Telehealth is becoming the new normal. According to the American Hospital Association (AHA), 76 percent of U.S. hospitals provides some form of remote consultation.
Teleradiology has long been at the forefront of Telehealth. The expansion of this medical specialty was closely linked to the transition from analog to digital imaging. The improvement of the communication network and the reliance on imaging diagnostics fueled its widespread development.
According to a recent report by Markets and Markets, teleradiology is expected to reach USD 22.8 billion by 2025 from USD 7.9 billion in 2020. The growth is fueled by the rise in the geriatric population and associated diseases. Declining reimbursements, the increasing regulatory burden in the US, and data breaching of imaging reports may hamper its wide adoption.
Discover how teleradiology is changing the way imaging is conducted and how both the patients and the healthcare actors can benefit from it.
History of teleradiology
Teleradiology, or the ability to interpret and diagnose patients’ imaging distantly. In the 1980s’ Teleradiology relied on the postal service. Physical copies of films were sent by email to a remote radiologist, and a paper report was then sent back.
No need to say the may drawback resided in the delay between imaging, diagnostics, and treatment. The turnaround was in days, if not in weeks. This process was efficient for routine analyses but could, of course, not be used for urgent care.
In 1983, the American College of Radiology (ACR) developed a standard for medical imaging’s digital storage in partnership with the National Electrical Manufacturers Association. Know as ACR/NEMA 300; this initiative was not widely adopted due to legal and technical limitations. The ACR published the first standards for Teleradiology in 1994. They lead to the currently used Digital Imaging and Communications in Medicine standards (DICOM).
DICOM is used worldwide to send images and store them. It is an integral part of the patient’s Electronic Health Record (EHR). In a nutshell, DICOM is for radiology, the equivalent of the jpeg format for pictures. Digital images are compressed and analyzed from anywhere using web-based picture archiving and communication systems (PACS).
The use of the DICOM format allows fast and secure transmission and analyses. Contrary to X-rays, the brightness and contrast of the images can be fine-tuned. The system also offers the ability to zoom on a specific part of the image to improve diagnostics. In a nutshell, the DICOM format offers the ease of using a standard picture for medical imaging.
Present of teleradiology
In 2019, a survey published in the Journal of the American College of Radiology analyzed the current state of Teleradiology practice. Among the 936 radiologists who participated in the study, 85.6% reported performing teleradiology within the past 10 years. 46.2% performed remote radiology services for rural areas and 37.2% for critical access hospitals.
The main perceived challenges for smooth teleradiology service were electronic health record access (62.8%), quality assurance (53.8%), and technologist proximity (48.4%). Reducing turnaround time and providing real-time and around the clock analyses by relying on imaging centers located in different areas or countries can be critical. Teleradiology is already improving the quality of care.
The use of Teleradiology also seems to be linked to the size of the practice. For radiology groups with less than 10 members, only 79.1% said they engaged in this new approach. The number jumped to 94.4% for practices or groups with more than 100 members.
In the Age of social distancing, remote interpretation of the images by radiologists located in different states, countries, or even at home is a convenient way to protect both the patient and the personnel.
Challenges remain, though. For residents and fellows, not being able to sit next to the radiologist during the images’ interpretation is not ideal to ensure proper training. On top of that, to receive images, the internet connection must be fast and secure enough to comply with HIPAA standards. This can be a real challenge for small rural hospitals.
Picture Archiving and Communication (PACS system) must also comply with the standards meaning continuous technical and IT personnel investment.
Future of teleradiology
In the United States, Rosenkrantz et al. found in a study conducted in 2018 found that geographical disparities existed not only in radiologists but also in the radiologists’ subspecialization. Radiology is a complex medical specialty. A local community will be less likely to have a pediatric radiologist or an MRI radiologist than big urban centers.
The current years have seen an increase in radiologists’ subspecialization, especially toward breast imaging, abdominal imaging, and neuroradiology. The remote analysis is the only way to provide consistent quality care to patients independently of their location.
For interventional radiologists, pre-operative assessment can be performed remotely and relies on the benefits of Telehealth. Radiology practices can also see the use of remote imaging to protect both the patients and the clinicians.
The hybrid model with the on-site and off-site radiologist is also to consider. On-site physicians perform the needed procedures and maintain a direct relationship with the patients, while more specialized radiologists will conduct off-site analysis.
Many of the benefits of Telehealth appeared clearly during the pandemic and improved the speed and rate of adoption of these new technologies. Once the investment in technologies has been completed, there will be no turning back. Teleradiology certainly has a bright future that will ultimately benefit the quality of care.
To summarize: Benefits and Challenges of Teleradiology
Just like any new technology, pros, and cons exist. The challenges need to be addressed quickly for teleradiology to become common practice and its many benefits to serving patients and physicians.
- Improves patient care and turnaround time for small rural or community hospitals,
- Ability to quickly get a second opinion,
- Reduce the workload of on-site radiologists and let them concentrate on operational procedures,
- Can be used as an educational resource.
- Medicare and Medicaid does not allow reimbursement for services outsourced out of the U.S.,
- Emergency Room physicians do not know the remote radiologists. Can lead to miscommunication and lack of trust,
- Incompatibilities between PACS systems,
- Teleradiologists must be certified by the American Board of Radiology and submit to the patient state’s laws,
- Technical investment and maintenance