Changing Blog Link
As the saying goes – there is nothing certain in life but change. So change it is. The SWTRC blog site has changed and thus the link has too. All of the previous blogs have been moved over to the new host site and a “button” added to the SWTRC website for easy connection to the blog. From now on the link for the SWTRC blog is http://southwesttrc.org/blog/list
We encourage you to follow us on the new site as we continue to update you on our activities and on telemedicine in general!
Telemedicine Talks in Unexpected Places
Telemedicine pops up in the most unexpected places! I was fortunate to attend the 4th International Conference on Information Technologies in Biomedicine (ITIB) in Kamień Śląski, Poland (a lovely little town northwest of Krakow which was a seat of knights and noblemen families in the past and where the castle in which St. Jacek was born is located – which is now a quaint conference center and sanatorium) and in addition to image analysis, computer-aided surgery, bioengineering, bioinformatics and signal analysis are 2 sessions dedicated to telemedicine!
The session was preceded by an invited lecture by Jurgen Zerth, PhD who compellingly discussed “Some Aspects on Effectiveness and Efficiency for Ambulatory Care Assisted by Mobile Technological Devices”. He noted what many of already see as one of the key drivers of telemedicine – the rapidly increasing population of people of 65 who are not only living longer than previous generations but doing so with more chronic conditions such as diabetes, Parkinson’s and dementia. Health care systems around the world are facing the challenges of caring for this population – and trying to do so in a manner that keeps them in their homes as long as possible.
He presented a model and data demonstrating the complex nature of the problem and showing that finding the point where mobile have an impact in terms of care and cost is challenging and needs to account for a variety of factors. The question of course is whether the findings are generalizable from one country/healthcare system to another. I would say yes but more data are required to validate the model – data we really need as this is an ever-growing problem worldwide.
The focus of the session was squarely on remote monitoring. Three of the talks (Mitas, Ridzki, Skotnicka & Lubina; Borik, Babisiak & Cap; Mitas, Rudzki, Wieclawek, Zarychta & Piwowarski) discussed activity monitoring systems (accelerometers, gyroscope and other wearable sensors) and although each were intriguing from an engineering perspective they had yet to be validated completely in an elderly sample of subjects in vivo.
The lingering question is whether people will actually be willing to wear these types of sensors. Will the potential benefits of automatic fall detection outweigh the potential nuisance of wearing the monitors? Will the false positive and false negative rates be low enough to warrant 24/7 use? Will we have the infrastructure in place that is necessary to do something once someone has fallen – can we get help to them any faster than we can now? In the long-run I think the answers are yes, but not right now.
Another talk reported on “The Application of Adapted TICS (Telephone Interview for Cognitive Status) for Diagnostics of Cognitive Function Disturbances in Elderly Patients: A Pilot Study” (Derejczyk, Stepien-Wyrobiec, Hanusiak, Bednorz, Karasek, Hornowska-Suchon, Szymszal & Pogonowska). It verified the usefulness of TICS compared to the standard MMSE and MoCA tests and found high correlations (MMSE & MoCA = 0.8170; MMSE & TICS = 0.7955). The TICS is a 19 question survey that does not use pictures or require any other materials so it can readily be done over the phone. Initial results are very promising, although further validation is required and there are, as with all tests, limitations (e.g., tester cannot tell if someone is with the person being tested and helping them). This test will surely become part of the battery of tools we have to help people in their homes as they start to experience cognitive declines. With the increasingly use of smartphones and the ability to have video conversations the potential is even higher!
There was a neat talk on “Telemetry Recording of the EMG Activity of Female Reproduction Tract” (Brzozoska, Oczeretko, Pawlinski & Gajewski). This very interesting talk had two parts. The first discussed the Monica AN24 device which attaches electrodes to a pregnant woman’s abdomen for recording fetal ECG, fetal heart rate variability, mother’s heart rate variability, EHG of uterine muscles, and arrhythmia identification. This part was more an overview of the possibilities of such a system – it would be used to telemonitor at risk pregnancies. Pretty neat!
