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TELERADIOLOGY Different levels of image sharing


This paper describes the different levels of data and workflow sharing in medi- cal imaging and examines the issues in the implementation of cross-organiza- tional or cross-border teleradiology.


T


eleradiology has gained wide acceptance among the radiologists during the last decade to such an extent that it is used in the majority of depart- ments where Picture Archiving and Communi-


cation System (PACS) and Radiology Information System (RIS) are available [1]. However, the use of teleradiology is limited mainly inside a single healthcare organization, thus not allowing gain the real benefit of image-related data sharing and shared workflows. The most typical areas of teleradiology implementations are sharing the images inside the hospital or providing radiology service from home. These are by far the most common situations and are followed by less used services such as workflow dis- tribution in hospital network, second opinion on request, and use by teleradiology companies [1]. Cross-organizational and cross-border teleradiology have long been considered as having the potential to increase the quality and effectiveness of radiology reporting [2]. Despite these high expectations, cross-border teleradiol- ogy is still used only at a very low extent compared to in- house teleradiology. Currently there are few commercial companies in EU providing cross-border teleradiology service [4]. One of the main reasons for this seems to be the complexity of organizational issues, including the establishment of trust between the reporting service pro- vider and the customer.


EVOLUTION IN IMAGE AND WORKFLOW SHARING


Classic data flow in a healthcare organization is linear [7], meaning that the clinical information and images are stored on paper, film or isolated digital data storage media and almost all data move with the individual patient or physician. Simultaneous and asynchronous access to the patient health data is complicated and limited to copies taken from the original papers, films or DVD-s. The development of digital imaging and PACS has


allowed new types of data sharing between the different healthcare actors. Digitalization of images and related medical data enables different tasks in the patient’s diag- nostic and care pathway to be carried out simultane- ously and work to be distributed across clinical specialties.


Dr P Ross and Dr H Pohjonen are at the Institute of Clinical Medicine, Tallinn University of Technology, East Tallinn Central Hospital, Pärnu mnt 104, 11312 Tallinn, Estonia.


e mail: peeter.ross@e-tervis ee 16 DI EUROPE


Simultaneous access enables time saving, avoiding of unnecessary exams and reducing repeated radiation expo- sure [8]. The possibility of sharing data can also change the work process in radiology. Clinical information is available instantly for different users inside the healthcare institution or for users outside the healthcare facility who access it remotely. The individual patient or physician is no longer the only information carrier.


LEVELS OF IMAGE AND WORKFLOW SHARING


Digitalization of images and image related data and devel- opment of information technology (IT) are changing the reporting process and allowing re-engineering of clini- cal workflows [5]. However, there is no universal model for implementation of new data sharing applications. The successful implementation of teleradiology service requires an understanding of the predicted outcome and potential benefits. Dividing teleradiology in different lev- els helps to understand necessary actions and estimate implications of re-engineering. Images and related data can be shared inside an orga-


nization, between organizations in one region or across country borders, and also with the patient who can have instant secure access to the medical data and images. All those levels exist simultaneously today but are in use at different extents, depending on the business process of a particular imaging service. Extending the workplace across different borders requires technical and standard- ization issues to be addressed, but also that organizational, semantic, quality and feedback related, and legal and financial issues [4] be taken into consideration. Proper handling of the above subjects paves the way for the reli- able relations between healthcare professionals as well as between healthcare professionals and patients [6]. It is important to note that most of the barriers to


teleradiology have their origin from initial teleradiology setups inside one and the same organization. Although substantial research has been carried out to define stan- dards and profiles for cross-organizational implementa- tion, most data sharing implementations are used for one organization’s internal workload balancing. Implementa- tion of image sharing and shared workflow decreases significantly the time between image acquisition and the availability of the image report in the healthcare environ- ment. Quick image sharing places higher demands on image quality and the image management process but


APRIL/MAY 2012


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