RESUMO
Background: Telemedicine as a technology is expected to resolve issues such as doctor shortages and disparities in medical services. However, high costs of system installation and maintenance inhibit its widespread use.Introduction: This study involved a cost minimization analysis for installation of a teleradiology system in the Hokkaido prefecture of Japan. Conditions under which system utilization is cost-efficient and system utilization is effective for cost reduction were analyzed.Materials and Methods: A cost minimization analysis was conducted using three geospatial points of 50, 100, and 200 km from Sapporo city, the prefectural capital of Hokkaido, assuming a central imaging diagnosis center in Sapporo. The analysis was conducted from the standpoint of both patients and requesting hospitals.Results: From the patient's standpoint, a cost reduction effect was observed at all three distances from system installation. In contrast, from the hospital's standpoint, a cost reduction effect was found only when teleradiology examination was conducted from a distance of at least 100 km from Sapporo.Discussion: Results show that the cost reduction effect for patients increased as the travel distance increased. Although the teleradiology service is beneficial for a wide range of patients, the financial burden on requesting hospitals is significant.Conclusions: The following conditions were found necessary to reduce the requesting hospital's financial burden: the hospital should be far from the imaging diagnosis center, an inexpensive system is to be selected, and the system needs to be utilized continuously.
Assuntos
Controle de Custos , Análise Custo-Benefício , Telerradiologia/economia , Humanos , Japão , Viagem/economiaRESUMO
INTRODUCTION: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS: A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
Assuntos
Telerradiologia/organização & administração , Humanos , Processamento de Imagem Assistida por Computador/métodos , Aplicativos Móveis , Avaliação de Processos em Cuidados de Saúde , Radiologia/organização & administração , Sistemas de Informação em Radiologia/organização & administração , Reprodutibilidade dos Testes , Smartphone , Telerradiologia/economiaRESUMO
BACKGROUND: Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital. METHODS: A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes. RESULTS: Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was $333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05). CONCLUSIONS: Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant.
Assuntos
Redução de Custos , Transferência de Pacientes , Exposição à Radiação/prevenção & controle , Telerradiologia/economia , Telerradiologia/métodos , Ferimentos e Lesões/diagnóstico , Adulto , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Masculino , Oregon , Sistema de Registros , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/terapiaAssuntos
Telerradiologia/tendências , Competição Econômica , Registros Eletrônicos de Saúde/economia , Registros Eletrônicos de Saúde/tendências , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Modelos Econômicos , Serviço Hospitalar de Radiologia/economia , Telerradiologia/economia , Meios de Transporte/economiaAssuntos
Serviços Contratados/economia , Emprego/economia , Custos de Cuidados de Saúde/tendências , Telerradiologia/economia , Serviços Contratados/organização & administração , Redução de Custos , Análise Custo-Benefício , Emprego/organização & administração , Previsões , Humanos , Inovação Organizacional , Controle de Qualidade , Telerradiologia/organização & administração , Estados UnidosRESUMO
The aim of this study was to evaluate the diagnostic accuracy for detecting breast cancer using different telemammography configurations, including combinations of both low-cost capture devices and consumer-grade color displays. At the same time, we compared each of these configurations to film-screen readings. This study used a treatment-by-reader-by-case factorial design. The sample included 70 mammograms with 34 malignant cases. The readers consisted of four radiologists who classified all of the cases according to the categories defined by the Breast Imaging Reporting and Data System (BI-RADS). The evaluated capture devices included a specialized film digitizer and a digital camera, and the evaluated displays included liquid crystal display (LCD) and light-emitting diode (LED) consumer-grade color displays. Receiver operating characteristic curves, diagnostic accuracy (measured as the area under these curves), accuracy of the composition classification, sensitivity, specificity, and the degree of agreement between readers in the detection of malignant cases were also evaluated. Comparisons of diagnostic accuracy between film-screen and the different combinations of digital configurations showed no significant differences for nodules, calcifications, and asymmetries. In addition, no differences were observed in terms of sensibility or specificity when the degree of malignancy using the film-screen method was compared to that provided with digital configurations. Similar results were observed for the classification of breast composition. Furthermore, all observed reader agreements of malignant detection between film-screen and digital configurations were substantial. These findings indicate that the evaluated digital devices showed comparable diagnostic accuracy to the reference treatment (film-screen).