The second half was on a project that implants sensors and records EMG signals from the bulb and isthmus of the oviduct and uterus corn during estrus and early pregnancy in pigs. Televeterinary? Absolutely! But it also provides basic scientists with data to help us better understand the physiology and pathophysiology of the reproductive system – yes pigs and humans are that similar!
There were two talks on teldermatology. My talk discussed the utility of using eye-position recordings of expert dermatologists to train dermatologists and residents on how to use and interpret accurately photographic and dermatoscopic images. These tools are widely available, relatively inexpensive and fairly easy to use – but interpreting the images correctly to determine if a lesion is benign or malignant is not as easy. Thus most patients with single pigmented lesions (suspicious for melanoma) need to travel and wait to see a dermatologist – enter teledermatology! Thus the need to develop better training methods and maybe understanding how experts look at these images can help.
Oddly enough my talk was followed by one on an “e-Melanoma Diagnosing and Learning System: Current Status” (Hippe). The project is compiling a set of synthetic images of melanocytic skin lesions that can be used for training tool development as well as perhaps development of automated image analysis tools.
A lot of the other talks – whether the authors realized it or not – were also about telemedicine. After all, telemedicine increasingly involves all sorts of images and automated analyses of these images (not just radiographs and pathology slides) are clearly going to be part of the future of telemedicine. Likewise, telemedicine means big data and big data means bioinformatics – what are we going to do with all the data these remote monitoring systems are collecting?!
It’s one thing to say everything will be uploaded to a data analysis service and the healthcare system notified of events out of the ordinary, but it’s quite another thing to actually do this. As Dr. Zerth noted at one point in a discussion – this is where the expenses comes in! Once the event occurs we still need to deploy resources to deal with it and help the patient in need – and that is what we still need to figure out in many, many applications.
But that’s what makes research and listening to these dedicated scientists (and their students) at conferences like ITIB so exciting! Kudos to the organizing committee, especially Ewa Pietka, PhD of the Silesian University of Technology, Poland!
ATA 2014 – Another Great Meeting!
It’s impossible to summarize the 2014 American Telemedicine Association meeting for those unable to attend as it was impossible to see the whole thing even for those attending! ATA grows every year and this year was no exception – it was huge and it was exciting!! Believe me when I say I got quite a cardiovascular workout running between sessions and up and down the stairs between the conference rooms and the Exhibit Hall – which was probably a half-mile long and filled with vendors!
The meeting was held in Baltimore, MD May 17-21and was the largest ever, with approximately 5000 attendees from 43 different countries. Attendees had a wide variety of backgrounds, with 20% Healthcare Providers/Administrators 6% Research/Academia, 23% Industry, 13% Technician/Engineer/IT, 21% C-Suite/Exec Management, and 17% Other (Consultants, Policy, Students, Finance, Legal). There were 18 pre-conference half and full-day courses on topics ranging from telemedicine basics to those dedicated to specific topics such as human factors, publishing in telemedicine, business, and legal perspectives and basics. There were nearly 600 presentations overall including breakout sessions, pre-meeting courses, ePosters, plenaries, and various dedicated special interest sessions.
The program had 14 tracks highlighting key elements of telemedicine today: Chronic Disease Management, Patient-Focused Care, Critical and Acute Care, Clinical Services Case Studies, Mental Health, Business Strategies, Operational Tools, Legal and Regulatory, Pediatrics, Federal Programs, Research and Evaluation, ePosters, Industry Executive Sessions, and Innovative Spotlight Sessions. There were some dedicated telepathology talks within some of these tracks, but only a very small amount. The same was true for teleradiology, as opposed to previous years where there were many more in both of these areas. Perhaps these two areas are so mature that the ATA is the wrong place for presenters who are more commonly found at dedicated pathology and radiology society meetings.
