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Teleradiology Reporting Company

Panademic Crisis Boon Teleradiology

A medical system by which patient’s radiological images from a variety of health care facilities are transmitted electronically for review and reporting by experienced, offsite radiologists and that’s teleradiology. The resulting reports are then transmitted back to the original facility, providing key insights about the images and helping to determine the course of further patient care. The true fact is that this system is grown within the medical field over the last number of decades, only a few are familiar with the particulars of teleradiology.

Now in the present scenario use of teleradiology is highly recommended as the covid 19 crisis threatens the entire world. Moreover, it ensures the safety of professionals and patients simultaneously. However, optimization of IT solutions and implementation of the right change process is a significant milestone for a successful transition.

Radiology plays an important role during the pandemic as it is essential to maintain the continuity of the health service to the patients. Using such technology based on the transmission of radiological patient images from one location to another and allows radiologists to provide services without having to be in contact with the patient is peculiarly important to minimize the expansion of the covid 19 virus.

In some countries, radiology departments in public and private experienced this solution of remote working, showing a positive impact during the outbreak.

The physical distance between the technologist radiologist, the referring physicians, and the patient is of great advantage now as concerns the present situation. If the concerned patient is in self-quarantine due to exposure to a covid patient, in such situation teleradiology helps much with doctors as being able to read, albeit from far x-rays or CT scan of coronavirus patients.

In China at an early stage of a pandemic outbreak, before swab testing was really available, CT scan was used by doctors to assess the probability of covid 19 infections, same time used to track and monitor the progression of the disease as described by some researchers from China.

Teleradiology allows radiologists to work and be productive when isolated from the rest of their community, while the necessity for social distancing is inevitable in the current pandemic, definitely help to restrict the virus transmission. This practice of receiving images to interpret from a facility and that too is out of radiologists’ geographical vicinity is a truly valuable contribution at this time of unprecedented crisis. By supporting areas of the physician shortage and backing up they are in hospital counterparts, teleradiology serves in a significant way to relieve some of the stresses that global health care systems are currently experiencing.

Medical Science has proven time and again that when the resources are provided, great progress in the treatment, cure, and prevention of diseases can occur.

When there is a crisis we can use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger and the other for opportunity. In a crisis, be aware of the danger but on the other hand recognize the opportunity. It’s really an unpredictable situation for the medical field globally, the danger is on the way we move on. But on the other side of the coin, we are forced to find innovative solutions to problems we may never face before.
When we approach the crisis from a hopeful perspective rather than with a stance of resistance, we can navigate this difficult situation by making it beneficial for the modern medical system knows to be teleradiology.

Teleradiology Solutions India

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.

Teleradiology Reporting Services India

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

Teleradiology Services 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 in India

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 works 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 helps 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. 

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