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Medico-legal issues in Teleradiology

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*.

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Medico-legal issues in Teleradiology

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  1. Medico-legal issues in Teleradiology Aditya Daftary Teleradiology Solutions

  2. 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/MoreRAD/Teleradiology/Tele.html

  3. 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

  4. Medico-legal Issues in Teleradiology • The good news: • A lot of it is still unclear • The bad news: • We’re dealing with lawyers!

  5. 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

  6. Many a slip…. • Qualification • Liability and Insurance • Radiologist duties

  7. 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

  8. Qualification • Medical board certification: • USMLE/LMCC/recognized MBBS • Specialty qualification: • ABR/RCPS/FRCR • Subspecialty qualification: • Certificate of added Qualification (CAQ) • Licensure • Credentialing • CME

  9. 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!

  10. 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

  11. Medical Liability: Radiologist • The teleradiologist is as liable as any other radiologist in the given setting • Technical issues • Interpretation and misses • Communication

  12. Medical Liability: Technical • Much of this is now redundant, but there are 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

  13. 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

  14. 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

  15. 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

  16. 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!

  17. Questions?

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