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Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Telerradiologia/métodos , Área Sob a Curva , Feminino , Fractais , Humanos , Processamento de Imagem Assistida por Computador/métodos , Variações Dependentes do Observador , Curva ROC , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Telerradiologia/economiaAssuntos
Assistência Integral à Saúde/organização & administração , Comportamento Cooperativo , Comunicação Interdisciplinar , Internacionalidade , Procedimentos Cirúrgicos Operatórios , Telemedicina/organização & administração , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/tendências , Redes de Comunicação de Computadores/economia , Redes de Comunicação de Computadores/organização & administração , Redes de Comunicação de Computadores/tendências , Redução de Custos/economia , Redução de Custos/tendências , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Alemanha , Hospitais Universitários/economia , Hospitais Universitários/organização & administração , Hospitais Universitários/tendências , Humanos , Melhoria de Qualidade/economia , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/tendências , Procedimentos Cirúrgicos Operatórios/economia , Procedimentos Cirúrgicos Operatórios/tendências , Telemedicina/economia , Telemedicina/tendências , Telemetria/economia , Telemetria/tendências , Telerradiologia/economia , Telerradiologia/organização & administração , Telerradiologia/tendências , Ferimentos e Lesões/cirurgiaRESUMO
INTRODUCTION: In teleradiology services and in hospitals, the extensive use of visualization displays requires affordable devices. The purpose of this study was to compare three differently priced displays (a medical-grade grayscale display and two consumer-grade color displays) for image visualization of digitized chest X-rays. MATERIALS AND METHODS: The evaluated conditions were interstitial opacities, pneumothorax, and nodules using computed tomography as the gold standard. The comparison was accomplished in terms of receiver operating characteristic (ROC) curves, the diagnostic power measured as the area under ROC curves, accuracy in conditions classification, and main factors affecting accuracy, in a factorial study with 76 cases and six radiologists. RESULTS: The ROC curves for all of the displays and pathologies had similar shapes and no differences in diagnostic power. The proportion of cases correctly classified for each display was greater than 71.9%. The correctness proportions of the three displays were different (p<0.05) only for interstitial opacities. The evaluation of the main factors affecting these proportions revealed that the display factor was not significant for either nodule size or pneumothorax size (p>0.05). CONCLUSIONS: Although the image quality variables showed differences in the radiologists' perceptions of the image quality of the three displays, significant differences in the accuracy did not occur. The main effect on the variability of the proportions of correctly classified cases did not come from the display factor. This study confirms previous findings that medical-grade displays could be replaced by consumer-grade color displays with the same image quality.
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Apresentação de Dados/economia , Radiografia Torácica/economia , Radiografia Torácica/instrumentação , Telerradiologia/economia , Telerradiologia/instrumentação , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/instrumentação , Humanos , Intensificação de Imagem Radiográfica/economia , Intensificação de Imagem Radiográfica/instrumentação , Software , Ecrans Intensificadores para Raios X/economiaRESUMO
Commercial teleradiology is well established in the US. There are many factors to consider when engaging a teleradiology provider. One of the basic questions is what do you expect to gain from it? Do you want a final reading from an attending radiologist (known as a consultant radiologist in many countries) or would you be satisfied with a preliminary reading from a teleradiology provider and a final reading from your own in-house radiologist the following day? Do you simply require after-hours coverage or do you need to supplement the coverage provided by your own internal radiologists during normal working hours? Teleradiology is not without its drawbacks. It can add additional costs, particularly for after-hours coverage. Teleradiology rarely provides in-house coverage for procedures, and the interpreting radiologist may sometimes be difficult to contact for consultation. Choosing a teleradiology vendor requires due diligence. When the contracting entity defines its expectations well and chooses its teleradiology vendor with care, the end result will be satisfactory for all concerned, including the patients.
