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The sufferings of humankind are immense and the struggle to find relief from them has led to discoveries that have challenged human existence. Technological advancements have tried to hack the human brain, body, mind to understand and predict human behavior.…Read More

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Teleradiology in India means cross-section, so for all practical purposes, the available pool of radiologists is just 40% out of which expert general radiologists ( if we say ) are just 10%.

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Overcoming The Issue Of Revolving Door Of Changing Names Of Radiologists – An Indian Perspective

In radiology, one of the biggest problems that a client hospital or a referring clinician encounter is the revolving door of new names of radiologists with each report. It is easy for a referring clinicians to become discouraged when they are bombarded with a long list of radiologists reporting their cases. And if on top of that the phone call is being answered or routed to someone else other than reporting radiologist, it is surely going to be a deterring factor for trust-building between the teleradiology provider and the client hospital or diagnostic center.

Why is there a revolving door of new radiologists with each report?

The size of the teleradiologist’s panel is an important criterion for searching for the right match for your organization. The optimum size of the panel to cover all 24 hours is important, at the same time stability of the teleradiologists with constant names is key to develop trust for a long-term relationship with the referring clinician. Hiring a large panel of teleradiologists for a small hospital doesn’t make sense always. Generally, large panel radiologists have a high turnover rate. Continuously changing the names of the radiologists will hamper the trust-building between the referring surgeon and the teleradiologists.

Besides panel size turnover rate of radiologists may indicate the stability of the group. Large panel teleradiology providers in India generally comprise multiple part-time radiologists who otherwise are doing ultrasound practice at their clinics. Such groups may lack a teleradiology culture. Imagine a CT abdomen scan for a suspected case of bowel perforation being read by a sonologist within his time slot provided by the telerad provider who is looking for gas under the diaphragm on the scanogram.

In contrary to an experienced teleradiologist who is reporting hundreds of CT scans a day sitting for hours in his office who is trained to look for even a tiny extraluminal air.

In India, radiology practice is largely modality driven ( X-ray, ultrasonography, CT scan, MRI, nuclear imaging, etc are the main modalities ) Roughly 60% of Indian radiologists practice only ultrasound, 30% do ultrasonography plus CT, MRI (CT MRI are also called cross-section imaging) and only 10 % practice dedicated cross-section. And out of this 10% just 2 to 4% may be doing full-time teleradiology.

Teleradiology in India means cross-section, so for all practical purposes, the available pool of radiologists is just 40% out of which expert general radiologists ( if we say ) are just 10%.

So today if we come to the core domain only 10% of the radiologist’s pool in India belongs to the core domain of full-time teleradiologists or cross-section general radiology experts. These 10% radiologists are again engaged in different institutes as in-house radiologists.

What happens after the covid pandemic? The entrepreneurs start teleradiology companies and without trying to understand the above classification they start employing every possible radiologist available without bothering about his core domain. They start allotting time slots to every radiologist who is interested irrespective of his core domain expertise and form large teleradiology groups or panels. (Just a software is installed on radiologists PC and reporting the cases is started) This obviously gives rise to an issue called Revolving Doors Of Changing Names Of Radiologists.

Needless to say, such teleradiology providers are running their show ‘without any Teleradiology Culture.’

How To Overcome The Issue Of revolving Door Of Changing Names in Teleradiology?

At Radever we are the complete team of only full-time teleradiologists. Because an experienced full-time radiologist can easily report double or even triple the number of cases a part-time (all modality) radiologist can do in a given time, a full-time teleradiologist is equal to 3 part-time radiologists, thus answering the issue of Revolving Doors Of Changing Names Of Radiologists.

At Radever, we make it a point to maintain the optimal balance between the workload and the number of available radiologists. Each client will have one radiologist as a team leader who will handle all queries and be in touch with clinicians and other team radiologists.

We maintain a uniform reporting pattern and uniform viewing protocols across all anatomical systems to ensure ‘consistent reading methods and homogeneous reports’ which helps in easy comprehension of reports and clinicians’ trust-building.

