healthcare pathway into discrete components that may be carried out and paid Virtual radiology networking
The re-invention for according to need, creates the potential for the commoditisation of medical As e-Bay has given rise to R-Bay, so the huge success of sites that support social
activities. And to the extent that these may be safely and properly conducted networking has led to exploration of the benefits of social networking technology
of entire by individuals or organisations that may be remote from the patient, virtual (Web 2.0) in the field of medicine. One such system, called PACSMail
8
(commercial
outsourcing is likely to form an increasing part of purchasing resources in the 21st interest declared: the author is CEO of the company that runs this service) allows
healthcare century healthcare economy. radiologists to set up their own reporting practices and to develop their own
network of clients without the need to invest in a PACS. The service combines Web
pathways Trading in radiology commodities 2.0 technology (used by Facebook and MySpace) with DICOM/PACS technology,
As the baby boom generation ages, and as controlling costs features more and creating a secure diagnostic imaging platform that can be accessed via standard
more highly on government and corporate healthcare agendas, the development internet broadband.
of increasingly sophisticated ‘market’ or ‘trading’ systems to facilitate access to
healthcare commodities will be seen – and at the lowest price possible. Since its launch in 2005, PACSMail has been widely adopted in the UK and is used
by radiologists, orthopaedic surgeons, sports club doctors and physiotherapists,
Evidence for this is already available in the area of radiology outsourcing. Over the allowing them to collaborate in the delivery of a variety of virtual diagnostic
past 10 years, teleradiology companies have grown up around the world, providing and treatment support services. These range from simple remote reporting of
services such as night-time reporting for increasingly overstretched radiology radiological images to more complex services that can be provided through using
departments. Until recently, the business model for these ventures was relatively the system; for example, to share information with more than one clinician, such
simple. A PACS system is set up and a group of radiologists to do the reporting is as may be required in the event of a sports injury where the advice of a remote
hired – then their services are sold to whoever wants to buy them. Among the radiologist and an expert in knee surgery may be critical in making decisions about
largest of these in the UK is Medica
4
and in the US, Nighthawk
5
, each carrying out injury and rehabilitation management.
radiology reporting for multiple clients connected via virtual private network links
to their corporate PACS. PACSMail challenges the conventional view of a healthcare information network.
It not only allows those providing reporting services to link together across
In many regards, this is no different from one hospital offering reporting services to organisational boundaries, but also enables the referring clinician’s desktop to
another and, from the point of view of a radiologist, the companies concerned offer become an integral part of the flow of information between those that need
simply another form of employment with payments and contracts accordingly. to work together to provide multi-disciplinary, cross-organisational healthcare.
The service overcomes the need, for example, to send copies of scans by post,
However, the recent emergence of websites that are designed to facilitate links eliminating the difficulties experienced by receiving clinicians who no longer need
between individuals wishing to offer radiology services and those that wish to buy to work out how to access files from yet another (possibly encrypted) CD, and
them, suggests that these traditional models of teleradiology service delivery are all within the precious few minutes that they have with the patient. PACSMail
about to be challenged by something that has more than a passing resemblance also avoids the need to learn how to use multiple web-PACS browsing interfaces;
to a commodities trading floor. there is a limit to the number of different log-in and user interfaces that any one
clinician can happily, let alone safely, handle.
Two examples of this are R-Bay
6
and TeleRays
7
, both launched during 2008. These offer
the means by which buyers and sellers of diagnostic services can interact within the The benefits of Sybermedica’s PACSMail platform are perhaps best described by
context of a ‘virtual auction’. R-Bay is a European Union (EU) funded project which was Chelsea Football Club’s Doctor, Bryan English who says:
initially designed to ensure free access to radiology expertise throughout the European “What Chelsea needed was a way for experts to report scans for us quickly and for us to
Community, notably in those countries with limited radiology resources. TeleRays is a be able to receive images and reports on-line at club level. Teleradiology was obviously
United States (US) venture designed to provide a marketplace to facilitate interaction the way forward but the technology at that time was very much focused on the needs
between US radiologists and hospitals that wish to access their expertise. Both sites of hospitals and not the needs of referring doctors, especially where they are working
allow bidding, a development, though probably inevitable, that has alarmed many within large sporting organisations such as Chelsea. PACSMail has taken teleradiology to
in the field who view the buying of reporting services from the lowest bidder as the a whole new level, allowing the rapid sharing of key diagnostic information between
beginning of the end of radiology as it is known today. reporting radiologists, club doctors, surgeons and physiotherapists.
62
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IMAGING & ONCOLOGY
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2009
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