In a survey presented to the European Congress of Radiology, 80 percent of respondents reported a strongly positive opinion of teleradiology. Forty-six percent predicted that its importance would grow. Dr. Erik Ranschaert, the staff radiologist at Jeroen Bosch Ziekenhuis teaching hospital in the Netherlands who presented the survey, predicted that teleradiology would continue to grow because of demand for on-call services, emergency services, second opinions and sub-specialty opinions.
As teleradiology options multiply all over the globe, commercial teleradiology services need to ensure they provide quality for the patients they serve. More and more health care providers are calling for standardization of qualifications and regulations. Until these standards are resolved not only in countries but also internationally, teleradiology providers should follow these four primary quality assurance best practices.
Appropriate Licensure and/or Board Certification
The American College of Emergency Physicians (ACEP) recommends that physicians only consult teleradiologists whose credentials meet or exceed those of in-house radiologists. They should be licensed within the state where imaging is performed, and they should be board certified or board eligible according to state laws. The American College of Radiology (ACR) goes further by recommending these qualifications for all teleradiologists:
- Training in an accredited residency program. ACR recommends that teleradiologists complete their residencies in a program accredited by the American Council for Graduate Medical Education (ACGME). Each teleradiologist should have documented training in each imaging modality that he or she interprets. Alternatively, teleradiologists can produce evidence that they meet ACR practice guidelines or technical standards in each imaging modality.
- Licensure and continuing medical education (CME). The teleradiologist should have all licensure required at both the receiving and transmitting sites.He or she should meet all CME and continuing experience (CE) requirements to comply with both state regulations and facilities accreditation requirements.
- Institutional compliance. Teleradiologists should obtain appropriate privileges at the institutions for which they interpret. They should also conduct themselves according to institutional policies and bylaws.
Excellent Verbal and Written Communications Skills
Thanks to EHRs and PACS, more patients are obtaining access to their own imaging scans. In addition, mobile devices enable patients to view, manage and send their imaging scans anywhere at any time. As they review their own images and seek Web resources to interpret those images, more patients are communicating directly with radiologists. Even teleradiologists who deal primarily with medical providers should be qualified to communicate directly with patients.
When talking to patients, teleradiologists should clarify reports and offer second opinions in easy-to-understand language. Since many institutions are increasingly judged based on patient satisfaction, teleradiologists will have to develop a good “bedside manner” when communicating with patients.
Another crucial component of communication is to ensure clear labeling and documentation of all reports sent to medical facilities. Preliminary reports and final reports should be easy to distinguish from one another. When a final report differs significantly from preliminary findings, the teleradiologist has an obligation to ensure that the physician receives the new information. That obligation continues even if the final report is issued days after the initial interpretation.
Timeliness Without Compromising Accuracy
The ACR discourages teleradiologists from providing guaranteed scan interpretation turnaround times because the organization fears that unreasonably fast turnaround could compromise accuracy. Instead, teleradiology providers should set their turnaround times according to the in-house requirements of the facilities for which they interpret. They should only make exceptions if the patient’s condition requires faster-than-normal image interpretation.
A teleradiology provider should have a peer review and quality assurance system in place. Important components of this system include:
- Clear resolution process for discrepancies in preliminary and final results.
- Making the interpreting teleradiologist available for consultation, both with the ordering physician and with any local radiologists.
- A means for local physicians and radiologists to request and receive second opinions.
- A process to provide additional review upon receipt of additional patient information as well as methods for dictating any addendum to a final report.
Until more uniform government regulations are in place, health care facilities must take responsibility for choosing only the most highly qualified teleradiology professionals. They should also ensure that their teleradiology partners have adequate medical liability insurance.
About the author: Ginny Howard reports on telemedicine trends in the United States for a number of publications.