Teleradiology is the sending of radiological patient images and reports in multiple modalities from one location to another, for the purpose of sharing studies and results with other radiologists and physicians.
Until the 1990s, teleradiology was mostly used to interpret the occasional emergency studies from offsite locations, often the radiologist’s home. The connections were made through analog phone lines.
Teleradiology expanded rapidly with the growth of the internet and broad band. The occasional x-ray studies per week became several a night. Because ER physicians aren’t trained to read CT or MRI scans, a radiologist’s day went from working 8-10 hours, five and a half days a week to a schedule of 24/7 coverage. Teleradiology increased 15% annually, compared to 2% growth of radiologists. This became a critical challenge in smaller facilities that only have a solo radiologist. I can recall several times an ER doctor asked my opinion on a film or scan because a radiologist was not available. Not a spot a technologist should be put in.
These circumstances created a barrage of firms and groups that provide outsourced, off-site teleradiology on-call services to hospitals and radiology groups around the country. As an example, one of these companies might cover trauma at a hospital in Wisconsin with radiologists based in Florida.
Teleradiology has its issues:
- Healthcare industry has little control over how and when they receive their reports.
- Often, the reports aren’t customized to fit the needs of individual practitioners
- Report language must be clear and concise to avoid any confusion.
- Access to prior medical records is needed (but often lacking) to aid radiologist in exam findings.
- Images must be of sufficiently high quality to allow interpretation.
Picture Archiving and Communication Systems (PACS) have advanced the sharing of images and some documentation. The DICOM (Digital Imaging and Communications in Medicine) standard helps to facilitate data exchange between imaging devices and PACS. Through standards developing organizations such as HL7, the interoperability of imaging data has progressed far beyond the current state of interoperability of medical records.
The goals of teleradiology can only be accomplished when useful reports are delivered. To fully achieve this, the teleradiologist must have access to the same patient information as they would in a hospital. This includes previous imaging, examinations, laboratory reports and other clinical data. There are two broad approaches to accomplish this – either let the radiologist access the hospital’s EHR system, or transfer the medical records to the radiologist electronically. The former is easier to do if the EHR system allows user-friendly remote access.
With rapid adoption of new standards such as HL7 FHIR (as reported in previous blogs from our team, the latest of which talks about our work Implementing a FHIR Terminology Server ), effort towards interoperability between terminologies such as LOINC and RadLex, and clinical natural language processing technologies, one can hope that seamless semantic interoperability between clinical and radiology systems to support teleradiology will be achieved in the very near future.