job and therefore works a full quota of
days in a year, thereby delivering greater
productivity for lesser cost.
High Communication Levels
In the setting of emergency teleradiology, most communication occurs via two
media, electronic and verbal (telephonic).
Given that within the healthcare enterprise today, a significant quantum of
physician-physician communication is
telephonic, the additional distance of the
teleradiologist in no way detracts from
the level of interaction. Similarly, collaborative workflows allow for simultaneous
viewing and discussion of complex cases.
Critical values communications are
frequent in emergency teleradiology,
given that the clinical spectrum is primarily directed towards acute care. In
contrast to the initial concerns that teleradiology diminishes verbal interaction,
the quality of verbal communication is in
fact enhanced by emergency teleradiology, since the physician and radiologist
staffing patterns tend to parallel each
other, allowing for strong, albeit virtual
Teleradiology providers today utilize
sophisticated workflow platforms that
allow for efficient distribution of images
and reports across the enterprise. These
platforms are extremely sophisticated
and may even outperform large enterprise type PACS. A combination of utilization of e-faxing systems and online
report access from the RIS allows for
seamless connectivity between hospital
and teleradiology center. Coupled with
messaging systems technology that alerts
referring physicians to positive results,
the entire electronic enterprise that
forms the foundation for teleradiology
is geared towards effective and efficient
communication of positive and, in particular, critically positive results.
Emergency Teleradiology: The Cons
Some teleradiology providers have in the
recent past become increasingly corporatized and investor- or market-driven.
With private equity investors actively
seeking out funding opportunities and
rapidly growing teleradiology firms who
see value in taking external investment to
rapidly scale, the stage has been set for
aggressive growth and funding/invest-ment in teleradiology. The issue with
this is that it subjects teleradiology providers to influences that are determined
and driven by financial constraints rather
than the quality of care.
Competition and the pressure to
grow rapidly and be profitable also lead
to rapid changes in business model,
which are not always desirable. Over
time, emergency after hours teleradiology providers begin to provide 24 × 7
coverage with on-site staffing. The effect
of this is to pit the teleradiology provider as a predatory antagonist pitted
against the on-site radiologist, which is
not a healthy situation. Teleradiology is
meant to be a support for the existing
radiologic practice, and should not aim
to replace the on-site radiology practice,
which will always remain a critical part
of the healthcare paradigm. In the United
States, some large corporatized teleradiology providers have come under scrutiny for adopting practices that have led
them to compete with, and potentially
displace, locally established clinical radiology practices.
One of the challenges that is currently
faced in the practice of emergency teleradiology is the lack of relevant and comprehensive clinical data. All too often the
clinical information provided is in the
form of a cryptic ‘abdominal pain’ or
‘trauma’ with no reference to the specific
location or nature of the pain/trauma,
associated symptoms or relevant clinical examination, laboratory results, or
pertinent surgical history. Interpreting
scans without the availability of relevant
clinical information is not in the interest of optimal patient care. However, this
is only a temporary challenge, as Health
Level 7 (HL7) interfaces permit the
extraction of relevant information from
the HIS to be made available to an interpreting radiologist on their RIS, and so
this negative will soon be history.
The evolution of increasingly large
imaging datasets, in the era of ultra-thin
section, high resolution CT and MRI,
also poses a potential challenge to emergency teleradiology. If the scan takes a
longer time to transmit because of large
file size, then this may potentially impact
the reporting time. However, solutions
already exist in the form of technologies
such as multi-threading routers and with
the ever-increasing magnitude of high
bandwidth connectivity spectrum, this
too shall pass.
In summary, the benefits afforded by
emergency teleradiology by far outweigh
the negatives, and the overall value proposition of teleradiology in the emergency
setting remains sound and robust. If practiced conscientiously and, if permitted to
grow and deliver its true value, emergency
teleradiology has the potential for sustaining a paradigm shift that will truly benefit
emergency medical care, enhance patient
outcomes, and save many lives.
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