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Medico-legal issues in Teleradiology Aditya Daftary Teleradiology Solutions
Teleradiology • Needs no introduction • Teleradiology is a means of electronically transmitting radiographic patient images and consultative text from one location to another* *http: //www. radiology. uiowa. edu/More. RAD/Teleradiology/Tele. html
Goals of Teleradiology • Providing timely consultative and interpretative radiologic services • Making radiologic consultations available in medical facilities without on-site radiologic support • Facilitating radiologic interpretations in on-call situations • Providing subspecialty radiologic support as needed • Enhancing educational opportunities for practicing radiologists • Promoting efficiency and quality improvement • Providing interpreted images to referring providers • Supporting telemedicine • Providing supervision of off-site imaging studies
Medico-legal Issues in Teleradiology • The good news: – A lot of it is still unclear • The bad news: – We’re dealing with lawyers!
Conceptually simple • • • Imaging data acquired at one site Network transmits images to a server Data can be reviewed and interpreted at a remote site • Report generated and transmitted electronically back to the parent site
Many a slip…. • • • Qualification Liability and Insurance Radiologist duties
Qualification • Varies – Country (US, Singapore, UK) – State – Institution • Law can be a little vague • Best to be safe: full qualification in geographic area and institute for whom one is interpreting
Qualification • Medical board certification: – USMLE/LMCC/recognized MBBS • Specialty qualification: – ABR/RCPS/FRCR • Subspecialty qualification: – Certificate of added Qualification (CAQ) • Licensure • Credentialing • CME
Medical Liability Insurance: Why? • Establishment of a physician-patient relationship – No case examples, but probably YES – You are being consulted and you are getting paid! • Jurisdiction for accountability – Where do you get prosecuted? Texas or India? – May not be teleradiologist, but definitely parent hosp/group – UK-Europe: Primary/alternative site – No case examples – Not too many people going to put themselves on the line for you!
Liability Insurance • Covers one against possible litigation • Find someone willing to insure off site/off country reading: not much experience • Will look at all qualifications to assess risk • Costs increase with time • On site group to get clearance from their insurer • Teleradiologist must have coverage • Terms of coverage must be very clear
Medical Liability: Radiologist • The teleradiologist is as liable as any other radiologist in the given setting – Technical issues – Interpretation and misses – Communication
Medical Liability: Technical • Much of this is now redundant, but there a few areas: – Image acquisition • • Digitized radiographs Unsupervised ultrasound Patient motion Contrast – Image transmission/viewing • Some modalities not DICOM compliant (PET) • Acceptable compression ratio for emergencies • Appropriate viewing stations: mammography, radiographs, MPR need – Patient privacy, data encryption – Preliminary versus final read
Medical Liability: Interpretation and Communication • Teleradiologist has a duty to communicate as effectively as any other radiologist • Typical communication by written report – Reports to include • Patient demographics, procedural details, relevant findings, impression (unless short) – Preliminary reports • Time sensitive, limited by absence of prior etc • NOT complete reports • Must provide information to deal with immediate care http: //www. acr. org/s_acr/bin. asp? CID=541&DID=12196&DOC=FILE. PDF
Medical Liability: Interpretation and Communication – Non routine communications • Situations: – Findings needing immediate intervention – Discrepant from prior report – Unexpected, but serious findings • Direct conversation best; others (fax, pager. email etc) less reliable • Must be documented
Medical Liability: Minimizing Error • Preliminary reports to include relevant issues, small details not necessary • Call when in doubt/something seen later • Ask for additional/repeat imaging as needed • Recommend appropriate clarification studies • Everyone misses…have a good QA system in place
Summary • Teleradiology is an excellent empowering technology which enhances patient care • Legal issues on teleradiology are still vague • A safe strategy is the best strategy – – – Do not compromise patient care (primum non nocere) Appropriately qualified radiologists Clear contracts and insurance a must to cover liability issues Efficient communication in a clinical setting Quality assurance programme A very friendly lawyer!