At Radever we make it a point to ‘communicate each and every report to the referring clinician via a Text message. We have recently started the RAI (‘Relevant Annotated Images’ ) service wherein we select the most relevant images for a given diagnosis, mark the image, annotate it and email it to referring surgeon or physician. *The RAI service can prove to be of great value in providing spatial orientation to the surgeons, effective communication of the diagnosis, and creating relevant data for selective retrieval and future research in deep learning. This RAI service at Radever Teleradiology is gaining us high clinician satisfaction.

Conclusion

During our 12 years of practice at Radever Teleradiology, we have not only observed a constant rise in demand for better and specialized interpretations but also referring clinicians’ expectations from teleradiologists. Patients and clinicians deserve the best radiology interpretation irrespective of their geographical location, where the test is performed, or when (the time of day or night) it is performed.  Being prompt, precise, and persistent are the three Ps critical to developing a strong teleradiology culture which in turn is directly proportional to the referring clinician’s satisfaction and trust-building.

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How Teleradiology Has Been a Boon Healthcare?

The sufferings of humankind are immense and the struggle to find relief from them has led to discoveries that have challenged human existence. Technological advancements have tried to hack the human brain, body, mind to understand and predict human behavior. It’s unimaginable how world chess champion Gary Kasparov was defeated by an IBM supercomputer called Deep Blue. Humans might not have predicted that technology would checkmate them. But it did. All said and done technology is a double-edged sword. One cannot deny that technological advancements find their source in the human mind and imagination.

We have progressed in the field of healthcare to find solutions to challenging situations and diseases. Teleradiology is one such solution that has overcome the challenge of time and space. Let’s say a critically ill patient requires an urgent diagnosis and the doctor needs an immediate interpretation of the CT scan or MRI. The radiologist isn’t available at that time. What could be done and how technology could provide a solution?

Teleradiology initiates a process where the CT scan or MRI is sent to a teleradiologist based in some other hospital/center (maybe in some other geographical region- city or country) through the internet and he/she interprets the report, which is immediately sent back to the doctor or patient. The result is a quick diagnosis and timely treatment working as a boon to the patient’s life.

Geographical barriers have faded with the invention of the internet and no one could have imagined that it would benefit innumerable patients and assist healthcare professionals.

Today, we delve a bit deeper into how teleradiology has further changed our lives.

How teleradiology has been a boon to healthcare?

Benefits to remote areas in India:

Why is teleradiology a boon?

Indian healthcare challenges are unique. Contrast is evident where at one end plush hospitals in cities give quick access to urbanites while health centers in rural areas lag behind significantly in providing even the primary healthcare facilities. We are referring to the remotest areas in India. In rural areas Primary Health Care centers are limited. Also in some areas, the healthcare facilities cannot be reached within 5 km.

Though we see hope with the implementation of the National (Rural) Health Mission that has helped to improve infrastructure in the Indian Government healthcare system. Technology-enabled rural virtual healthcare is spearheading access to healthcare in these remote areas.

According to the Future Health Index 2021 report India witnesses a shift of priority to improving remote care and adopting digital technologies.

Teleradiology is providing the much-needed support to this shift. When the radiology reports need to be interpreted and a radiologist is not available at the hospital/healthcare center, the report is sent to a teleradiologist in urban areas via the internet. A detailed interpretation is done by a teleradiologist and sent back to the hospital in the rural area. It’s true these areas face internet connectivity issues but it’s just a matter of time that Indians living in remote areas will soon experience better internet connectivity. Soon rural populations will start benefiting more from telehealth and teleradiology as internet service providers shift their focus to rural areas.

How teleradiology has helped people around the world during the pandemic?

Teleradiology is electronically transmitting radiological patient images from one location to another to interpret them and consequently arrive at the course of treatment immediately.