As usual the keynote speakers were all healthcare visionaries and the talks were not only exciting but inspiring. Paul Farmer, PhD founding director of Partners In Health (PIH) spoke on “Telemedicine and the Future of Global Health”; Stephen Hemsley President and Chief Executive Officer of UnitedHealth Group discussed “Integrating Telemedicine”, Reed Tuckson, MD Managing Director Tuckson Health Connections, LLC, spoke on “Making the Possible Happen”; and Jonathan Woodson, MD Assistant Secretary of Defense for Health Affairs U.S. Department of Defense presented a very inspiring talk on “A Global Health Mission, A Smaller Military Force: The Promise and Opportunity for Telehealth in the Department of Defense”.
One short course of interest to those in the SWTRC region was “Legal & Regulatory Issues Part 2: Lessons Learned and Advice From Telehealth Pioneers” presented by the Four Corners Telehealth Consortium (FCTC) whose members have made significant progress in addressing legal and regulatory barriers. The FCTC serves as a model on how states with common issues and characteristics can create legal and regulatory change by combining forces and leveraging telemedicine expertise from a variety of programs and resources. The course provided lessons learned from the telemedicine pioneers who have worked together over the years to address interstate legal and regulatory challenges. Participants learned about specific language for seeking parity and other legislation, examples of successful interstate telemedicine collaborations, and methods to use to approach legislators with ideas for enhancing statewide telemedicine efforts. The session was moderated by Elizabeth A. Krupinski, PhD (University of Arizona) and the presenters were Mei Kwong, JD, Policy Associate, Center for Connected Health Policy Ronald Weinstein, MD (Director Arizona Telemedicine Program, University of Arizona), Dale Alverson, MD (Medical Director, Center for Telehealth and Cybermedicine Research, University of New Mexico), Marta Petersen, MD (Vice-Chair and Professor of Dermatology, University of Utah) and Jay Shore, MD (Associate Medical Director, Colorado Physicians Health Program, Associate Professor, Psychiatry, Centers for American Indian and Alaska Native Health, University of Colorado). If you are interested in the presentations and materials provided please contact me (krupinski@radiology.arizona.edu).
The ATA meeting would be nothing without the trade show and as usual it was the focus of action for many attendees as there was ample time to investigate and interact with the various vendors. The exhibit hall was the biggest ever with about 250 vendors covering all market segments of the telemedicine industry. For the second time, there was also a “Start Up Zone” for new technologies in the Exhibit Hall which was an interesting peek into the future of what’s to come in telemedicine. In addition to traditional vendors, there were representatives from various publishers, and service providers.
The National Telehealth Resource Centers also had a booth and traffic was high – people are clearly interested in starting up new programs or expanding existing ones. Of particular interest seemed to be cross/multi-state programs and figuring out how to make them work. GlobalMed (http://www.globalmed.com/) generously provided time at one of their booths for highlighting the TRCs and their resource efforts.
Elizabeth Krupinski, PhD from the SWTRC presenting an overview of the National TRCs.
If you weren’t able to make the meeting you can go to the ATA website to get more details and there are transcripts of the meeting available for purchase (http://www.americantelemed.org/ata-2014/program-overview#.U4xAPii4OQE). More importantly – try to make it to ATA 2015 May 3-5 in Los Angeles!!
What’s New in Imaging Informatics?
Telemedicine, telehealth, e-health, m-health – it’s all healthcare. But where would healthcare be today without informatics? Broadly, healthcare informatics deals with the resources, devices, and methods needed to optimize acquisition, storage, retrieval, and use of information in health and biomedicine. Imaging Informatics is the study and application of processes of information and communications technology for the acquisition, manipulation, analysis, and distribution of medical image data in particular. Most people think of imaging informatics as dealing only with radiology and maybe pathology, but if you think about telemedicine is all about images!
So where do you go to learn about imaging informatics? For me the best place is SIIM – the Society for Imaging Informatics in Medicine (http://siim.org/) and this week was the annual meeting in Long Beach, CA. As imaging spreads across the healthcare enterprise, more and more IT departments and telemedicine programs are looking to radiology to help with their imaging needs.
