January 2021 – Cloudex Radiology

Teleradiology Enhancing The Patient Satisfaction and Quicker TAT for Referring Physician

Once upon a time, teleradiology was considered as a fragmented and interrupted experience where the images, texts, and speeches were getting delivered on a different medium. And the poor communication between the referring physician and teleradiologist might have resulted in confusion in the patient’s mind or the high cost or undesirable clinical outcomes.

Currently, technological advances have revolutionized the way teleradiology is conducted and are contributing to quality healthcare service delivery. Today, teleradiology represents the integration of the many advanced multimedia technologies which supports the upload/download of reports along with other necessary support documents (other than radiological images), display of images (multiple viewing/screening options), tools for image annotation, image/report archival and retrieval, communication between the group/team, audio reporting and its conversion into text report are some of the important features facilitating the remote reporting equivalent to real-time reporting.

At present, Teleradiology addresses the key concern of the referring physician – accurate report at the earliest with the provision of communicating with teleradiologists in real-time.

These concerns get addressed and benefit him in multiple ways.

Benefit of Support from the extended team during the deciding moments becomes crucial for those who are based in healthcare centers where the radiology department works in stipulated working hours or patients are referred to other centers for radiology services. In such a scenario, the treating physician is benefitted by receiving accurate reports within the decided TAT and can interact with the teleradiologist for further clarification. Overall, the referring physician has an extended team outside his team (employed/assigned team) to support him in providing quality patient care and on whom he can rely during his crucial deciding moments.
Benefit of 24 x 7 Reporting services empowers the referring physician in providing quality patient care round the clock without any delay. This benefits the physician as well as the patient in saving the time and cost, the shift of patient to emergency service and unexpected situation.
Benefit of Expert Opinion when an ambiguous situation. A qualified and expert panel of subspecialists can support the referring physician in more than one way – correct diagnosis, prognosis, and working out the appropriate treatment plan or in understanding/monitoring the treatment outcome. This works wonders for the multispecialty hospitals who need the subspecialty reporting and expert opinions for critical cases additional to their regular radiologist’s reporting; especially in cases of Orthopaedic, Neurology, Oncology, Paediatric or Emergency to name a few.
Benefit of Remote Reporting has brought about a paradigm shift in the quality of patient care extended in primary or secondary care centers located in tier 2 / 3 towns or geographically challenging locations. Teleradiology has built a connection where referring physicians can interact with the reporting teleradiologist in real-time. As a result, Referring Physician can inform the patient about the criticality of the patient in emergency cases and guide the patient in taking appropriate action or referring a patient to comprehensive healthcare centers at right time.
Benefit of Selective Reporting services is an option where the referring physician can choose from different types of teleporting services based on the need; like during the absence of regular radiologists due to holiday/weekend / off-duty / night-time. The different services available to opt for are night call reporting, weekend reporting, overload reporting, vacation reporting. All these selective options are available to ensure patient care without any delay.
Benefit of Answers to the queries of Patient which helps in building trust. Many times, the internet-savvy patient from the metro and tier 1 town throws a series of queries for a better understanding of the situation and for taking appropriate action (shift to a specialty center for surgery/treatment). The patient’s interaction with the reporting teleradiologist who has given the detailed imaging report helps in briefing those critical characteristics playing a crucial role in prognosis. The building of trust depends on many aspects and this can prove to be one of the ways.

Cloudex Radiology Solutions empowers the Referring Physician with a winning edge…

Cloudex teleradiology services empowered with its qualified & experienced experts and subspecialty teleradiologist extends the benefits of technologically advanced infrastructure (RIS-PACS) supported with interactive multimedia components, advanced visualization, and communications (voice message/text/messenger app-based communication, etc.). All these features help in low TAT, quality reporting, and increase the Physician’s satisfaction and confidence with service resulting in the effective clinical outcome – patient care. In today’s competitive world where the patient is ready to go extra mile for better information, better patient care, better treatment option; Teleradiology empowers the referring physician with that winning edge.

