The ESR agrees that all stakeholders (including patient associations) should be alerted to the potential as well as the pitfalls of teleradiology.

Development of teleradiology

www.myESR.org