During the present COVID-19 pandemic X-ray, chest CT scans are needed on an emergency basis. The interpretation has to be done immediately and treatment decisions need to be made quickly to save the life of patients. A large number of CT scans and X-rays have to be performed and here teleradiology provides an apt and quick solution.

Also, the medical staff /radiologist have to comply with social distancing norms to protect themselves, and patients against the spread of the virus. Thus, many have adopted teleradiology to remotely interpret medical images by working from home.

Work from home by using teleradiology is the best solution where the radiology teams have started working remotely.

All non-invasive imaging like X-rays, CT scans, MRIs, and ultrasound can be interpreted through teleradiology.

Rohit Sathe, VP Health Systems at Philips India shared his view on the present situation. He said that the COVID-19 has challenged the Indian healthcare system with high patient volumes. But it has led to the adoption of virtual care delivery in India enhancing health care. We have now realized that digital is the future of Indian healthcare and we need to incorporate strategies to adopt digital technologies in our healthcare organizations.

3-D post-processing services:

Advanced post-processing encompasses the manipulation of radiology images to arrive at better quality data. It can add significant value to the interpretation of radiology reports. This facilitates diagnosis, treatment, and follow-ups leading to improved patient care. This process aims at providing 3-D images so that healthcare professionals- surgeons, specialists can view the finer aspects of the image or objects.

These 3D processing services are available through teleradiology thus, improving the quality of healthcare outcomes.

Teleradiology has been a boon especially during the pandemic and it is up to us how we use this tool to extend superior healthcare facilities to patients. Patients are now gradually accepting it as the best treatment tool to save human lives.

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Teleradiology is a 21st century medium of interpreting radiological images ( CT scan, MRI, XRAY, Ultrasounds) with the potential to get the best results irrespective of time or place.

India is recognized to have provided many trained personnel in the IT field, customer care, health & telemedicine across the globe.

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https://radever.com/blog/how-to-choose-the-right-indian-teleradiology-partner/

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Teleradiology is the most mature and rapidly evolving branch of telemedicine. It uses computers and telecommunication networks to transmit diagnostic images and data from one location to another for primary review and interpretation as well as specialist consultation.

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Teleradiology is a 21st century medium of interpreting radiological images ( CT scan, MRI, XRAY, Ultrasounds) with the potential to get the best results irrespective of time or place.

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How To Choose The Right Indian Teleradiology Partner

Teleradiology is a 21st century medium of interpreting radiological images ( CT scan, MRI, XRAY, Ultrasounds) with the potential to get the best results irrespective of time or place. 

India is recognized to have provided many trained personnel in the IT field, customer care, health & telemedicine across the globe. 

Before April 2020 teleradiology in India was confined to a handful of service providers. However, on March 25th, 2020 Ministry of the health of India officially made teleconsultations legal. On top of that, the outbreak of the COVID-19 pandemic led to a surge in Indian teleradiology providers in order to answer the need for huge volumes of HRCT chests done at every level from tier 3 to tier 1 city.    

During the pandemic, teleradiology was embraced by many radiologists in India as it could compensate for reduced ultrasound cases without risk of getting infected. As a result, many teleradiology service providers have emerged in India and are functioning presently.

As a client or hospital, settle what you want first putting your patient at the center. Whether you want to answer specific issues (such as night emergencies, delayed TAT, etc) or to enhance the quality of radiology services ( to improve the quality of reads and TAT).

With our experience of 12 years in this sector, we have put together handy tips that will guide you through choosing the best teleradiology service provider in India.

Quality of Teleradiology Service Provider

It’s tough to assess the impact of any diagnostic health Care Service by any sort of ratio or statistics. Referring Clinician satisfaction and client retention can be good indicators in general for assessing the quality of a given teleradiology Service Provider. Before signing a service level agreement the client should ask for access to prior reports by each of the Radiologists from the given Teleradiology Services provider or sample reports and check the profoundness by reporting style. Going one step further one may ask for a trial by assigning some random cases to the provider as per your needs. For example, an Orthopaedic Hospital can assign a few trial prediagnosed MRI joints or CT scan trauma studies with subtle tiny fractures. Or a General Hospital client can assign proven cases such as pulmonary embolism, acute appendicitis, thin subdural from the Emergency Room to test the efficiency.  