So what was new and exciting at SIIM that applies to telemedicine – well just about everything but here are some highlights. One big question facing just about every specialty is how do we integrate all these images being acquired from all these sources (visible light, radiographs, pathology etc.)? Let’s face it – to date it’s pretty much been a hodge-podge of solutions that are unique to an institution or even a department. Getting access to the stored information at the Enterprise level is often a challenge. One new standard that may help solve that is HL7 FHIR (Fast Healthcare Interoperability Resources).
More details can be found at http://www.hl7.org/implement/standards/fhir/ but basically FHIR uses modular components called “Resources” that are assembled into working systems to solve integration and exchange problems at a significantly lower cost than existing alternatives. It is suitable for mobile phone apps, cloud communications, EHR-based data sharing, server communications and a host of other healthcare scenarios. We will be hearing much more about this as vendors are very much on board with adoption!
Workflow was probably the second most popular topic at the meeting with a strong focus on using analytics to better capture and understand what clinicians are doing, what information resources they are accessing, how they are accessing them, from where and using what types of devices. The role of Cloud services and issues associated with using the Cloud to store medical records and images was of high interest as more and more institutions are using the Cloud and vendors that provide services via or on the Cloud. Rest assured, there are lots of companies with some pretty sophisticated mechanisms in place to address privacy and security measures!
The American Telemedicine Association’s Annual Meeting follows directly from SIIM – but on the other side of the country in Baltimore, MD. It will be interesting to see how often informatics comes up there and in what context!
SERVICE PROVIDER SHOWCASE – MARK YOUR CALENDARS!!!
Are you thinking about getting into telemedicine either as a service provider or using a service provider but have no idea what’s available, how to find customers as a service provider, or as a user find a service provider? Wouldn’t it be great if there was somewhere you could go to find out what’s out there and ask all the questions you have?
Well wait no longer! The Arizona Telemedicine Program, the Southwest Telehealth Resource Center, and the Four Corners Telehealth Consortium are collaborating to bring you the first annual Telemedicine and Telehealth Service Provider Showcase (SPSTM).
The SPS will be held October 6-7 at the Hyatt Regency in downtown Phoenix, AZ. The meeting is designed to foster partnerships that will bring quality telemedicine services to hospitals, clinics, private practices, homes and schools.
The meeting will showcase service providers covering a variety of clinical specialties to improve patient care and outcomes. By bringing healthcare and telehealth service providers together partnerships can be forged that will increase market shares for all parties. Recent changes in the healthcare system and the increasing body of evidence supporting the numerous benefits of telemedicine make this the ideal time to enter the market. Telemedicine is growing exponentially and this is your opportunity to ride the wave!
SPS will provide attendees with practical information for getting into telemedicine as well as the opportunity to explore what telehealth service vendors have to offer. The meeting will attract 400-500 critical stakeholders including governmental officials, policy makers, corporate executives, administrators, legal, regulatory and reimbursement managers, service providers, healthcare professionals, patient advocates, consumers, and equipment vendors.
The organizers of SPS are nationally and internationally renowned experts in telemedicine: Dale Alverson, MD University of New Mexico Health Sciences Center; Elizabeth Krupinski, PhD Director of the Southwest Telehealth Resource Center at the University of Arizona; Marta J. Petersen, MD, Vice-chair and Professor of Dermatology at the University of Utah; Jay H. Shore, MD, Associate Medical Director of the Colorado Physicians Health Program and Associate Professor of Psychiatry, Centers for the American Indian and Alaska Native Health, University of Colorado; and Ronald Weinstein, MD Director of the Arizona Telemedicine Program at the University of Arizona.
Get your walking shoes on and your questions ready! We hope to see YOU in September!!
For more information visit us at www.ttspsworld.com
Teledentistry for Arizona Children
By Julia Wacloff, RDH, MSPH Chief, Office of Oral Health AZ Department of Health Services
Tooth decay remains one of the most common chronic diseases of childhood especially for Arizona children. Many Arizona Children start school with tooth decay, a disease that is largely preventable. Early tooth decay can start in children as soon as the first teeth erupt and progresses with age. By the time Arizona children reach 3rd grade, over 75% of them have experienced tooth decay. Arizona’s oral health workforce is challenged by the high dental needs of the state’s children, especially in rural areas which extend into 80% of the state’s land. Workforce solutions are complex and require a multi-level approach for improving access to care.
