Transcript Learnshop No 1: Enabling eHealth – Telemedicine

Africa Telehealth Conference 2010
Cairo, Egypt
International Teleradiology
Experience in Developing vs
Developed World
Dr Ashish Dhawad
COO, TeleDiagnosys
CEO, Medsynaptic
Definition of Teleradiology
Definition
 Needs no introduction
 Teleradiology is a means of electronically
transmitting radiographic patient images and
consultative text from one location to another*
 Teleradiology is the most mature of
Telemedicine areas
Source: http://www.radiology.uiowa.edu/MoreRAD/Teleradiology/Tele.html
History of Teleradiology
Beginning
Mr Watson,
Come here, I
want you
In 1876, simultaneous
beginning of telephone
and telemedicine
Alexander
Graham Bell
Early Adoption
1930 – Queen Mary ocean
liner used the ship radio
for medical consultations
with onshore experts
Middle Ages
1960-1970 – Closed
circuit and broadcast
Television used for
medical consultations
Evolution
1980 – Computer
usage began for
telemedicine
Maturity
1990 – Internet
becomes popular
21st Century –
Modern
Teleradiology using
High speed Internet
and mobiles
iphone
Concept of Teleradiology
Conceptually simple
 Imaging data acquired at one site
 Network transmits images to a server or
receiving station
 Data is reviewed and interpreted at the
remote site
 Report generated and transmitted
electronically back to the parent site
Teleradiology: Components
1. An image sending station
2. A transmission network
3. A receiving/image review station
Sending Station: The Source
 What can be sent? Anything!
– Non-digital (conventional) films can be
digitized using scanners
– Most studies are now digital from the start:
Computed Radiography, Digital Radiography
 CT
 Ultrasound
 MRI
 Nuclear Scans
 Mammography

Sending Station: The Source
 Connection can be directly from the
equipment (CT scanner, etc.) or from a PACS
(Picture Archiving System) or a Workstation
 Requires adherence to the Digital Imaging
and Communication in Medicine (DICOM)
lossless compression standard.
 DICOM gateway is required between the
source and the transmission network.
Sending Station: The Source
CT Scanner
MRI Scanner
Ultrasound
DIFFERENT IMAGING MODALITIES
DR/CR
Mammography
Nuclear Scans
Sending Station: The Source
 A virtual private network (VPN) is
required to assure compliance with the
Health Insurance Portability and
Accountability Act (HIPAA)
 VPN’s can be software or hardware
based
Transmission Network
 Wire
 Fiber optics
 Microwave
 Internet
Receiving/Image Review Station
Consists of:
1. Network interface
2. Personal computer with storage medium
(e.g. hard disk drive)
3. One or more Medical monitors
4. Optional hard copy device printer
Receiving/Image Review Station
What is the need of Teleradiology
 Increase in radiology workloads worldwide
 Shortage of radiologists is a worldwide phenomenon
 More and more imaging procedures being done
 Radiologist compensation getting higher increasing costs
 Inefficient operations, declining stability of radiology staff
 Faster services required by patients
Advantages To Customers
 Reduced Costs and increased profits
 Quality Service
 Access to quick opinion from experts speeding up treatment and
enhancing patient care
 24 X 7 X 365 Service
 Faster Reporting in critical cases
 Higher Levels of Patient Satisfaction
 Higher Cash flows to remote centers due to patient retention
 No worries about shortage of radiologists
Requirements to Setup
 Space
 Finance
 Technology
 Manpower
 Clients!!!
Space
 Assume 5 Workstations
 Thumb rule - 200 Sqft per person
 Total required – 1200 – 1500 sqft
 Includes space for reception, radiologists,
executives, Server / IT room, Conference
room
Finance
 Self funded
 Angel / VC
 Debt
 Finance required variable on location
IT Requirements to Start