At Cloudex, we support you to have that winning edge.

How Teleradiology Can Help Early Management of Acute Stroke

Dr. Shriram Varadharajan, Consultant Neuroradiologist (Neuroimaging & Stroke)

Awareness of stroke and immediate arrival to the hospital plays a major role in its treatment and recovery. Unlike acute coronary syndrome (ACS – heart attack) where pain plays a prominent role in patients presenting early, stroke patients ignore the negative signs such as sudden onset weakness or numbness. Often minor stroke or TIA (transient ischemic attack) serves as a warning for subsequent major stroke (CVA – cerebrovascular accident). Stroke patients need to complete timely evaluation with various imaging tools. Treatment decisions in acute stroke require ultrafast imaging. It should be performed immediately after clinical triage and emergency stabilization of the patient.

Imaging starts with the very basic question of differentiating Ischemic (clot in the vessels supplying the brain) from Hemorrhagic stroke (bleed) using a simple plain CT scan. Ischemic stroke patients may be given an injection called intravenous thrombolysis (IVT or clot lysis). Plain CT aims to exclude hemorrhage and established large infarcts which are contraindications to intravenous thrombolysis. Additional findings such as hyperdense vessel sign and ASPECTS are helpful to decide on endovascular thrombectomy. Further vascular imaging (imaging of the blood vessels – CT Angiography) is used in Ischemic stroke to detect patients with large vessel occlusion (LVO) i.e. clot inside larger blood vessels. They may need additional emergency endovascular thrombectomy (EVT or clot removal) using advanced catheter-based techniques in DSA (cath.) lab.

These treatments are currently offered to patients presenting within narrow time windows of stroke onset (3-4.5 hours for injection – IVT and 6 hours for cath. lab – EVT). CTA involves evaluating routine angiography and additional venous/delayed phases, regarding the site and presence of LVO as well as to estimate collateral status.

However, few patients who arrive late (beyond 4.5 to 6 hours and till 16-24 hours) can also be treated based on their imaging if we can identify salvageable penumbra (affected brain parenchyma but without permanent damage) using advanced imaging techniques that analyze brain parenchymal perfusion.

All of these decisions can also be taken collectively and more accurately using MRI. Ultrafast Stroke MRI takes less than 20 minutes using limited protocols and involves basic sequences as well as Angiography. MRI in acute stroke can be done without having to administer intravenous contrast and is especially very useful in differentiating from other mimics. Parenchymal and vascular information both can be obtained. MRI involves DWI for infarct core and MRA for LVO while FLAIR mismatch can be used for IVT in stroke patients with unknown time of onset or wake-up strokes. SWI can help detect thrombus/clot burden in RBC rich clots and serve as a penumbral marker by demonstrating vessels with raised oxygen extraction.

Teleradiology can thus be very effective in acute Stroke if reporting can be accelerated to avoid time delays. Simplified reporting formats can be developed based on local logistics. Although CT and CTA are widely practiced in acute stroke, MRI provides a non-contrast one-stop solution in the emergency especially if reported immediately by dedicated, trained tele-stroke Radiologists. Structured reports for such time-based emergency situations like acute stroke help avoid medico-legal consequences especially in the era of evidence-based medicine and helps guide the referring physicians in making treatment decisions.

References

1. Varadharajan S, et al. Computed tomography angiography in acute stroke (revisiting the 4Ps of imaging). Am J Emerg Med. 2016 Feb;34(2):282-7

2. Varadharajan S. ASAP In Stroke Imaging – Need to Simplify and Standardize in Emergency. Accepted for publication in Neurology India

Quality in Teleradiology Reporting

“Quality is the extent to which the right procedure is done in the right way at the right time, and the correct interpretation is accurately and quickly communicated to the patient and referring physician.” Hillman et al

Teleradiology is playing a crucial role in delivering patient care with its prompt and quality service.

