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International Teleradiology Experience in Developing vs Developed World

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

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International Teleradiology Experience in Developing vs Developed World

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  1. Africa Telehealth Conference 2010 Cairo, Egypt International TeleradiologyExperience in Developing vs Developed World Dr Ashish Dhawad COO, TeleDiagnosys CEO, Medsynaptic

  2. Definition of Teleradiology

  3. 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

  4. History of Teleradiology

  5. Beginning Mr Watson, Come here, I want you In 1876, simultaneous beginning of telephone and telemedicine Alexander Graham Bell

  6. Early Adoption 1930 – Queen Mary ocean liner used the ship radio for medical consultations with onshore experts

  7. Middle Ages 1960-1970 – Closed circuit and broadcast Television used for medical consultations

  8. Evolution 1980 – Computer usage began for telemedicine

  9. Maturity 1990 – Internet becomes popular 21st Century – Modern Teleradiology using High speed Internet and mobiles iphone

  10. Concept of Teleradiology

  11. 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

  12. Teleradiology: Components 1. An image sending station 2. A transmission network 3. A receiving/image review station

  13. 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

  14. 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.

  15. Sending Station: The Source CT Scanner MRI Scanner Ultrasound DIFFERENT IMAGING MODALITIES Mammography Nuclear Scans DR/CR

  16. 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

  17. Transmission Network • Wire • Fiber optics • Microwave • Internet

  18. Receiving/Image Review Station Consists of: • Network interface • Personal computer with storage medium (e.g. hard disk drive) • One or more Medical monitors • Optional hard copy device printer

  19. Receiving/Image Review Station

  20. 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

  21. 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

  22. Requirements to Setup • Space • Finance • Technology • Manpower • Clients!!!

  23. 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

  24. Finance • Self funded • Angel / VC • Debt • Finance required variable on location

  25. 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

  26. PACS/Teleradiology Software • Web based vs • Point to Point

  27. Point to Point • Sending Station • Receiving Station • Transmission Network • Older technology • Less flexibility

  28. Sample Architecture Receiving Stations Sending Station

  29. 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

  30. Sample Architecture Radiologist WS Sending Station Central Server

  31. 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

  32. 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

  33. 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

  34. 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

  35. Transcription • Inhouse or outsourced • Speech Recognition • Keep control of Quality

  36. Routers/LAN • LAN • CAT 5 • CAT 6 • Wireless • Gigabit Routers • VPN Routers

  37. Other Requirements • VOIP phones • Fax • Telephones • Toll Free numbers • Ergonomic Furniture • Printers

  38. Processes • Training • QA process • JCI/JCAHO • ISO

  39. 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

  40. Quality Policy • Should make all efforts to follows guidelines issued by organizations like HIPAA, ACR, ESR etc • Clearly defined Quality assurance policy

  41. Regulatory requirements • License • Credentialing • Insurance • Data Security • Legal

  42. Standards • ACR – American College of Radiology • ESR – European Society of Radiology • CAR – Canadian Association of Radiology • UK – Royal College of Radiology

  43. Market Hotspots • USA • Canada • UK • Africa • Singapore • India • Australia • China • Europe • Germany • Spain • Sweden • Norway

  44. 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

  45. 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

  46. 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 Developing vs Developed World

  47. Barriers to Success

  48. 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

  49. 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

  50. 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

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