By definition, distributed radiology, or Teleradiology 3.0, is the progressive step in transforming mutual exclusivity of onsite radiology practice and teleradiology outsourcing into a seamless radiology distribution model. By extending deeply into acute and ambulatory health systems, distributed radiology utilizes data fluidity to provide rapid diagnostic interpretation regardless of exam origin or physician location. Distributed radiology surpasses traditional teleradiology service models by addressing fundamental flaws in delivery design and focuses on clinical nuances to efficiently manage radiology practices.
Teleradiology has played a major part in the evolution of healthcare imaging. From the moment film digitization transformed the way radiology exams were viewed, the concept of remote delivery was realized. Radiologists could move exams to different areas within the hospital, or out to associates and homes. Over the next 20 years, development of transport methodologies and architecture continued to influence how images were moved from the acquisition source to the radiologist. This development quickly created a marketplace for “teleradiology” services and the ability for organizations to approach capacity issues within brick-and-mortar institutions. From there, emerging teleradiology capabilities became a cornerstone of how radiology departments managed radiology workflow based on time of day and capacity.
The Teleradiology Advantage
This new environment created a progressive space where founding teleradiology service providers began competing with value propositions such as “access to sub-specialty radiologists” 24/7 coverage and final exam interpretations replaced informal “wet-read/preliminary” reports. Consumers of teleradiology were now able to access radiologist coverage, expertise and finalized clinical records regardless of location and time of day. However, diversity within pools of radiologists, snowflake workflows and a manufacturing-based approach to managing providers created a stigma for the teleradiology service. This stigma implied that service providers could not obtain the standard of quality and constancy as compared to a small pool of onsite physicians.
In response to this stigma, providers began developing strategies around faster turnaround times, creating virtualized presence within the hospital and guarantees of the right read by the right radiologist at the right time. While they were very enticing value statements, limitations of typical teleradiology platforms created a paradox in maintaining standards, consumer cost and quality. In reality, these marketing buzzwords had little impact on organizations that simply wanted radiology presence in the manner that they define, and at a cost they could manage. The service provider approach to distribution and teleradiology platforms was simply unable to meet the demands of clinical pressure that further compounded the teleradiology stigma.
The division between teleradiology and onsite continued to grow and became apparent as clearly different models. While both were complementary components of radiology, they were mutually exclusive. The effects were not limited to clients, but also resulted in fragmented provider capacity for dedicated onsite staffing, lugging stacks of provider-owned computer hardware into hospitals, requiring technologists to duplicate data entry, and providing the physician with incomplete clinical record sets.
Cloud-based teleradiology platforms began to emerge as the term “cloud” became a proven solution within technology infrastructures. The “healthcare cloud” followed suit and became a prominent sales pitch across competing providers promising Amazonian platforms, radiology clearinghouses, big-data mining and faster access to radiology reports. Unfortunately, “cloud” can reference any offsite location, destination or repository and did nothing to approach the outstanding distribution challenges. While a true cloud platform provided value for the service provider, it essentially changed very little for the customer. Teleradiology and onsite radiology were still mutually exclusive service lines, and will continue to grow further apart until service providers begin understanding the value in transitioning to a distributed radiology model.
Unlike teleradiology, which is narrowed to a single technology stack limited to origins of the exam and locations of radiologists, distributed radiology addresses the needs of a brick-and-mortar institution with seamless dispersion of radiology and non-radiology data across all associated systems. In layman’s terms the distributed model acts in concert with an onsite radiology, and decisions as to where/when/how an exam is read becomes a clinical decision, not a technical configuration. To accomplish this, the distributed radiology model requires the following layers:
• Clinical layer
• Distribution layer
• Data layer
These three layers provide stepping-stone requirements to enable seamless orchestration of distribution. Together they work in unison to overcome geographical limitations and snowflake workflows, and provide ultimate flexibility. Additionally, the distributed radiology model must be backed by highly efficient visualization technologies and dataflow capability to meet or exceed expectations within a hospital’s four walls regardless of where a radiologist sits. Because this model provides seamless block-chain style communication, it provides clinical decision-making based on robust and dynamic datasets aggregated within an enterprise view.
For example, clinical administrators can now make decisions such as ensuring exams with a high likelihood of requiring face-to-face conversation with a hospital clinician are held within the institution. Exam complexity, physician and provider relationships, and previous patient encounters can also be addressed and provide consistency regardless of origin of acquisition and radiologist location. Distributed radiology finally allows for a symbiotic relationship between onsite and offsite interpretation while transparent to service providers’ clients.
Distributed radiology is not designed as a traditional one-size-fits-all teleradiology solution and defies traditional approaches in defining customer requirements. Distributed radiology provides a methodology to accommodate any healthcare system; providing flexibility for all types of clinical department demands and robust data delivery to physicians. Distributed radiology eliminates the static teleradiology model and replaces it with rapid distribution regardless of the origins of exam, locations of radiologists, time of day and capacity of provider.
Dave Whitney is the chief technology officer at Medical Diagnostic Imaging Group (MDIG) based in Phoenix, Ariz., and a frequent contributor on the subject of health information technology.