The quality of radiological reporting depends on multiple parameters apart from the internal review and external feedback system like

Communication between the reporting radiologists and referring physician for better understanding of the case

PACS and workflow management

Operational team (CTC)

Access to reporting tele-radiologist for clarification / discussion

The Internal Parameters can be listed as –

1. Internal Quality Assurance Team sets up an auditing system involving methodology on random review of the reports and peer reviews at regular intervals. The key performance indicators (KPIs) are prepared by the team in alignment with the organization’s objective and external auditor’s standards (if involved). The experts evaluate the reporting by carrying out random double reporting, peer review, and discuss the discrepancies with reporting radiologists.

Evaluation of the discrepancies, formulation, and implementation of corrective measures followed by evaluation of implementation is a cyclic process in order to improve the quality of report and service delivery. The option of contacting the reported tele-radiologist for further clarification and discussion on prognosis is available.

The new recruits are initially engaged in preliminary reporting for familiarization with the tele-reporting system and are supported with constant review and feedback. This also involves eLearning, teleconferencing, telemedicine, and other technological processes.

2. Procedure Protocol indicates the Right Procedure & Right Way which impacts many other parameters. The protocol includes a checklist drafted by the team on imaging procedures, image uploading/transfer, availability of support documents, defined TAT for emergency & regular cases, filled request form, to & fro communication between the referring physician and reporting radiologists, assigning of images to radiologists, etc.

3. Credentials of the tele-radiologists including the sub-specialization and experience per se augment the value of the report. In critical cases like emergency / STAT reporting, the unique skill of picking up the hidden markers in a short time plays a critical or decisive role. Their clinical focus in reporting improves referring physician’s proficiency to advise or decide on suitable investigations/management of patients.

4. TAT is variable and crucial for referring physicians in taking control of the situation, be it for emergency or regular cases. Today, because of the technological benefits, the TAT for an emergency case is approximately less than 30 minutes whereas for any inpatient or outpatient 4 to 8 hours is maintained. Especially in teleradiology, the other factor which determines the TAT is mutual agreement between the service provider & referring center and considering cost factor as well.

5. Miss Rate is determined by continuous reviewing of reports at regular intervals by the review panel and a lot of measures are undertaken to keep it low. The positive culture of the review panel establishes an environment that is instructive, supporting cognitive debiasing and retrospective analyses. Clients are also encouraged to report “misses” by categorizing them based on their implicating severity. Feedback and discussions with referring physicians help in the process.

The External Parameters which can be considered are

1. Client’s feedback system serves two purposes – understanding the quality of report and reporting services although both (service provider and referring center) would have laid down the SOPs to be followed at either end. The upload of images of other recently conducted investigations, along with other laboratory, pathology reports and previous documents like discharge summary / clinical and operational notes helps in the accurate and detailed interpretation of the images.

2. Accreditations by the authoritative body confirms compliance with protocols set by the authority matching the industry requirement and benefitting every stakeholder. Inspections are conducted to check the protocol implementation and service delivery at regular intervals and the certification is renewed accordingly. If any discrepancy is noticed, a Plan of Correction (POC) is provided with the timeline for implementation.

Cloudex Solutions ensuring the right procedure, the right way, right time, and correct interpretation

A team comprising of qualified experts like radiologists, clinicians, and technologists who are well supported with state-of-the-art RIS PACS technology, round the clock (24 x 7 x 365) reporting services complement to the client’s advantage. The objective of doing the right thing at right time in the right way is achieved by integrating programs to adhere to protocol, utilize the quality improvement tools, and conduct of skill up-gradation workshops.

Cloudex brimming with experts and a wide range of tele-reporting services ensures delivery of the correct interpretation at right time in the right way; enabling the healthcare service provider to deliver quality patient care without delay and assuring proper treatment saving on time and money.

At Cloudex, we support you to have that winning edge.

Teleradiology Reporting Services: Do You Really Need It? This Article Will Help You

The ever-evolving medical world keeps bringing out solutions to the challenges posed by the fast pace populace. Radiology is keeping pace with modernity and has very well integrated technology and telecommunication to formulate a remote mode of extending services – Teleradiology.