Recent initiatives to improve the oral health workforce have lead many partners to a readiness to promote strategies to enhance dental teams. These strategies include teledentistry practice. Teledentistry practice utilizes offsite collaborating dentists to coordinate dental care using electronic and communication technologies to reach children and populations in underserved areas.
You can learn more about how Teledentistry can help individuals, communities and providers by watching our video.
Inaugural Flagstaff ATP Telemedicine Training: Sellout Crowd and Great Reviews
By Nancy Rowe on April 4, 2014
The inaugural Northern Arizona presentation of the Arizona Telemedicine Program (ATP) and Southwest Telehealth Resource Center (SWTC) telemedicine training conference was a resounding success, with a sellout crowd and nationally recognized speakers representing several high-profile Arizona telehealth programs. The ATP and SWTRC presented the full-day “Arizona Telemedicine Course: Applications, Infrastructure, Reimbursement” at Flagstaff Medical Center on Tuesday, April 1.
“I think it’s well rounded and I appreciate the opportunity to have this in northern Arizona,” said Cheri Wells, Director of Behavioral Health for Flagstaff-based Native Americans for Community Action, which started a telebehavioral health program about a month ago. “I’ve learned a lot about the big picture of telemedicine and its administration as well. I really appreciate learning about all the resources that are available online and through ATP.”
The conference provided an overview of telemedicine as well as an in-depth look at clinical applications. Designed for those who are new to telemedicine as well as those interested in expanding the scope of their telemedicine services, it included discussions of:
- Telemedicine, telehealth, and mobile health applications – building a successful telemedicine program (Ronald S. Weinstein, MD, ATP Director )
- ¡Vida!, a video-based educational series for breast cancer patients and their healthcare teams (Ana Maria Lopez, MD, ATP Medical Director)
- Using videoconferencing to teach northern Arizona providers how to provide Hepatitis C care (Sean Clendaniel, MPH, Director of Education and Research, North Country HealthCare)
- Teleneurology and telestroke (Bart Demaerschalk, MD, FRCPC, Professor of Neurology and Director of the Mayo Clinic Telestroke and Teleneurology Program)
- How to evaluate telemedicine programs and where to find resources and guidelines (Elizabeth Krupinski, PhD, ATP Associate Director for Evaluation and SWTRC Director)
- Selecting telemedicine technology (Gigi Sorenson, RN, MSN, Director of Telehealth, Northern Arizona Healthcare & Janet Major, ATP Associate Director for Facilities)
- Business aspects of telemedicine (Donald Graf, Director of Telemedicine, UnitedHealthCareTM)
- Teleradiology and how to select a teleradiology vendor (Tim Hunter, MD, Professor, University of Arizona Department of Medical Imaging)
- Telecardiology and telediabetes outreach (Donna Zazworsky, RN, MS, CCM, FAAN, Vice President of Community Health and Continuum Care, Carondelet Health Network)
- Telespychiatry (Sara Gibson, MD, Medical Director of Telemedicine, Northern Arizona Regional Behavioral Health Authority)
- Telemedicine best practices and tips for success panel (Sorenson; Weinstein; Lopez; Hunter; Krupinski; Sue Sisley, MD, ATP Associate Director, Interprofessional Education; Mike Holcomb; ATP Associate Director, IT; Nancy Rowe, ATP Associate Director, Outreach)
Attendee Lynn Bedonie, Telemedicine/School Health Specialist for Tuba City Regional Health Care Corporation, has been involved in telemedicine for more than 16 years. “We were one of the original charter sites for the Arizona Telemedicine Program,” she said. “So I’ve been there from the beginning, from when we used modems to now—and everything in between.” Bedonie came to the training to learn more about billing and teleneurology. “A lot of it was really informative, even though I’ve been to several of these,” she said. “The information changes all the time.”
