View teleradiology as a benefit, not as a threat

Teleradiology is well established in many hospitals and imaging practices in the U.S. Geographic and demographic factors have contributed to its growth, but the shortage in radiologists has also played a part.

By comparison, much of Europe lags behind in implementation of teleradiology reading services, perhaps due in part to skepticism about these services among European radiologists. Most view teleradiology merely as a tool for reading studies on their laptops at home, rather than as a professional reporting service that can help improve workflow.

Among teleradiology's numerous benefits is that it encourages the use of a relative surplus of radiologists in some EU countries, such as Belgium, to provide expertise where there is a shortage. It can also optimize workflow by increasing productivity and improving report turnaround time. Practices that face staff shortages due to vacation, sickness, or postgraduate training are ideal candidates for this type of support.

But several valid concerns remain, primarily related to differences in language, training levels, registration policies, and varying experience with more advanced techniques. The absence of a legal EU framework also causes some unease within the European Association of Radiology.

A good technical infrastructure, including a PACS/RIS (radiology information system) and state-of-the-art workstations, is essential for large-scale teleradiology. The public network can be used for image transmission, provided a secure connection is created with attention to data security and privacy requirements.

All medical specialists who have qualified in the EU are eligible for full registration in other EU countries. EU nationals need no additional licenses, and some nations do not require specialists to register to conduct teleradiology studies. This has caused some unease about differences in training levels. Other concerns are the lack of personal contact between the distant teleradiologist and the referring physician and the inability to participate in clinical conferences, which could completely isolate these radiologists from clinical experience.

The surplus of radiologists in Belgium was a driving force behind the creation of teleradiology provider Eurad Consult. Eurad's model is that of a teleradiology center or hub where several radiologists provide real-time interpretations of complex studies containing numerous images, with a quick report turnaround time. Companies such as Eurad Consult must obtain liability insurance covering all countries in which they are active, including coverage for their radiologists' activities. Studies sent to the teleradiology center are automatically imported into the radiologist's work list, and urgent cases can be assigned priority. Reports are electronically transmitted and may be incorporated in the client's RIS or electronic patient record via an HL7 link.

Eurad has developed important selection criteria: Radiologists must have trained in a center of excellence and be approved by the company's medical advisory board, composed of academic radiologists. All radiologists currently working for Eurad were trained at the University of Leuven, Belgium, and are fluent in several languages, including French and English.

Each new client undergoes a testing phase during which 25% of all reports are reviewed. Quality reports are sent to the client on a monthly basis, if requested. In a second phase, a smaller number of reports (up to 10%) are systematically reviewed. Good communication between radiologist and image provider is essential. Eurad radiologists meet the local medical staff and participate regularly in staff meetings or clinical conferences onsite. Radiologists include their cell phone numbers on every report and use a Web-viewing system to discuss the examinations with referring clinicians.

Furthermore, agreements have been made with several academic centers that allow them to do clinical work on a part-time basis so they do not lose their clinical experience.

Eurad provides second opinions and expert readings: A network has been created between the teleradiology hub and several renowned subspecialty radiologists.

The ability to transmit cases for expert opinions through teleradiology offers many advantages. In regions where expert knowledge is lacking, patients will not have to be transported unnecessarily. They will be helped faster, and their management will more often remain local. Teleradiology consultation might lead to changes in therapy in up to 25% of cases, according to some reports. As a result, the relationship between the treating physician and the patient will improve, and the medical staff will be satisfied that more effective treatment is being provided.

Radiologists must understand that companies providing teleradiology services are not their enemy but, rather, a virtual extension of their practices that enables them to work more efficiently. Rather than a threat, a teleradiology service is an insurance policy for practices. It helps radiologists maintain continuity of care, and it is easier to hire teleradiology services than recruit a locum. Quality of care can improve because subspecialty advice and expert knowledge are available at a mouseclick. Teleradiology provides expert advice to more patients and improved support for doctors in peripheral hospitals or private practices. A prerequisite is that high-quality services are safeguarded.

DR. RANSCHAERT is a radiologist at Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands. He is a founder of Eurad Consult.