Teleradiology & Remote Reporting: Clinical & IT Aspects

Transcription

1 Teleradiology & Remote Reporting: Clinical & IT Aspects Dr Neelam Dugar Consultant Radiologist RCR Annual Scientific Meeting

2 Rising Demand 41% increase in radiology exams in England from 2002/3 to 2012/13 Workload for radiologists increasing in volume, and complexity (which are more labour intensive) CT exams increased by 167% over 10 years (10% increase per year) MRI exams increased by 211% (12% increase per year) 60% more images per study in many common CT exams Radiologists need to review more previous studies as there are more cancer survivors are under active surveillance with imaging Currently England has 4.8 radiologists per 100,000 population (In comparison Germany 7.8, Spain 8.3, Sweden 10.7 and France 11.3)!

3 TELERADIOLOGY TYPES Radiologists! Payments No. of! Institutions

4 Radiologists Payments Insourced Radiologist! paid by NHS job-plans Outsourced Radiologist! paid by private provider

5 No of Institutions! Multi-institutional more that 1 RIS and PACS to connect! Single Institutional:! Very easy

6 4 Teleradiology Types Multi-institutional!! Single Institution! a.outsourced Medica, RRO, a. Emergency on-call VPN Inhealth etc! (2Mbps) and 19 Laptop! b.nhs Regional Networks b. Flexible home-working-vpn (Night, special interests (100mbps) and workstation support)

7 Last 10years Trend EMERGENCY ON-CALL! with LAPTOPs! OUT-sourced multiinsttitutional Teleradiology

8 Multi-institutional Teleradiology

9 Technology Platform Separate Teleradiology PACS! Teleradiology RIS (Reporting software)! Workstations Remote

10 Teleradiology Platform! Connections DICOM connection (CT scanner or Hosp PACS)! H7 ORM integration (Hosp RIS)! HL7 ORU Integration (Hosp RIS-PACS)

11 Image Data Flows CT DICOM Push Teleradiology platforms Tele- workstaion Hosp PACS

12 Request Info-HL7 ORM Hosp RIS HL7 ORM Teleradiology Platform- Tele- workstaion Hosp PACS

13 Report Flows-HL7 ORU Hosp RIS Teleradiology platform HL7 ORU Tele- workstaion Hosp PACS

14 Multi-institutional

15 Technology

16 Actionable Report! Medical Opinion! Answer the clinical question! Tentative or Differential Diagnosis! Advice on next step

17 Full Imaging History Fujifilm PACS showing full imaging history

18

19

20 Cancer MDTM- Next step advice

21 Limitations: Tele-Rad! Platform Lack of full imaging history! Lack of access to blood results, histopath reports, clinical letters, discharge summaries, etc! Face to face relationship lacking

22 Use-cases: Teleradiology! Platform Previous imaging history not relevant! Blood results, histopathology results etc not relevant! Yes/No answers are required

23 Use-cases -Multi-instutional! Night-time emergencies! A&E plain plain x-ray reporting! Support special interests (should NOT replace)-and 2nd opinions

24 Outsourced-TeleRIS-PACS

25 Regional Network SHEFFIELD CHESTERFIELD BARNSLEY DONCASTER ROTHERHAM RADIOLOGIST

26 Single-institutional Teleradiology: Remote Reporting-Home

27 Workstation at home import awesome!the Anglerfish Song by Hank Green!Yes it's true that I once went through life As a guy who always had to rhyme life with strife Yes, I've been burned and I've been spurned And through it all, yes, I have learned That love is not about whether you get stabbed But how slow the knife gets turned!but my friends I've found an animal Who doesn't feel neenasdesign this pain And my life is l l l l l l so much better Now that I can feel the same!because you can't hate the night If you've lived your whole life without light And you can't hate the dish If you've only ever eaten fish And you can't feel alone If it's all you've ever known!yeah the deep sea anglerfish Has no reason to be happy But it has no frikkin' idea What else to be!dftba!

28 Active Directory SSO NHS No: Hospital No: PAT12 Surname: BLOGGS Forename: JOE Date of Birth: 27 Mar Sex: Male Address: 1, AB2 3CD Clinician: Harry Potter Location: A Place Clinical Data: :-) Radiology PACS Ordercomms RIS EPR

29 Reporting Worklist PACS PACS RIS RIS Reporting Worklist for ND URGENT 1. Joe Bloggs-Chest CT 2. Bob Wilson-CT Abdomen! NON-URGENT 1. Hannah -Floris-MRI Pelvis 2. Joanne Hampson-MRI Neck RIS PACS TITLE OF SUBJECT PACS