Hence it is necessary to integrate into the partnership deal with the teleradiology provider, a Continuous Quality Improvement (CQI).

Analyzing the peer review system in the workflow as to how it works, how quickly the images are routed for peer review can be important.

Assessment of experience of all reporting Radiologists in the field of required modalities and subspecialties is an important factor. Indian Radiology Practise is highly modality driven. The majority of radiologists in India practice ultrasound but do part-time teleradiology in a particular time slot or on weekends. You may have a Radiologist with 10 years of experience on his CV but is only occasionally reporting gastrointestinal CT scans or MRI joints. 

Large versus Small Panel Teleradiology Service Providers

The size of the teleradiologist’s panel is an important criterion for searching for the right match for your organization. The optimum size of the panel to cover all 24 hours is important at the same time stability of the teleradiologists with constant names is key to develop trust for a long term relationship with the referring clinician. Hiring a large panel of teleradiologists for a small hospital will doesn’t make sense always. Generally, large panel radiologists have a high turnover rate. Continuously changing the names of the radiologists will hamper the trust-building between the referring surgeon and the teleradiologists.  

Besides panel size turnover rate of radiologists may indicate the stability of the group. Large panel teleradiology providers in India generally comprise multiple part-time radiologists who otherwise are doing ultrasound practice at their clinics. Such groups may lack a teleradiology culture. Imagine a CT abdomen scan for a suspected case of bowel perforation being read by a sonologist within his time slot provided by the telerad provider who is looking for gas under the diaphragm on the scanogram. 

In contrary to an experienced teleradiologist who is reporting hundreds of CT scans a day sitting for hours in his office who is trained to look for even a tiny extraluminal air. 

In contrast to the large groups small but stable panels of teleradiology service providers who are full-time teleradiologists are at an advantage of building trust and a comfort level with the referring clinicians due to low turnover rates. 

We need to understand the difference between the optimum sized panels of stable, full-time teleradiologists versus large panels of revolving part-time radiologists.

Most of the large groups employ radiologists who are full-time ultrasonologists and reports cross-section studies (CT or MRI scans) on a part-time basis or on weekends, so the size of the teleradiology panel is a factor in bethinking. However, the large panels have many panel radiologists needed to provide coverage which is an advantage.  

Communication Of Critical Findings And Coverage

In emergency cases, the consequences for the patient can be severe if there is no direct communication between the referring surgeon or critical care physician and the reading radiologist.

 Ideally, a teleradiology service provider should have a protocol outlined for the proactive steps required to communicate the emergency findings or unexpected findings. For example, the policy may be only to contact the referring clinician on phone in the case of a life-threatening disease or other situations such as clinically unsuspected cases such as metastasis. Also, it is equally important that the reporting radiologist himself receives the call immediately to clarify the clinician’s doubt in an emergency situation. The use of mobile SMS or WhatsApp can add value. 

Needless to mention, a good teleradiology service provider should be covering 24/7 for 365 days.

Work Flow and Turnaround Time

Turnaround time is the time frame between when the request of a teleradiology service provider is ordered and when the report is sent back. A good turnaround time for acute stroke should be between 10 to 30 minutes. Teleradiology service providers must have a case prioritization feature inside the PACS software. However, it is also important to give the reporting teleradiologist a comfortable environment by allowing longer Turn around time for nonemergent subspeciality focus cases.

Technology and Infrastructure

As far as IT infrastructure is concerned there are three types of teleradiology service providers in India

1. self-developed commercial IT and reading services. 2. teleradiology reading service providers that have developed their own IT ( although IT is not available commercially). 3. teleradiology reading service providers using third-party IT solutions.

