Personal teleradiology The future is here. Within reach.

Personal teleradiology. What is it?

Intro

We all usually move around in our accustomed environment. We follow certain people on social media and usually read the magazines that suit us. We visit the websites and portals we identify with.

This also applies to our everyday professional life - we move in small bubbles. These seem natural and natural to us - that's where we feel comfortable.

So it's not surprising if, as a radiology specialist, you raise eyebrows even within the medical profession when it comes to the topic of teleradiology.

For this reason, teleradiology will be explained first - a very exciting and very special field of radiology that has been controversially discussed in Germany for years. In the meantime, however, it is gaining more and more importance internationally and there is a danger of being left behind again in international competition.

Tiamana Medical has been following developments in the field for years, gaining a lot of experience and identifying the challenges.

We have defined the workflow improvements that have been made as "Personal Teleradiology" and have designed Tiamana Medical's working model with the future in mind from the very beginning.

In this article, we will present our thoughts and explain why we are convinced that personal teleradiology combines the best of both worlds.

 

The status quo

In radiology, we continue to see the classic operation, in which there is nothing wrong for the time being - at least in theory. There are two areas that make up the main part - radiology in hospitals / clinics / hospitals and the outpatient medical practices for radiology.

In general terms, the procedure is relatively simple - the person to be examined goes to the radiology department, lies down in the machine with the help of the technical assistant, then images are taken (e.g. X-ray, CT, MRI), the radiologists examine the images at their own workstations and prepare the findings. It is clearly defined that the person to be examined is informed about the examination and any risks are pointed out.

Teleradiology

If you search for the definition of teleradiology, you will quickly find such a phrase:

"Teleradiology, as a sub-discipline of medicine, is concerned with the direct transmission of radiological imagingmedia via a (tele)communications facility to remote locations and parallel transmission of informational material to various addressees for review of the material."

 

So far, so good. Now, what does that mean for everyone involved?

By separating non-medical services (creating the images on the device) from medical services (reviewing the images and creating the written report), radiology primarily gains significantly in flexibility and can thus play in the league of innovative professions such as software development.

The most common use in Germany is to view images from home as part of a hospital's emergency background service. Classically, radiology residents are on-site at the hospital as foreground duty and cover the hours after the daytime service until the next daytime service (e.g., from 16:30 to 08:00 on weekdays and from 08:00 to 08:00 on weekends and bank holidays).

The hospital is obliged to guarantee a specialist standard. For this reason, a specialist background or on-call service is also organized. The specialists can access the images from home with the help of teleradiology and support the staff on site.

There are scenarios or models in which there are no longer any radiology specialists on site. Many factors play a role here - often it is the size of the hospital, but there are other reasons, such as staff shortages.

When the radiologists are at home, the attending physicians (e.g. from surgery or neurology) take over the tasks on site - this involves the educational discussion and monitoring in the event of a complication during the radiological examination.

The radiologists can decide by telephone, on the basis of the information provided, whether the examination is to be carried out (so-called provision of the justifying indication), the examination is carried out by the medical-technical radiological assistant (MTRA), the radiologists can connect to the radiology department via an encrypted Internet line, examine the images, pass on the findings to the supervising physicians by telephone and then prepare the written findings.

 

What does it look like from the point of view of the doctors in charge? Is the procedure really so different from normal daytime operations?

The fact is that even in daytime operations, personal contact with radiology is rather limited. There are several reasons for this:

• The doctors in the OR and on the ward have enough to do to run to radiology for every finding.
• Physicians usually rely on the diagnosis from radiology - whether it is a preliminary phone message or the final written report in the hospital IT system.
• Case conferences are offered to discuss cases so that an entire department is up to date and to minimize multiple reporting of findings and thus insufficiencies in procedures.

 

This means that in most cases, a phone call is sufficient and a face-to-face meeting is not necessary - especially when non-emergencies are involved.

This fact becomes even clearer if one considers outpatient medicine - here, weeks or months often pass between the examination with preparation of the findings and the renewed presentation in the referring practice (e.g. general medicine or orthopedics).

 

Why then do some clinical colleagues find teleradiology so unsatisfactory?

Personal experience shows that we as a specialist group are sometimes envied for the possibility of teleworking. This may sound strange, but it is indeed elegant to sit at your own desk at home, watch the recordings and not drive through the rain or snow at night.

Another reason is that some colleagues value the personal conversation on site very much and have become accustomed to it.

 

How does it look from the patient's point of view?

That's a very good question, and it's often very easy to answer, at least in the hospital - they don't recognize the difference, because they don't see the radiologists even during the daytime operation, or rather exceptionally.

In outpatient practices, there are the two options - doctors* talk to each person, or there is no face-to-face contact.

Some doctors only take care of the privately insured, others make it dependent on the patient - if the conversation is desired, it is held - otherwise not.

 

Teleradiology as an emergency solution

The complex economic and socio-economic developments of the last decades have led to the fact that we are partly experiencing a shortage of specialists also in radiology.

There is a redistribution of capacity in favor of metropolitan areas with increasingly difficult rural areas to cover.

