TELERADIOLOGY
EU extremely complex. Besides the EU directives, there are additional legislative documents which have to be considered in implementing teleradiology services [9]. Additional issues to be addressed are semantic interoperability and language. There is no professional and commercially available radiology report translation software [4]. Sharing digital images via the web with patients is a new fea-
ture in medical imaging management. Only recently advances in user identification, data privacy and security, and streaming technology have allowed the citizen to access personal image files in image archive. Access to images opens up new options for the patient: sharing images with other clinical specialists and improving his or her knowledge of the treatment process [9].
FigUre 1. Different barriers depending on the level of data sharing.
does not require any additional legal measures as long as the images do not cross organizational borders. However, admin- istration of user rights and management of log files are new tasks for the organization and need complementary resources [9]. [Figure 1]. Sharing images between the healthcare organizations cre-
ates new challenges regarding quality control, trust, workflow management, legal issues, reimbursement and interoperability of electronic patient records (EPR), RIS and PACS [9]. Also, integration with other databases and applications are seen as factors that increase the complexity of workflow. The most important challenge is to ensure that reporting of images outside the organization does not in any way reduce the quality of radiology services provided to the patient [10]. To achieve this goal, relevant healthcare organizations must work towards creating a professional, reliable relationship between clinical partners. Trust can be developed by on-site visits and familiarization with clinical radiology workflows at hospitals. Also, the appointment of one particular radiologist to act as the responsible person for inter-organizational teleradiology communication is necessary [4]. There are new emerging standards and profiles to sup-
port sharing of medical information. Integrating the Health- care Enterprise (IHE) standards for document and image sharing are growing fast. The Cross-Enterprise Document Sharing (XDS) registers and shares electronic health-record documents between healthcare enterprises. Cross-Enterprise Document Sharing for Imaging (XDS-I) extends XDS to shar- ing images, diagnostic reports and related information across a group of care sites [11]. However, the implementation of XDS-I standard profile for sending and receiving images, which would allow image sharing between organizations, demands additional resources for upgrading software appli- cations so that they are compatible with IHE standard profiles. The basic issues that need to be addressed in an interorga-
nizational setting also apply to cross-border settings. However, the legal issues are more complex because of the differences in healthcare, and in particular, how EU member states regu- late telemedicine [6]. EU legislation covering teleradiology services consists of multiple directives and legal documents, which makes the interpretation of the legal system in the
18 DI EUROPE
BENEFITS AND INCENTIVES ON DIFFERENT LEVELS To re-engineer the radiology workflow in a manner such that patients’ medical data and also the care workflow are shared between the different organizations to achieve the best care for a patient is still a challenge. The planning of new cross- organizational or cross-border teleradiology service demands precise identification of the actors involved and the predicted outcomes, as well as characterisation of parties who will ben- efit from the change and the outlining of potential barriers. It is clear that in principle data sharing and shared workflows in medical imaging allow limitless collaboration between differ- ent actors and implementation of new services in the health- care domain [12]. However to achieve the anticipated benefits of a new application, all the collected health related informa- tion needs to be stored in a standardised, shared, consistent and non-redundant form [13]. In addition to technical issues, the changes in daily routine that digitalization brings about include organizational, semantic, legal and financial issues which make the implementation of cross-border teleradiology service complex. Consequently, successful implementation of a new cross-organizational teleradiology application or service needs careful planning and recognition of multiple and some- times disparate issues [4].
«
...sharing digital information with
patients over the web is a new aspect of medical imaging management...»
Using the most recent advances in technology and orga-
nization of digital data sharing and shared workflows, there are potential benefits that cross-organizational teleradiology can offer the radiological community [3]. Widespread and simultaneous access to the images, clinical data and process- ing functions will open new opportunities for radiologists and referring physicians. Data and workflow sharing across organizations enables radiologists to sub specialize, allocate reporting time more efficiently or have time for meetings and consultations with clinicians or patients. If used properly cross-organizational or cross-border teleradiology can give access to highly specialised expertise [3]. This can be used as an additional benefit in case of rare pathologies or spe- cific findings. Data sharing with other radiologists increases the confidence of local radiologist and allows more specific
APRIL/MAY 2012
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