HIPAA compliance

Health Insurance Portability and Accountability (HIPAA) rule that guard patient information about their health. For a standard teleradiology service provider, it is necessary to comply with HIPAA rules, which are concerned about the privacy and security of patient information.  

Teleradiology services in India are in general 20 to 40% cheaper compared to US telerad providers.   

At the end, before hiring a teleradiology partner one should be clear about the goals your organization wants to achieve. An Indian teleradiology partner can be equally effective as a USA teleradiology provider if chosen appropriately.

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Impact Of Teleradiology On Health Care

Teleradiology is the most mature and rapidly evolving branch of telemedicine. It uses computers and telecommunication networks to transmit diagnostic images and data from one location to another for primary review and interpretation as well as specialist consultation.

HISTORY

One review claims that the first reference to telemedicine in medical literature can be traced back to 1950. It talks about how the transmission of radiology images began in 1948. Then Canadian radiologists built on this early work to create a teleradiology system well into the 1950s.

However, technology evolution in teleradiology began with the invention of RIS/PACS in the early 90S and then to workflow, enterprise teleradiology, cloud, and now its AI and deep learning at the doorstep. Like any other branch of telemedicine, teleradiology began as a solution to overcome the shortage of radiologists in remote areas, small hospitals, and emergency departments. In the early years of the 21st century, emergency nighthawk work was one of the chief drivers of global teleradiology by using time zones in the USA, India, Australia, and Israel.

There were concerns in the beginning that remote interpretation by external teleradiology providers would have potentially negative consequences for the specialty as a whole in the way of commoditization, reduced reimbursement, displacement of radiology groups from their hospital contracts, increased encroachment by non-radiology specialties, and loss of direct touch with the patient doubted to lower quality. These concerns were addressed with legalizations, HIPPA compliance, technology, and proactive efforts by teleradiology providers. Still, such concerns exist in developing countries, which is purely due to anarchy or lawlessness.

However, since the last few years, teleradiology has witnessed tremendous growth and has leaped since the covid19 pandemic. According to market surveys, global teleradiology is likely to become a 20-billion-dollar industry by 2025.

The obvious impacts of teleradiology on health care have been:

REDUCING THE TURNAROUND TIMES AND IMPROVING THE QUALITY OF REPORTS IN AN EMERGENCY SETTING

In the pre-teleradiology era, the scans in the emergency department either remained unreported till the following day or were reported late. The technician used to wake up the radiologist, who would drive down to the department every time to review the studies. Often, the radiologist spent the night without sleeping and then again work for the next day, which naturally affected the efficiency in the day and at night.

Today after the implementation of teleradiology, the benefits are apparent. The professional teleradiology groups have strict service level agreements with the hospitals to ensure rapid turnaround times. Accordingly, multiple experienced radiologists are scheduled to work in short shifts to cover the entire night. Rapid turnaround times as fast as ten minutes are provided by professional teleradiology service providers like Radever Teleradiology conforming with the dictum Time Is Brain. Thus ensuring early treatment in acute stroke, benefiting both the patient and the treating emergency clinician.

How has global teleradiology improved the quality of reporting?

Here are some of the reasons which we could make out through the perspective of our 12-year teleradiology practice in Radever. The first reason could be, by reporting a large number of cases daily with a pinpoint focus on emergency findings, immediate peer reviews, and feedbacks, a full-time teleradiologist today has gained a considerable competence to excel in the interpretation of acute findings such as pulmonary embolism, Hyperacute stroke on CT brain, aortic dissections, perforations, small pneumothorax on Xrays, detecting active hemorrhages, acute adrenal crisis and trauma. Thus, teleradiology enables a radiologist to become uniquely competent as an expert generalist who is comfortable interpreting CNS or GI, or Respiratory emergencies.