There are many reasons for this:

• Aging society
• Attractive career opportunities and family options in metropolitan areas and/or abroad
• Emerging professional opportunities outside of patient care

 

All this has a negative impact on the coverage of the radiological service as well.

This effect is reinforced by the fact that the radiologists are well aware of the above-mentioned facts and can use their position in negotiations for their own benefit. In this way, contracts are created that cover pure daytime service, but do not include the unpopular night and weekend services.

Teleradiology can provide a solution to this shortage and compensate for the lack of radiologists both during the day and at night. This offer of expertise takes place independent of location and facilitates the planning and design of alternative career and life concepts for radiologists*. At the same time, the on-call service can experience greater acceptance due to the possibility of working from home.

 

Advantages and disadvantages

If we look at the previous considerations, it quickly becomes clear that the advantages clearly outweigh the disadvantages:

• Compensate for shortage of skilled workers
• Location-independent availability of expertise
• Alternative career and life concepts
• Higher acceptance of the on-call service

 

On the other hand, there are possible disadvantages:

• Slight time delay due to data transfer (only partially relevant in emergency operation)
• No personal contact on site
• Failure concepts necessary in case of emergency (failure of internet connection or IT)

 

International comparison

Germany may be the only country in the world that does not yet have a speed limit on the autobahn, but it brings up the rear when it comes to average internet speed.

Even when it comes to the topic of "teleradiology", there is no need to fly across the Atlantic and look for examples of how it can be done better - our neighbors have already been showing us how it can be done for years - companies such as TMC (Telemedicine Clinic) with locations in Barcelona and Sydney and the possibility to work radiologically from home have been covering large parts of the radiology market in Europe for years, both in daytime and emergency operations - with the exception of Germany.

Attractive time- and location-independent working models, breathtaking panoramic views from the workplace over the Mediterranean Sea and the Barcelona skyline compete with windowless rooms on first floors and basements with thick walls without WLAN or cell phone reception. Thus a comment by a colleague who was upset about the premises during his residency: "If animals were kept here, animal welfare would have been on the scene long ago."

 

Note: Not all that glitters is gold! The working environment is only one facet of the complex topic of "radiology as a workplace". The increasing pressure to perform and the low compensation per case, as well as the threat of competition from countries with lower incomes, are important topics that we could address in another article.

 

Prejudices

Why then is it so difficult to see and accept teleradiology as a future-oriented alternative? Why is teleradiology bad-mouthed and reasons sought why it cannot work?

On the one hand, there are clinical disciplines, colleagues, and rigid and complex administrative apparatuses that generally see change as a threat to the status quo. How often do we hear "That's the way it's always been done" - this attitude nips any attempt to innovate in the bud and generates a high level of frustration and dissatisfaction among people who would be willing to go down new, innovative or disruptive paths.

The result is an arbitrary blockade against progress and flexibility, which for the time being isolates us from the outside world in order to protect established structures and work processes - with the risk that more and more colleagues will seek out the companies that offer them flexibility, respect, quality and an attractive working environment - if necessary outside the medical field.

In the long run, this leads to a huge disadvantage for the medical profession in Germany and even more important - for all patients.

 

Future scenarios

What options do we have? Simply carrying on like this will work for a few more years. But it will end in disaster. Germany invests enormous amounts of resources to train medical personnel, only to lose them in the end due to an unattractive professional environment, a lack of vision and rampant bureaucracy.

Medicine is becoming increasingly industrialized, the first departments are merging and being bought up by external non-medical investors - it's all about returns, optimizing processes and maximizing turnover on the edge of what is legally possible - this has not been ethical for a long time.

Parallel to this, the control mechanisms of the health insurance companies and the associations of panel doctors are at work, hammering the last nail in the coffin of the supposedly free profession of doctors with cuts in services and recourse.

But it doesn't stop there. The so-called artificial intelligence is developing splendidly, the IT corporations sense new markets and growth potential. The medical profession is being automated. Yes, it's not there yet, but it will happen faster than you think. If we stick with this concept and type our findings in front of us in a dark room, we will soon be replaced.

 

Personal teleradiology

What can we do about it?

We asked ourselves this intensively during the planning of Tiamana Medical. The answer is sobering at first glance, but surprisingly simple - there's nothing we can do about it!

We have to accept progress and go with it. We have to find ways to put the patients back in the foreground and to take over important tasks that the computer cannot take away from us.

 

Our answer to this task is the best of both worlds - at Tiamana Medical we call it "personal teleradiology" (PTR).

We combine the advantages of teleradiology and location-independent radiological reporting with current technologies that have more than proven themselves in recent years, including in the context of the COVID pandemic.

In this way, we can conduct a detailed clarification conversation via video conference and examine the recordings in peace and in high quality. Subsequently, we can explain the findings in detail and comprehensibly in a renewed video conference with live demonstration on the screen, independent of location.

The advantages are obvious - patients remain flexible as they can choose all appointments freely, the stay in the examination center is shortened to a maximum and personal contact (via video call) with us is generously planned.

We see all of this as a main part of our concept and as the answer to the gap in expertise caused by demographics - both nationwide and internationally.

It's about quality, flexibility and humane care - even beyond the individual case - unimaginable today from an economic point of view.

Briefly speaking - we treat our patients the way we want to be treated.