Written by: Jena Heflin, MBA, RT(R), CMOM
Adjunct Faculty, ADU, Department of Radiologic Sciences
One might assume that their local hospital, no matter how rural, has all required personnel on site twenty-four hours a day, seven days per week. That may be loosely accurate. The hospital may not have staff on site, but rather have arrangements with a larger hospital site that provides coverage and assistance. This arrangement may be as simple as health professionals discussing a case over the phone or using advancements in technology to conduct a video conference.
Telemedicine is a modern term that replaces an old practice called “in absentia care” or “care at a distance”. In earlier days, small villages would communicate via smoke signal to warn others to avoid visiting due to a serious disease. In the early 1900′s some isolated towns would communicate via two-way radio.
The use of telemedicine is not limited to a specific specialty. Teleradiology, for example, is the ability to send radiographic images from one location to another for review/consultation. Looking at the above example of a rural hospital, imagine a patient presents in the emergency department (ED) after a traumatic car crash. The ED physician suspects a possible pneumothorax and orders a STAT chest x-ray. After obtaining the x-ray the ED physician wants to confirm this diagnosis with the radiologist. The radiologic technologist sends the image over the network to a larger local hospital for the radiologist to review and connects the ED physician with the radiologist via telephone. After discussing the case the ED physician can proceed with treatment.
This seems simple, right? The answer is essentially “yes”, but the right components and security must be in place first. Teleradiology requires three important components – an image sending station, a transmission network and a receiving station. Such programs must meet compliance requirements set forth in the Privacy Act if 1974 and the Federal Information Security Management Act of 2002. While radiologists are enjoying this new modality, various accreditation and government agencies are keeping a close eye on this practice to ensure the quality is not compromised.
There are serious risks that must be weighed and considered before implementing a teleradiology service such as: physician qualifications/credentialing, licensing, equipment, electronic archives, security and HIPAA, liability and testing.
Physician Qualifications: Physicians must meet criteria established by the American College of Radiology (ACR) and the governing body of their institution; such as: Joint Commission on Hospital Accreditation (JCAHO) or similar. Physicians must also understand there is potential for a delay in communication with the technologist obtaining the images which may not be an issue for those radiologists on site.
Licensing: The topic of licensing remains contentious. Physicians who provide services across state lines may be required to be licensed in each state services are provided while others may feel it is appropriate to operate under a single state licensure.
Equipment: The equipment required for teleradiology various from facility to facility. The equipment utilized must meet the requirements of the ACR and the National Electrical Manufacturers Associations (NEMA) to comply with digital imaging and communication in medicine (DICOM).
Electronic Archives: A significant number of facilities utilize electronic archiving and must abide by state and federal regulations for medical record retention. It is unclear whether a digitized image is considered a “original” and if meets the requirements under the law.
Security / HIPAA: This is possibly one of the most important components that is yet to be clearly defined. Most institutions are meeting requirements of HIPAA however, there are institutions that remain out of compliance. As the demand of teleradiology increases appropriate measures must be implemented to ensure safety of data transmitted.
Liability / Jurisdiction: Teleradiology is not immune to medical misfortune. The standard of care may vary from state to state and those radiologists providing teleradiology services across state laws may face a higher cost of litigation, possibly utilizing unfavorable laws or a suite across multiple jurisdictions.
Testing: The ACR guidelines implemented January 1, 2003 require institutions to maintain a certain level of quality control, development and implementation of policies and procedures and methods to ensure safety of equipment performance.
While it may seem an insurmountable task to implement a teleradiology program there are great opportunities for institutions to become pacesetters in this modern service line that allows physicians and institutions to extend their grasp further than the immediate community.
Collmann, J., Alaoui, A., Nguyen, D., & Lindisch, D. (n.d.). Safe Teleradiology: Information Assurance as Project Planning Methodology. Retrieved May 10, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC543831/
Teleradiology: Risks and Rewards. (n.d.). Retrieved May 10, 2015, from http://www.pepperlaw.com/publications/teleradiology-risks-and-rewards-2004-01-23/
What is Telemedicine? (2010, January 9). Retrieved May 10, 2015, from http://www.news-medical.net/health/What-is-Telemedicine.aspx
What is Teleradiology? (2010, January 9). Retrieved May 10, 2015, from http://www.news-medical.net/health/What-is-Teleradiology.aspx
This blog was contributed thanks to Jena Heflin, one of our valuable adjunct faculty members in the Department of Radiologic Sciences. Jena Heflin is a graduate of Adventist University (formerly Florida Hospital College of Health Sciences) earning an Associates and Bachelors Degree in Radiologic Sciences. She earned her Masters in Business Administration at Southern Adventist University. She has earned a certificate as a Certified Medical Office Manager (CMOM) and currently manages a Pediatric Hematology Oncology practice. She is a member of the American Society of Radiologic Technologists.