imaging technologies to be used. The use of automatic capacity management gives the opportunity not to interfere with local worklists, but to send exams, that are assigned for the reporting by a tele- radiology provider, to the correspond- ing worklist. Similarly, access to relevant priors and other clinical data can be achieved simultaneously using the XDS profiles and many-to-many integra- tion, which in turn has the potential to increase the quality of reporting. Sharing of standardised data has the potential to provide radiologists with tools that help them to compare dynamic changes in image findings. Viewing relevant clinical data from different databases, reporting and presentation tools enable radiolo- gists to perform highly comprehensive and valuable reports.
«
...the legal issues are more complex .... because of
diffrerences in how EU member states regulate telemedicine...»
For the healthcare institution, the
implementation of collaboration plat- forms (eMarketplace-type of applica- tions) opens the whole market of report- ing service providers [9]. This enables coordinated sharing of imaging and reporting resources that can allow for evening out-of-workload peaks, avoid- ing selection of lucrative cases by radi- ologists, problem-solving in diagnostic and treatment processes, and follow-up in a virtual, dynamic, multi-institutional setting with health professionals.
PREREQUISITES FOR SUCCESSFUL IMPLEMENTATION AND THE FUTURE SCENARIOS OF CROSS-BORDER TELERADIOLOGY Trust is the most fundamental require- ment for establishing and maintaining teleradiology services [4]. This is true in all cases: where healthcare profession- als become accustomed to their new IT applications or services, between the customer and the service provider in cross-organizational service set ups, and where a citizen’s consent is needed to share health information over the Internet. Ensuring
transparency in
performance and use of quality indica- tors is a prerequisite for sustainable,
APRIL/MAY 2012
cross-organizational teleradiology ser- vice [6]. Legal issues concerning teleradiology
in the EU are regulated by EU direc- tives and the legal situation in member states. Besides EU directives there are additional EU legislative rules and also documents issued by the European Soci- ety of Radiology, which, however, are not legally binding. The fact that teleradiol- ogy is regulated by multiple directives and legal acts makes the interpretation of the legal system in the EU extremely complex. Fortunately, the EU is taking steps to harmonize national legislation in the area of eHealth, including telera- diology [9]. Concerning technical interoperabil-
ity implementation of data exchange standard profiles (XDS-family) in cross- organizational data and workflow shar- ing is one of the most important issues. The IHE cross-organizational standard profiles aim to define integration rules using standards already in use. Fortu- nately, the implementation of IHE pro- files is increasing worldwide. The presentation of patient data
should follow data integrity, availabil- ity and confidentiality requirements. Medical data have
to conform to
clinical needs and must be presented in accordance with legal regulations. Convenient design of presentation applications for images, previous stud- ies and medical data, is also of utmost importance for seamlessly fitting into daily routine workflows. The goal
is
to streamline the use of medical data according to the user profile. Profiled information opens the way to create new, data enriching radiology services in complex healthcare networks. Trans- ferring clinical data and reports across boundaries or regions raises the ques- tion of the language of the request and report. Cross-border teleradiology ser- vice providers have to address language issues in full responsibility. The linguis- tic quality of the report is as important as the trust between clinical partners and the quality of the radiology service. Structuring reports into a computer processable mode has great impact on future research involving computer assisted and automated image inter- pretation. Combining images with the imaging report and surgical and patho- logical findings will open completely new IT applications and services.
DI EUROPE
TELERADIOLOGY Recent developments in data shar-
ing and in implementation of shared workflows allow wide-spread access to images and related clinical and administrative data, and remove dif- ferences between internal and cross- organizational workflow management. The data can be used at anytime and anywhere depending on when and where
the decision process, imag-
ing or reporting is taking place. For clinical staff involved in the delivery of care, successful integration of dif- ferent healthcare databases make the information technology systems just as important and mission-critical as the imaging modalities [14]. In modern teleradiology settings reporting can be performed in the most reasonable way taking into account agreed ser- vice levels, complexity, subspecialties, etc. Radiologists can report images that are acquired in different locations and stored in a shared environment.
CONCLUSION
Cross-organizational and cross-border teleradiology has considerable poten- tial
to become a mature healthcare
service. However, seamless implemen- tation of data (including image) shar- ing and shared workflows requires: a) more research in the areas of struc- tured reporting and automatic report translation; b) improved organizational implementation of new services; and c) legal and semantic interoperability, and common reimbursement schemes.
REFERENCES 1. Ranschaert
E. ECR 2012 abstracts. Eur Radiology supplements 2012; 185.
2. Thrall JH. Radiology. 2005; 236: 382. 3. Bradley WG Jr. Radiology 2008;248: 337
4. Ross P, Sepper R, Pohjonen H. Eur J of Radiology 2010; 73: 20
5. Siegel E & Reiner B Am J Roentgenol 2002; 178: 563
6. Barneveld B et al. Eur J Radiol. 2011;78 : 205.
7. Saluse J et al Eesti Arst 2010; 89 :659 (in Estonian)
http://eng.e-tervis.ee/ images/stories/digimpact/digimpact_en_ rev4_29102010.pdf
8. Kenny LM & Lau LS Med J Aust 2008; 188: 197.
9. Ross P & Pohjonen H. Insights into Imaging, 2010; 2: 141.
10. McCall I, Eur Soc of Radiology, 2009. Insights Imaging 1:2-11
11. IHE (2012)
http://www.ihe.net/ (last accessed 15/04/12)
12. Lundberg N et al. Eur J Radiol 2010; 73:10. 13. Winblad I et al. Telemed J E Health.2011; 17: 118
14. Pohjonen H, Ross P et al. IEEE Transactions on Inf Techn in Biomedicine. 2007; 11:81.
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