Teleradiology Kenya – Cloudex Radiology

Teleradiology Services Are Forerunners Among the Healthcare Providers to Adapt to Hybrid Work in Contemporary Times

The healthcare management faced a tough situation during a pandemic time and emerged victorious in extending the best care to COVID & Non-COVD patients as well as safeguarding its medical care providers (clinical & non-clinical); and with the understanding that technology-driven practices and contact-less patient care are the new norms and necessity.

Today, medical technology integrated with deep learning and artificial intelligence is one of the major contributing factors. On-line consultation through telemedicine, teleradiology, drone services, e-pharmacy, remote working, and at home services are some of the examples contributing to reduced or no exposure. Radiology was among the forerunners that made a swift adaption to new norms and supported the system with remote working. The technology companies too supported the medical system’s functionality either in maintaining or increasing the efficiency of the operational team during the patient flow surge.

Teleradiology system driven by technological advancement has emerged as one of the most reliable modes of the patient care system in any given situation to deal with, be it a reporting for emergency or isolated COVID patients or IP/OPD patients, and could cope with the surge in image reporting through the option of remote reporting. This hybrid work norm supported many institutions in delivering patient care without any delay. Today’s teleradiology is integrated with the latest PACS, AI enabled workflow, internet connectivity with wide bandwidth and an experienced back-end support team that has made the reporting possible with short TAT. Technology companies have developed systems to transfer and archive the large dataset with integrity fulfilling the radiologist’s need for high-quality images for reporting.

Machine Manufacturers are also contributing by developing systems that capture high-quality images with low dose radiation and high sensitivity. And to catch up with the trend of imaging services at point-of-care, compact mobile machines are getting developed to fulfill the need. The ultrasound machine and mobile X-ray machines are proving it with their wire-less and cloud-computing features.

Remote Learning is being embraced by educators and many clinicians. The online recorded or live sessions have become the mode of learning for aspiring future physicians and medical professionals. Webinars/conferences and interactive sessions are being conducted virtually benefiting the healthcare providers and patients.

With progressing time, the positive and productive approaches of radiologists, healthcare providers and technology companies the recovery from the pandemic is becoming a reality.

Cloudex Teleradiology Solutions during Pandemic

Cloudex with its advanced teleradiology service in India supported many health centers worldwide managing the patient surge with its prompt reporting services. The reporting was dominated by X-rays, CT and MRI scan mainly for emergency cases as other patients were curtailed from outpatient services. Our experienced and expert teleradiologists team extended their much needed services relentlessly round the clock. Safety measure guidelines were strictly followed by the back-end team while reporting was done remotely. The non-stop and timely service deliverance which includes subspeciality reporting in this crucial time helped many centers in facilitating patient recovery and saving lives and it turned out as their winning edge.

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

Cloudex Celebrates its 10 years of Teleradiology with 6 million patient’s smile curves

A humble start of Cloudex’s teleradiology services in 2012 has grown in leaps and bounds and has reached this celebration point. The journey so far covered has been full of coordination, compassion and patience filled. Each day has passed by with learning, growth and sometimes stumbling’s too. Today, we can share and write on our success stories; and redefine it with growing service demand, advancing technology and addition of sharper minds.

Our success is because of our dedicated team who nurtured Cloudex’s initiation into international presence, helped in soaring the service avenues and winning many hearts and clients.

The intention of contributing to community has been formulated with care in order to bridge the gap in radiology services – learning & skill upgradation programs apart from setting up radiology service centres and teleradiology service support to healthcare centres. Cloudex has initiated online and offline developmental programs for aspiring radiology clinicians, expanding its service network through partnership beyond boundary. We are intensifying our venture in improving accessible radiology by establishing scan centres under PP partnership where increasing patient scan numbers talks about our investment on people, technology, equipment and customer service.

Our Milestone achievements in past 10 years can listed as –

Over 6 million patients benefitted with our services
Over 100 Radiologists contributing to the smile curve
International presence of 16+ countries
Team of 40+ roped together with one mission of service

Currently, Cloudex is extending its clinical service to healthcare centres across India including those located in difficult to reach terrains and rural parts. And internationally, some of the centre in African countries like Botswana, Ghana, Ethiopia, Sudan, Nigeria, Uganda, Kenya, Tanzania and Southeast Asian countries like Malaysia, Philippines, Indonesia, Thailand, Vietnam are benefitting from our services.

In this demanding pandemic time, empowering the health centres with the winning edge seems to be success mantra. And Cloudex accepts it and strives to remain at par with industry trend, match the expectations of the associated healthcare service providers, raise the service delivery standards. And create a conducive work environment for the team which propels to give their best efficiently. At Cloudex, we strive to provide that winning edge or satisfaction and saving life.

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.