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Plantão Médico/métodos , Telerradiologia/economia , Telerradiologia/métodos , Telerradiologia/organização & administração , Plantão Médico/organização & administração , Plantão Médico/normas , Atenção à Saúde/métodos , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços Terceirizados/normas , Serviços Terceirizados/estatística & dados numéricos , Radiologia/métodos , Radiologia/organização & administração , Estados UnidosRESUMO
Teleradiology services are now embedded into the workflow of many radiology practices in the United States, driven largely by an expanding corporate model of services. This has brought opportunities and challenges to both providers and recipients of teleradiology services and has heightened the need to create best-practice guidelines for teleradiology to ensure patient primacy. To this end, the ACR Task Force on Teleradiology Practice has created this white paper to update the prior ACR communication on teleradiology and discuss the current and possible future state of teleradiology in the United States. This white paper proposes comprehensive best-practice guidelines for the practice of teleradiology, with recommendations offered regarding future actions.
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Telerradiologia/normas , Comitês Consultivos , Certificação , Segurança Computacional , Serviços Contratados , Competição Econômica , Ergonomia , Honorários e Preços , Humanos , Seguro de Responsabilidade Civil , Licenciamento , Revisão por Pares , Privacidade , Garantia da Qualidade dos Cuidados de Saúde , Sistemas de Informação em Radiologia/normas , Sociedades Médicas , Telerradiologia/economia , Telerradiologia/legislação & jurisprudência , Fatores de Tempo , Estados Unidos , Fluxo de TrabalhoAssuntos
Formulário de Reclamação de Seguro/legislação & jurisprudência , Medicare/legislação & jurisprudência , Área de Atuação Profissional/legislação & jurisprudência , Radiologia/economia , Radiologia/legislação & jurisprudência , Centers for Medicare and Medicaid Services, U.S. , Humanos , Autorreferência Médica/legislação & jurisprudência , Telerradiologia/economia , Telerradiologia/legislação & jurisprudência , Estados UnidosRESUMO
We evaluated a low cost device for digitizing X-ray films. It consisted of a locally-made wooden box and a readily-available digital camera. Two experienced paediatric radiologists interpreted the original X-ray films (the reference standard) and the corresponding images obtained in the photo light box. Ninety paediatric chest X-ray films were used (30 were normal chest radiographs, 30 showed pneumonic-consolidation and 30 had interstitial infiltrates). The presence or absence of the three signs most frequently found in acute respiratory pathologies were evaluated: normal pulmonary transparency, pneumonic consolidation and interstitial infiltration. There was very good agreement between the X-ray films and the digitized images, with kappa values from 0.86 to 0.98. There was good agreement between the two observers, with kappa values from 0.67 to 0.90. The low-cost photo light box represents an accessible and low-cost approach to transmitting X-ray images, allowing findings or a second opinion from a specialist radiologist to be obtained from a distance.
Assuntos
Telerradiologia/métodos , Humanos , Fotografação/economia , Fotografação/instrumentação , Fotografação/métodos , Radiografia Torácica/economia , Radiografia Torácica/instrumentação , Radiografia Torácica/métodos , Telerradiologia/economia , Telerradiologia/instrumentaçãoRESUMO
OBJECTIVE: To calculate the costs and benefits of the introduction of teleradiology at a general practice on the Dutch island of Ameland from the perspectives of three different entities: (a) the family doctor (investor); (b) patients; and (c) health insurance companies. DESIGN: Descriptive, cost-benefit analysis. METHOD: For the year 2009, one and a half years after the introduction of a teleradiology facility at a general practice in Ameland, the operational and financing costs, the patient's saved travel time and expenses and the teleradiology costs for health insurance companies were compared with the costs that would have been made without teleradiology. RESULTS: In 2009, 426 X-rays had been taken at the general practice of which 241 for trauma and 185 for non-traumatic cases. With a reimbursement of 100 per X-ray taken during normal working hours and 200 for those taken during evenings and weekends, benefits for the family doctor (investor) were 46,698 and the costs amounted to 45,710, or a positive balance of 980. Patients' savings in travel time and expenses were calculated at 111,068. Health insurance companies reimbursed a minimum of 89,265 less on diagnosis and treatment. CONCLUSION: The introduction of teleradiology a general practice in Ameland resulted in a considerable cost reduction for patients as well as for health insurance companies. In the future, diagnosing in this manner could be expanded in particular to regions in which the distances to hospitals are greater: a part of secondary healthcare could be conducted at a reduced cost.