Today, Teleradiology has enabled the clinician in providing the best of patient care and saving lives and thus becoming an indispensable healthcare service. Teleradiology supports the clinicians/hospitals/healthcare service providers with many solutions, compensating the shortage of radiologists and reporting for all imaging modalities – X-Ray, Ultrasound scan, CT scan, MRI Scan, PET scan, Nuclear Medicine, Interventional imaging.

1. Round-the-clock Reporting service supports the healthcare service providers with radiology services round the clock for all days irrespective of no. of radiologists on-site or subspecialty reporting requirement.

The defined reporting TAT ensures a quick TAT of as early as 30 to 60 minutes for all modalities of imaging both in cases of emergency and regular cases. In this competitive and fast-paced environment, Teleradiology enables hospitals from remotest places to small or mid-size hospitals to provide patient care effectively irrespective of time.

2. Nighthawk Reporting services work out as an ideal option for many healthcare service providers who cannot afford to recruit a radiologist beyond regular working hours and get benefitted from after-hour radiology services.

Nighthawk reporting allows the radiology department to exhibit its duty of quality reporting without any delay. This late-night radiology coverage empowers the hospitals in extending patient care to a high level with better outcomes, and in a bigger perspective improves the face-value and bottom-line score of Hospitals.

3. Subspecialty Reporting services help in identifying the subspecialty pathologies apart from identifying the common findings, normal variants quickly. The accuracy of reporting and detailed interpretation of the images (expertise in particular anatomy or type of reports/modality) improves the prognosis by facilitating the early diagnosis and proper treatment planning. Subspecialty reporting adds value eliminating the need for a second opinion; and improves the productivity and reporting TATs also.

Subspecialty reporting can be categorized into the following specialty –

· Thoracic Imaging

· Breast Imaging

· Cardiac Imaging

· Abdominal Imaging

· Musculoskeletal Imaging

· Neuroradiology

· Neuro-interventional Radiology

· Vascular Interventional Radiology

· Emergency Radiology

· Pediatric Radiology

· Nuclear Medicine

4. Emergency Reporting services ensures the early intervention and initiation of required action for emergency case. The involvement of expert radiologists reduces the TAT duration and contributes to the immediate diagnosis of acute conditions and patient care.

5. Weekend / Holiday Reporting services ensure the regular radiologists are able to utilize their break productively and return to job energized without any of the radiology reporting being stalked/trailed at the health center.

6. Second Opinion Reporting service is access to expertise for getting detailed imaging reports to facilitate a better understanding of the situation or decide on the course of treatment or to understand the progression of disease or treatment outcome. Experts are able to contribute through their experience and make a value-added difference to disease management/treatment.

7. Access to Radiology by healthcare centers present at geographically challenged areas either by altitude or distance. Primary or secondary healthcare centers have benefited from teleradiology which diminished the need for on-site radiologists and have benefitted from subspecialty reporting too. This has improved patient care services through quality and timing.

Benefits of Teleradiology reporting:

· Availability of radiology services round the clock (24 x 7 x 365) including night-time and on weekends/holidays

· Access to subspecialty radiologist’s reporting

· No backlog/delay in imaging reports delivery (improved TAT)

· High-quality patient care without delay

· Reports checked by more than one radiologist (preliminary/final reads)

· Better time management of radiologists due to login enabled cloud-based system (saves on commuting)

· Software enabled workflow helps in timely delivery of reports

Cloudex Radiology Solutions offers a plethora of Teleradiology Services:

The team of experienced, expert and qualified radiologists at Cloudex’s panel extend teleradiology services encompassing all type of reporting services to fulfill the growing demand of radiology services of health providers by defying the distances and time zone. The quick TAT, accuracy, standardized report protocol, coordination network between the reporting radiologists, clinician/surgeon/technician, and administrator contributes to the delivery of services benefitting the hospital and patient.

At Cloudex, we support you to have that winning edge.

Tele Radiology

Monthly Archives: January 2021