Global group creates framework to regulate teleradiology

In what is likely a precursor to uniform standards for clinical teleradiology, an international network of radiology organizations has drafted guidelines for the burgeoning teleradiology industry.

The "Top 10 Principles of International Clinical Teleradiology," approved this year in Vienna by the International Radiology Quality Network, is an evolving document that is sure to spark discussion and fuel debate among stakeholders.

"It's not easy to get everyone to sit down and talk about this touchy subject," said Dr. Lawrence Lau, chair of the network, of the three years it took the International Clinical Teleradiology Standards Workgroup to review the literature and agree on broad standards. "Internationally, teleradiology is big scale. Many parties are involved. The intent is just to make sure there are mechanisms in place to remind people what are the right things to do."

The workgroup is composed of members of the American College of Radiology, RSNA, European Society of Radiology, and World Health Organization, among other organizations.

Thedraft principles are merely suggestive and, possibly, preemptive.

"These principles have no teeth at all," Lau said. "They are not related to payment whatsoever, but over time one would expect that the payer will say to (teleradiology) providers 'you must follow certain requirements'."

The workgroup understood companies would offer varying levels of service, reflecting the available resources and stages of technical and professional development of teleradiology within different countries, Lau said. More definitive standards will be developed over time, after stakeholders have had a chance to review the principles and offer input.

The draft covers key elements such as image quality and security and a few controversial issues.

Item number 4, for example, states: "Liability coverage at referring and interpretation sites be governed by international law. In the instance of a legal dispute, plaintiffs should not be required to litigate in the foreign country."

Dr. Bill Craig, vice president of EagleEye Radiology in Reston, VA, hasn't been able to get a definitive explanation from lawyers on how such a scenario would play out. He is perplexed by this principle.

"The radiologist providing the final report must be a qualified specialist and meet the appropriately training, registration, certification, licensure, revalidation, credentialing, malpractice insurance, and continuing professional development requirements for the referring and interpretation countries," he said. "When I look at all the different credentialing and licensing and communication built into the document, it's a challenge to do it here. And once you take it overseas, it's an order of magnitude more difficult."

Howard Reis, director of business development for New York-based Imaging on Call, questioned the suggestion that radiologists need to be licensed at the referring and interpretation site. He asked if a physician who spends half the year in Washington, DC, and the other half in Switzerland, as is the case with one of his radiologists, would need to be licensed wherever he or she happens to be at any given time.

"Given the existence of modern technology, that might be a requirement that at least should be investigated a little bit," Reis said. "One of the nice things about this technology is it allows rads to be mobile. Are you putting additional burdens by making them have to be licensed in every location to work there?"

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