Server with Backup
PACS/Teleradiology Software
Storage – SAN, NAS
Radiologist Workstations
Medical Displays
Internet with Backup
Transcription hardware
Routers/LAN
Fax, VOIP, Telephones, Email
PACS/Teleradiology Software
 Web based
vs
 Point to Point
Point to Point
 Sending Station
 Receiving Station
 Transmission Network
 Older technology
 Less flexibility
Sample Architecture
Receiving
Stations
Sending Station
Web Based
 Sending Station
 Central Server
 Transmission Network
 Multiple workstations can be connected to the Central
Server
 More manageable and flexible
 Allows access from anywhere in the world
Sample Architecture
Radiologist WS
Sending Station
Central Server
Storage
 Medical Imaging generates large data
– Eg: 64 slice CT Scans generate 1 GB per scan
 Need to store images online for access
 Prior studies are sometimes required by radiologists
 Storage solutions like SAN or NAS can be
considered
 Storage policy needs to be in place
Radiologist Workstations
 Need to have better configuration than standard
computers
 Used for Image processing & Interpretation by
radiologists
 Handles large data
 Good Graphics card helpful
 Connected to Medical Displays
Medical Displays
 Different models available
 Grayscale/Color option
 Single Head/Dual Head
 5 MP – Used for Mammography
– Approx cost $ 15000
 3 MP – DR/CR/CT/MR
– Approx Dual Head cost – $ 5000 (Color) – $ 10000 (B& W)
 2 MP – CR/MR/CT
– Approx Dual Head cost – $ 5000 (Color) – $ 8000 (B& W)
 Leading vendors are Barco, Planar, Totoku, Eizo, NEC etc
Internet
 Bandwidth requirements depends on the
study volume
 Option of Wired/Wireless
 Needs to be fast and reliable
 Take a backup connection – preferably from
another provider
Transcription
 Inhouse or outsourced
 Speech Recognition
 Keep control of Quality
Routers/LAN
 LAN
– CAT 5
– CAT 6
– Wireless
 Gigabit Routers
 VPN Routers
Other Requirements
 VOIP phones
 Fax
 Telephones
 Toll Free numbers
 Ergonomic Furniture
 Printers
Processes
 Training
 QA process
 JCI/JCAHO
 ISO
Training
 Radiologists need to be trained on PACS
 Staff needs to know the defined protocols for
reporting
– STATs
– How to handle client questions
– Error reporting
– Rereads
Quality Policy
 Should make all efforts to follows
guidelines issued by organizations like
HIPAA, ACR, ESR etc
 Clearly defined Quality assurance policy
Regulatory requirements
 License
 Credentialing
 Insurance
 Data Security
 Legal
Standards
 ACR – American College of Radiology
 ESR – European Society of Radiology
 CAR – Canadian Association of
Radiology
 UK – Royal College of Radiology
Market Hotspots









USA
Canada
UK
Africa
Singapore
India
Australia
China
Europe
– Germany
– Spain
– Sweden
– Norway
Marketsize - 2010
 More than 1 billion imaging procedures performed
worldwide every year (X Ray, US, CT, MRI, Nuclear)
 More than 300 million in US alone !
–
–
–
–
–
200 million X Rays
35 million MRIs
75 million CTs
35 million Ultrasounds
18 million Nuclear scans
 Europe performing more than 150 million procedures
Potential Market
 Potential Market anywhere between 2.5 to 5
billion USD
 Increasing by atleast 10 % per year as
imaging volumes grow
 Not enough radiologists being trained every
year
 Creating a opportunity for service providers
Developing vs Developed World
 Infrastructure
– Variable from country to country
– Urban areas in Developing world as good as Developed world
 Manpower
– Advantage for developing world
 Regulations
– Missing in developing countries
 Licensing & Liability
– Major barrier in developed world
 Marketsize
– Large in developed world
– Moving towards subspecialist services
Barriers to Success
Regulations
 No uniformity or Teleradiology license
 Every country has different standards
 Need to follow regulations for each country
 May not be possible to provide services to
certain sectors like government insurance
Language
 Majority of the market does not pose
challenge as English accepted
 More prevalent in Europe
 Many countries require reports in local
language
 Translation costly and prone to errors
Expertise
 Getting the right manpower may be difficult
 Radiologists with required skillsets unavailable
–
–
–
–
–
Training, subspeciality
Licensing
Language
Time schedules
Relocation trouble
 Good IT support crucial
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
– 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!
The world is becoming a Global Village
For any questions please contact
Dr Ashish Dhawad
Tel: +91-9823041375
Email: [email protected]