Frits Barneveld Binkhuysen, MD

At first glance, the management of teleradiology services seems to involve the same principles and techniques as those used when running any other business. A closer look, however, reveals major differences and challenges.

Teleradiology is a relatively new service that can be used by radiologists, radiology departments, and many other stakeholders in healthcare in very different ways. It can be used for primary readings, second opinions, and nighthawk services.

Teleradiology cannot replace either the role of the radiologist as a consultant or the radiologist's direct interaction with the referring physician. It must be viewed as an extra tool that can help businesses operate in a more flexible manner. Common reasons for outsourcing reporting include a sudden or permanent increase in workload or a temporary staff shortage.

International teleradiology creates novel problems and cultural changes. How do you cope with data integrity and security issues? How do you set up medical insurance for exams performed and interpreted in different countries? How will radiological communities in each country react to such a scheme?

Teleradiology businesses first took hold in the U.S. Now several competing centers are operating in Europe and in other locations worldwide. The market for dedicated, efficient teleradiology reporting services is driven by rising demand for medical imaging at a time when institutions are faced with staff shortages. The key element to providing a successful service is to build added value on a platform of quality. This can be achieved only through quality assurance programs that monitor all steps of the process closely and review them constantly.

Models for operating a teleradiology business are quite different from those used in conventional practices. Difficulties involve dealing with long-term contracts, insurance requirements, analysis of costs, and people's misconceptions.

Another important aspect is the quality of the process, radiology service, and environment. Process quality includes issues of security, privacy, liability, and data transmission. The most stringent norms and regulations should be followed. Rules published by the joint NEMA/COCIR/JIRA Security and Privacy Committee guide the transmission of patient data and images. Liability insurance is vital for the company.

Radiologists must have liability insurance to cover their work in each client's home nation. Additional licenses to practice radiology in other European countries are often needed.

A teleradiology center should provide real-time interpretations of high-quality images, including complex cross-sectional studies and series containing numerous images. A good technical infrastructure, including an integrated RIS/PACS and state-of-the-art diagnostic workstations, is a prerequisite.

The teleradiology company Eurad Consult has taken steps to optimize quality. Reports are double-read, checked by a native speaker, and delivered within 24 hours. All reporting is performed in well-equipped offices. New clients undergo a testing phase; full reading services commence only after a selection of test cases has been reported. This allows the teleradiology center and referring institution to iron out clinical governance issues. Regular clinical auditing ensures that reports are comprehensible. Clients receive full details of the clinical audit as part of a monthly performance report.

One of the radiologists from the teleradiology center can act as a so-called account radiologist for a referring institution. This radiologist can join local clinical meetings on a regular basis to give teleradiology a "face."

A medical advisory board, composed of well-known academic radiologists, is used to aid selection of radiologists. New radiologists undergo an evaluation period, during which their reports are double-checked.

Radiology may be asked to participate in more preventive mass screening programs in the near future. The question arises: Where will this huge number of screening procedures be reported? National departments of health or insurance companies may put parts of the mass screening out to Europe-wide tender. As radiology continues to evolve, teleradiology will become part of this changing picture.

Editor's Note: Another perspective on teleradiology will be presented in November's Big Picture column.

DR. BARNEVELD BINKHUYSEN is president of the Radiological Society of the Netherlands. He is also a partner in Eurad Consult.

Frits Barneveld Binkhuysen, MD

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Teleradiology requires effective management