In this field, peer reviews and feedbacks are necessary. Apart from being instrumental in improving patient care and reducing the chances of any potential harm, peer reviews identify discrepancies and share learning from them. With this, practitioners can reduce the chances of further discrepancies and consequently improve report quality. There is also the fact that they contribute to departmental quality assurance (QA) programs which provide reassurance of safe service and stimulate service improvement. There is no doubt that peer review and feedback activity can promote self-improvement and learning when done with the right intention and attitude.

Utilization of time zone advantage in nighthawk international teleradiology to have fresh, awake radiologist who has taken adequate sleep can facilitate quality enhancement in emergency teleradiology.

SUBSPECIALTY TELERADIOLOGY – BRIDGING THE GAP

During our 12 years of practice in teleradiology, we have observed a constant rise in demand for better and specialized interpretations and patient’s expectations. We can not expect the best interpretation of an MRI wrist study if done by a radiologist who only occasionally looks at joint MRIs, no matter how advanced the MRI machine is. Needless to say, patients and clinicians deserve the best radiology interpretation irrespective of their geographical location, where the test is performed, or when (the time of day or night) it is performed.

The current trend that embraces subspecialty radiology services is a significant indication of the maturation of teleradiology. One substantial challenge in radiology development is that this will end matching suitable readers with the proper study. This is often hampered by location and economics as most radiologists are clustered in tier 1 and tier 2 cities. The small hospitals, tier 2, 3 cities, and remote areas are starved of subspecialty care. It’s not uncommon to find high-priced radiologists with salaries that are more than a facility’s revenues when outside large hospital systems and urban areas. Having this sort of pricing structure in small towns makes absolutely no sense.

This gap can be effectively covered with subspeciality teleradiology. With a network of subspecialty radiologists deployed either part-time or full-time, small and medium hospitals in small towns can enhance their patient care at a lower cost. In addition, teleradiology has variable pricing where small and medium hospitals don’t have to hire a full-time radiologist for as high as $700,000 when they can contract a subspeciality teleradiology service provider and pay him per click.

Thanks to these services, even general radiologists can get into what they do best and gain support from other experts. This trend is bringing a new paradigm that benefits small hospitals by elevating the service standards and separating them from the competition.

Due to the nature of the ambition and education of subspecialists, they need just the right volume of work to maintain competence in their field. In addition, subspeciality provides wider exposure to the subspecialists by connecting to the medium and small-town hospitals where their services are much needed and appreciated.

Some common subspecialty radiology services are ;

Neuroradiology

Gastro-Intestinal (abdomen) imaging

Pediatric neuroradiology

Musculoskeletal radiology

Oncoradiology and nuclear imaging

Breast imaging

IN REMOTE AREAS

Teleradiology is beneficial to small and medium healthcare organizations, especially in outpatient imaging centers and rural hospitals. Access to these services provides them with the experts they would otherwise have been unable to afford or recruit. It’s not uncommon to see rural areas operating without radiologists, but these small practices have the most significant need.

How can rural hospitals benefit from teleradiology and telemedicine? First, this health field helps in offering a quicker turnaround time for tests and consultations. Also, it brings about a better means to educate and inform healthcare providers while increasing the number of available services. Here are four distinct benefits that come with using telemedicine in rural communities:

Outsourcing saves hospital costs

Patients can save on travel time and other expenses

It reduces the pressure of patients having to miss hours of work

Local economies can bring in more dollars from using local health services like pharmacies and labs

CONCLUSION

With their pivotal role in patient care and emergency health services in small towns, teleradiologists are a core part of modern treatment plans. It’s also a field that is continuously updating its methods with technological advances. From all areas, we can see how teleradiology services positively impact affordable patient care while also sustaining smaller hospitals in a competitive space and increasing physician satisfaction.

According to Yulun Wang, president of the American Telemedicine Association, Telemedicine will become the core methodology of healthcare delivery in the future. That is where we are going to get the efficiencies we need to provide affordable care.

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Radever Teleradiology provides 24/7 teleradiology services to clients worldwide, providing radiology services to hospitals and healthcare facilities.