Teleradiology is evolving at different rates across Europe. There are some countries, like in parts of Spain, where a group that owns several radiology clinics can benefit in many ways by contracting all reporting to a single teleradiology firm. In other countries, where healthcare organization is different, autonomous institutions may choose to outsource only out-of-hours work. In Scandinavia, the teleradiology market is reasonably mature. In the U.K. the situation is much more volatile. Many U.K. National Health Service hospitals used teleradiology services over the past five years as part of a government initiative to reduce reporting times. This scheme has now ended and hospitals with strict targets may choose to contract individually with teleradiology firms or may find themselves having to alter their working practices. Some teleradiology companies are firmly established within a particular country. Others, like Telemedicine Clinic, are pan-European. However, all companies need to operate some sort of economy of scale to be viable. There is a fine line between profitability and survival. As Europe begins to move out of recession, some consolidation is inevitable as smaller companies merge or are acquired by the bigger players. I know radiologists who are concerned that they may lose their jobs to teleradiology firms, which can provide a reporting service more cheaply. However, when the cost of applying appropriate safeguards to ensure the quality of outsourced work is factored in, teleradiology providers might not be so competitive, representing less of a threat on purely financial grounds. Teleradiology companies use strict quality control processes not achievable in most conventional hospital radiology departments. In fact several teleradiology firms have implemented double-reading as standard. In Telemedicine Clinic, the RIS was designed so that if the second reader disagrees with the first reader, the first reader is alerted. If consensus is not then reached, a third expert intervenes. A system like that would be difficult to implement in a hospital environment. Radiologists at Telemedicine Clinic also have access to voice over internet protocol (VOiP) communication tools so that when necessary, they can easily discuss examinations with colleagues or referring institutions. And they do so on an hourly basis. With videoconferencing tools, teleradiologists can participate in multidisciplinary team (MDT) meetings, just as if they were sitting in the same room. However, when you start building in time for this type of activity, the economics can become quite challenging. If you employ radiologists who can report 10 or 15 MRI studies per hour, but they spend that time involved in MDT meetings, it inevitably impacts on service costs. A responsible firm that puts a premium on training and CME may find it is less competitive than its rivals. The answer must be to insist that this type of activity is part of any reporting contract. Teleradiology companies must also support their claims to have a high degree of radiological competence and expertise by auditing and publishing their own results. Legislators and accrediting bodies should be facilitating the growth of teleradiology in Europe in a responsible way. We need to think imaginatively and allow reporting to be outsourced across international borders, particularly with regard to on-call cases. A secure digital environment should allow on-call cases from European hospitals to be reported by radiologists in Australia during their daytime and vice versa. Would you rather your 3 a.m. emergency CT head scan was reported by an alert radiologist in Australia or a sleepdeprived radiologist in the U.K. who has to work the next day? Although advances in IT have brought teleradiology to its current level, there remain challenges. When reporting a chest x-ray, for example, all previous chest x-rays and reports need to be easily accessible. It can be difficult if not impossible to quickly and securely extract the information from the old RIS in many hospitals. We may all be doing very different jobs in 20 or 30 years’ time, from diverse locations. For the radiologist, teleradiology can provide an exciting opportunity to work in a flexible environment in another country. It would be unfortunate if something that could be done well, safely, and cost-effectively-and which might bring benefits to both patients and radiologists-was not facilitated in a responsible way.