30 Reporting Workflow: Automatic Context Synchronization Automatic display of Relevant Prior PACS- Current Chest X-Ray PACS- Previous Chest X-Ray Reporting Workflow Ordercomms Joe Bloggs Chest X-ray Clinical History: Shortness of breath! RIS Imaging History Chest X-Ray Chest CT MRI Reporting Workflow Show EPR DD/VR Current TITLE OF Chest SUBJECT X-ray Report: Bilateral chronic shadowing suggestive of PMF Previous Chest X-ray

31 Back to Reporting Worklist PACS PACS RIS RIS Reporting Worklist for ND URGENT 1. Joe Bloggs-Chest CT 2. Bob Wilson-CT Abdomen! NON-URGENT 1. Hannah -Floris-MRI Pelvis 2. Joanne Hampson-MRI Neck RIS PACS TITLE OF SUBJECT PACS

32 Full Imaging History Fujifilm PACS showing full imaging history

33 1 click-blood results

34 1 click-epr

35 Voice Recognition

36 Workstations at Home Workstation ONLY investment! Use hospital RIS-PACS over VPN over Broadband connection

37 Remote Radiologist! Retired radiologists- 10 hour contract! Women with young kids-8hours flexible

38 QA-Remote Radiologists Maximum 10 hours from home! Attend monthly discrepancy meeting face to face! For Special Interest Reporting face to face local dialogue mandatory! Emergency Reporting weekly on-site reporting mandatory.

39 Use Cases-Remote Radiologist GP Plain X-ray reporting! A&E plain X-ray reporting! GP referral for MRI brain, spines and knees

40 5 Types of Reporting Emergency Night (8pm to 8am)! Emergency Day-time and Inpatients (8am to 8pm)! A&E plain films! Elective General Reporting! Elective Special Interest Reporting

41 A. Night Emergencies (8-8) Life or limb threatening! Injuries-Head/Spine/Body CT! Reduced GCS Head CT!? aortic dissection Body CT? massive PE! KPI: 1hour turnaround of reports

42 B. Day-time (8am to 8pm) Emergency & Inpatients! Inpatient Investigations-CT/MRI etc! All Emergencies! KPI 1 hour for emergency reports, 12hours for urgent inpatient, 24hour for routine inpatient

43 C. A&E Plain Films! A&E Plain x-ray reporting! KPI: 48hour turnaround

44 D. Elective General! GPs (mostly plain x-rays)! General Medicine! Acute Internal Medicine! Geriatric Medicine! KPI? 2 week turnaround

45 E. Elective Special Interests Reporting=13 Gastro-intestinal! ENT/Maxfax/ Opthalmology! Neuro/Stroke/ Psychiatry! Genito-urinary! Gynaecology! Cardiac! Chest! MSK! Paediatric! Breast! Intervention! Haematology!

46 Actionable Report Answer the clinical question! Abnormality Tentative or Differential Diagnosis (access to blood tests, histopath, clinic letters etc)! Next Step Recommendations further investigations and referral based on local practices (depends on MDTM attendance)

47 Special Interest Radiology Elective Reporting -QA Attendance of local MDTMs-Face to face! Report adequate numbers! Feedback and reflection on reports

48 On-site Reporting Day-time emergencies and Inpatients (KPI 1hour, 12hr and 24hr)! Special Interest Radiology (based on local MDTM attendance)

49 Local Reporting Knowledge of local practices! Access to blood tests, histopath etc! Face to face Critical for high quality reports Cancer MDTMs -evidence

50 Remote Reporting A&E plain films (48hour KPI)! GP plain film (?2week KPI)! GP MRI (?2 week KPI)

51 Teleradiology Plaform Night emergencies

52 Special Interest Networks Special interest radiologist need support during holidays! Second opinion for difficult cases.

53 Report Turnaround Time Night-time Emergencies (1hour)! Day-time emergency (1 hr), Inpatient urgent (12hr) & Inpatient non-urgent (24hr)! A&E plain film (48hr)! General Elective (?2 weeks)! Special Interest Elective (?2 weeks)

54 4 Types-Regional Networks Night-time Network! A&E plain film Network! General Elective Network! Special Interest Network

55 Optimise Job-Plans Defined regional job-plan principles! Balanced Work allocation-emergency, inpatient, elective general and special interest in in each consultant job-plan! Local demand and capacity planning for each type of work! Use regional/outsourced networks for night tele radiology and A&E plain films

56 Full-time Job Plan MDTM and Special Interest Reporting! Procedures Intervention/US/ Fluroscopy etc! Emergency & Inpatient reporting (1-24hr)! A&E plain films! GP (plain films and MRI)

57 Regional Network-Success Regional Fairness in job-planning! Investment in Tele-radiology Platform! Investment in integration

58 NOT ENOUGH RADIOLOGISTS IN UK

59 Use Teleradiology to Increase Capacity Night-time Emergencies From Australia! Regional A&E and GP plain film reporting Networks! Flexible Home Reporting recently retired/part-time radiologists