We live in a highly connected global
village where the Internet has made remote healthcare widely available
round-the-clock. Teleradiology, an important part of telemedicine, involves
remote diagnosis through digitized images and remote advice. The process has
been beneficial to a majority of the world's population, as it balances out the
maldistribution of radiologists the world over. Used in war-torn areas, outer
space, on board ships, and in Antarctica, teleradiology, however, leaves some
questions unanswered in the milieu of its operations in India and elsewhere.
Dr Sumer Sethi, MD, Sr Consultant Radiologist
VIMHANS, Delhi and Director of Teleradiology
, a unit of Prime Telerad Providers Pvt Ltd. An author of
many academic papers and books on radiology, Dr Sethi specializes in
musculoskeletal and neuroradiology.
Q. What is telemedicine and teleradiology all about
and why are they important?
Teleradiology is the process of
transmitting and receiving digital radiology images comprising of X-ray,
ultrasound, MRI, etc., from one location to another through a secure digital
network. The images are transmitted using advanced computer systems, typically
over the Internet. Through teleradiology, images can be sent to another part of
a hospital, or anywhere in the world. It is a means of electronically
transmitting radiographic patient images and consultative text from one
location to another.
Q. How is teleradiology
important from the consumer's point of view? Does it bring down costs and
brings the best medical opinion available to the consumer's doorstep. The consumer
does not have to travel long distances to big cities with medical
infrastructure. He can avail of expert opinion and quality reports in his
remote hometown, saving on the costs of travel and accommodation. Teleradiology
also helps the patient secure diagnostic reports in 30 minutes' time nowadays,
enabling faster treatment.
Q. What is
the Medical Council of India's stand on teleradiology as a form of practice in
Council of India currently does not have any specific guidelines for
telemedicine. Therefore, the standards applicable to radiologists are also used
Q. What do you
foresee for the future of teleradiology in India in terms of demand and supply
within the country and outside?
The demand for radiologists is
great in India and abroad - they are, however, in short supply. Teleradiology
helps adjust this imbalance. India has a lot of talent and our doctors have
emerged as one of the major providers of teleradiology services in the Indian
subcontinent, the US, Africa, and the Middle East. Here, I must mention my
company - Teleradiology Providers. Its key strength is that we have extensive
experience working across both public and private hospital facilities. We have
sub-specialist abilities and experience in the areas of neuroradiology, breast
and cardiac imaging.
We also provide our own customized teleradiology software along with a
dedicated web-based server platform and have the ability to link up with any
centre in the world irrespective of the Internet speeds available.
raises interesting ethical and practical issues. These include patient
confidentiality, data security and image authenticity. How should these issues
Teleradiology is a
globally well-accepted method of radiology report delivery, and its systems and
processes are usually governed by standards like the Digital Images in Communications and Imaging (DICOM)
version 3.0, 1993 and the US
Health Insurance Portability and Accountability Act (HIPAA) 1996.
healthcare organizations must make sure that their teleradiologists are
sensitized to the issues of patient confidentiality and data security.
Teleradiologists, even when they work from remote locations, are basically
responsible doctors and must keep their patients' records confidential.
is a chance of data security being compromised when teleradiologists use an
email facility to support reporting - this should be avoided.
authenticity becomes an issue when a teleradiologist uses a jpeg image for reporting,
instead of a DICOM image. The DICOM format for images gives clearer pictures
and is ideally suited to radiology.
Q. How can
accuracy of reporting be increased?
For accuracy of
reporting, it is better if the same chest X-ray or mammogram is
shown to two radiologists. The practice followed in medical colleges is that
radiology reports are usually double or triple read - first the junior resident
reads it, then the registrar, followed by the faculty member, who has the final
It would definitely make sense to
follow such best practices and have standard double reads of reports to
increase accuracy and cut down on ambiguity.
The computer may play a significant
role in this area in future - recognizing patterns that could be later
super-read by radiologists. This will increase efficiency and reduce the margin
of error in spotting a significant issue.
Q. There are
many teleradiology companies making the same claims of quality and efficiency
today. Who do you think will survive the rat-race?
In the long term, only players with competent and quality systems in this field
who follow all standard Internet
security protocols like DICOM and HIPAA will survive.
Q. If there is an error in diagnosis,
who shares the responsibility in a court of law?
Here, the same law applies, as onsite
reporting. Teleradiologists take full
responsibility for error in diagnosis in a court of law. In our company,
teleradiologists take full responsibility of their work - they carry their own
indemnity insurance. Further, our performance improvement program continuously monitors quality and
performance parameters, ensuring an ongoing analysis of workflow and turnaround
times, random quarterly audits of reports, and statistical reviews of important
events with our chief radiologist.
Q. What is super cloud computing
technology? Will it be able to afford low-cost diagnosis? What are the new
techniques prevalent in teleradiology in the west? Have they reached India?
cloud computing can help store and share data, and connect more easily without
large capital expenditures. It offers a platform for better scalability and
flexibility. In our industry, the ability to work with large volumes of data
with greater ease provides benefits beyond better scalability and cost savings
- it makes a difference in patient care. With a cloud-based solution, images
can be shared digitally at different locations.
Benefits for the patient in super cloud
computing are that turnaround time is shortened and there are fewer
interruptions and breakdowns.
The new technique prevalent in the west
has to do with image pattern recognition by computers that the teleradiologist
super-reads. This is not available in India yet.
Q. How can
teleradiology help patients in remote rural areas in India? How can the cost of
treatment come down for the poor in urban and rural areas?
It is very unfortunate that while
70 percent of India's population lives in villages, the healthcare available
there is meager. Also, the quality of rural healthcare can hardly be defined as
state-of-the-art. As part of its Corporate Social Responsibility drive,
Teleradiology Providers have taken the initiative to bring state-of-the-art
diagnostics to a rural centre located in Mirpur, Haryana, where we do reporting
free of charge.
Our goal is to establish this centre
as a benchmark for rural healthcare in India so that ultra-modern facilities
can be established soon in every village. Rural patients are benefiting from
such philanthropic measures and are also deriving the benefit of quality
It is imperative for telemedicine to reach a wider population at a
faster pace, especially in the underpriviledged strata of society and in rural
areas. Medindia wishes Dr Sumer Sethi and his team at Teleradiology Providers success in their initiative at Mirpur Village, Haryana. About 100,000 villages in India have no provision for remote healthcare. Such
concerted efforts will definitely bear fruit in the long run to improve patient
care in our country