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Medicina de Família e Comunidade/métodos , Custos de Cuidados de Saúde , Telerradiologia/economia , Análise Custo-Benefício , Medicina de Família e Comunidade/economia , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Países Baixos , Satisfação do Paciente , Projetos Piloto , Telerradiologia/métodos , Fatores de TempoRESUMO
We have devised an inexpensive, web-based tele-ultrasound system using commercially-available video streaming equipment. We examined the spatial and grey scale resolution, and the delay time of the system. The receiving PC was tested at various distances from the transmitting site, from 3.2 km to 4828 km. Standard resolution targets and echocardiography movie strips recorded on DVDs were used to assess the image quality. A qualitative assessment was made by an expert sonographer. As the distance between the transmitter and the receiver increased, the scan smoothness decreased and the delay increased. At a distance of 3.2 km the delay was 2-3 s, and at 4828 km it was 10-15 s. The delay was short enough to allow realtime guidance of the scanning technician by telephone. The system allows inexpensive, readily available, realtime tele-ultrasonography.
Assuntos
Internet , Telerradiologia/métodos , Ultrassonografia/métodos , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Telerradiologia/economia , Ultrassonografia/economia , Gravação em VídeoAssuntos
Fraturas Ósseas/diagnóstico , Custos de Cuidados de Saúde/estatística & dados numéricos , Consulta Remota/economia , Serviços de Saúde Rural/economia , Austrália , Análise Custo-Benefício , Fraturas Ósseas/economia , Humanos , Transferência de Pacientes/economia , Projetos Piloto , Telerradiologia/economiaRESUMO
A common teleradiology practice is digitizing films. The costs of specialized digitizers are very high, that is why there is a trend to use conventional scanners and digital cameras. Statistical clinical studies are required to determine the accuracy of these devices, which are very difficult to carry out. The purpose of this study was to compare three capture devices in terms of their capacity to detect several image characteristics. Spatial resolution, contrast, gray levels, and geometric deformation were compared for a specialized digitizer ICR (US$ 15,000), a conventional scanner UMAX (US$ 1,800), and a digital camera LUMIX (US$ 450, but require an additional support system and a light box for about US$ 400). Test patterns printed in films were used. The results detected gray levels lower than real values for all three devices; acceptable contrast and low geometric deformation with three devices. All three devices are appropriate solutions, but a digital camera requires more operator training and more settings.
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Intensificação de Imagem Radiográfica/economia , Intensificação de Imagem Radiográfica/instrumentação , Software/economia , Telerradiologia/economia , Filme para Raios X/economia , Apresentação de Dados/economia , Desenho de Equipamento , Humanos , Controle de Qualidade , Telerradiologia/instrumentação , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/métodosRESUMO
Over the past half decade, teleradiology companies have served as invaluable business partners to local radiology providers grappling with declining reimbursements, shrinking budgets, and an imaging utilization explosion that has rendered workloads unmanageable. The teleradiology business model has helped to stabilize local imaging groups through economies of scale to control costs, by facilitating rapid workflow and report turnaround times, and offering a broad range of subspecialty expertise. Teleradiology has landed radiology at an important crossroads and market forces are actively shaping its future. This article examines the role of technological innovation in teleradiology's success, and suggests that persistent technological and operational limitations raise important questions regarding quality of care. This article also joins the imaging industry's discussion as to whether radiology can be (or has been) commoditized, and explores the feasibility of the commoditization of imaging and its impact on traditional radiology practice. There appears to be an important role for teleradiology in the provision of radiology services going forward, and yet boundaries must be thoughtfully drawn in order to achieve best practices for the specialty's future. tion, commoditization.