Transcript Medico-legal issues in Teleradiology

Medico-legal issues in
Teleradiology
Aditya Daftary
Teleradiology Solutions
Teleradiology
• Needs no introduction
• Teleradiology is a means of electronically
transmitting radiographic patient images and
consultative text from one location to another*
*http://www.radiology.uiowa.edu/MoreRAD/Teleradiology/Tele.html
Goals of Teleradiology
• Providing timely consultative and interpretative
radiologic services
• Making radiologic consultations available in medical
facilities without on-site radiologic support
• Facilitating radiologic interpretations in on-call
situations
• Providing subspecialty radiologic support as needed
• Enhancing educational opportunities for practicing
radiologists
• Promoting efficiency and quality improvement
• Providing interpreted images to referring providers
• Supporting telemedicine
• Providing supervision of off-site imaging studies
Medico-legal Issues in
Teleradiology
• The good news:
– A lot of it is still unclear
• The bad news:
– We’re dealing with lawyers!
Conceptually simple
• Imaging data acquired at one site
• Network transmits images to a server
• Data can be reviewed and interpreted at a
remote site
• Report generated and transmitted electronically
back to the parent site
Many a slip….
• Qualification
• Liability and Insurance
• Radiologist duties
Qualification
• Varies
– Country (US, Singapore, UK)
– State
– Institution
• Law can be a little vague
• Best to be safe: full qualification in geographic
area and institute for whom one is interpreting
Qualification
• Medical board certification:
– USMLE/LMCC/recognized MBBS
• Specialty qualification:
– ABR/RCPS/FRCR
• Subspecialty qualification:
– Certificate of added Qualification (CAQ)
• Licensure
• Credentialing
• CME
Medical Liability Insurance:
Why?
• Establishment of a physician-patient relationship
– No case examples, but probably YES
– You are being consulted and you are getting paid!
• Jurisdiction for accountability
– Where do you get prosecuted? Texas or India?
– May not be teleradiologist, but definitely parent
hosp/group
– UK-Europe: Primary/alternative site
– No case examples
– Not too many people going to put themselves on the
line for you!
Liability Insurance
• Covers one against possible litigation
• Find someone willing to insure off site/off
country reading: not much experience
• Will look at all qualifications to assess risk
• Costs increase with time
• On site group to get clearance from their insurer
• Teleradiologist must have coverage
• Terms of coverage must be very clear
Medical Liability: Radiologist
• The teleradiologist is as liable as any other
radiologist in the given setting
– Technical issues
– Interpretation and misses
– Communication
Medical Liability: Technical
• Much of this is now redundant, but there are a few areas:
– Image acquisition
•
•
•
•
Digitized radiographs
Unsupervised ultrasound
Patient motion
Contrast
– Image transmission/viewing
• Some modalities not DICOM compliant (PET)
• Acceptable compression ratio for emergencies
• Appropriate viewing stations: mammography, radiographs, MPR need
– Patient privacy, data encryption
– Preliminary versus final read
Medical Liability: Interpretation and
Communication
• Teleradiologist has a duty to communicate as
effectively as any other radiologist
• Typical communication by written report
– Reports to include
• Patient demographics, procedural details, relevant
findings, impression (unless short)
– Preliminary reports
• Time sensitive, limited by absence of prior etc
• NOT complete reports
• Must provide information to deal with immediate care
http://www.acr.org/s_acr/bin.asp?CID=541&DID=12196&DOC=FILE.PDF
Medical Liability: Interpretation and
Communication
– Non routine communications
• Situations:
– Findings needing immediate intervention
– Discrepant from prior report
– Unexpected, but serious findings
• Direct conversation best; others (fax, pager. email etc) less
reliable
• Must be documented
Medical Liability: Minimizing Error
• Preliminary reports to include relevant issues,
small details not necessary
• Call when in doubt/something seen later
• Ask for additional/repeat imaging as needed
• Recommend appropriate clarification studies
• Everyone misses…have a good QA system in
place
Summary
• Teleradiology is an excellent empowering technology
which enhances patient care
• Legal issues on teleradiology are still vague
• A safe strategy is the best strategy
–
–
–
–
–
–
Do not compromise patient care (primum non nocere)
Appropriately qualified radiologists
Clear contracts and insurance a must to cover liability issues
Efficient communication in a clinical setting
Quality assurance programme
A very friendly lawyer!
Questions?