The conference attracted 84 attendees from private and governmental healthcare systems and hospitals; community health centers and behavioral health clinics; tribal health departments and medical centers; and commercial telemedicine medical services providers. Participants included CEOs and other senior leadership; doctors, nurses, and other clinicians; IT directors and staff; administrators at all levels; and health educators, with experience ranging from clinicians just starting to think about using telemedicine in their private practices to hospital senior administrators who want to add sites and services to their already successful telemedicine programs.
Gigi Sorenson, Northern Arizona Healthcare Telehealth Director and one of the speakers, said, “I came hoping to learn more about other programs across the state and also to hear the needs of the state.” She heads “Care Beyond Walls and Wires,” which has improved patient health and reduced hospital readmission rates through home monitoring systems. “I thought it was a very comprehensive program,” she said, citing the opportunity for casual conversation and questions at the end of every presentation as the most helpful part of the conference. “I’m very happy that it was held in Flagstaff, and grateful for the opportunity to showcase all the work that’s being done in northern Arizona.”
Northern Arizona Healthcare was one of the co-sponsors of the conference, along with North Country HealthCare and Northern Arizona Regional Behavioral Health Authority. All three entities currently operate successful telehealth programs based in Flagstaff and, together with the ATP, they form the Northern Arizona Telemedicine Alliance, a partnership aimed at encouraging and enhancing telemedicine services in the northern part of the state. The SWTRC also was a sponsor. Director Elizabeth Krupinski, PhD, said, “The event was a huge success! Participants were eager to learn and the number and depth of the questions being asked was impressive. Telemedicine is clearly a core part of healthcare in Arizona and will continue to grow.”
This marks the first time the training program has been offered onsite in northern Arizona, but not the last. “We will be offering this program in Flagstaff at least annually from now on,” said ATP Director Ronald S. Weinstein, MD. “The response was overwhelming; people were wait-listed. We want to ensure that all those who are interested get a chance to attend this training.” Sorenson agreed: “You could see by the participation in the auditorium that repeating this at least on an annual basis is well worth the time and effort.”
Is Interstate Medical Licensure Around the Corner?
For years telemedicine has had a significant barrier – interstate licensure. Clinicians regularly see patients in their offices who live out of state, but when it comes to telemedicine they have for the most part been prohibited from doing this. In fact, it is easier to see an out-of-state patient when they actually leave the country by telemedicine than when they stay home.
This might all be finally changing. In November representatives from state medical boards from around the US announced after a meeting of the Federation of State Medical Boards that they had made progress in a new option for medical licensing that will speed up issuing licenses for physicians who want to practice in multiple states.
The proposed system is called the Interstate Medical Licensure Compact and physicians who are interested in practicing in multiple states would be able to receive a license in each state and be under the jurisdiction of the state medical board where the patient is located at the time of the medical interaction. The participating state medical boards would still retain their licensing and disciplinary authority but would agree to share information and processes essential to the licensing and regulation of physicians who practice across state borders.
For both states and physicians participation would be voluntary, but from the telemedicine perspective it is huge! There would be a significant reduction of barriers, helping facilitate licensure portability and telemedicine.
The committee is still finalizing the document and language in the document, dealing with key issues such as physician eligibility, information-sharing between boards, and disciplinary responsibilities.
The proposal has recently been applauded by 16 US Senators including. If your senators are not aware of this effort it may be worth your time and effort to make them aware and recruit their support!
With any luck will see significant progress on the critical issue in 2014!
What’s New in Medicare Reimbursement?
Telemedicine is slowly making progress in terms of more and more CPT codes for reimbursement being approved each cycle. For CY 2014 there are 2 new codes that have been added to the list of Medicare telehealth services!
The first one is CPT code 99495 for Transitional Care Management Services. There are required elements including communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, medical decision making of at least moderate complexity during the service period, and a face-to-face visit within 14 calendar days of discharge.
The second related one is CPT code 99496 for Transitional Care Management Services. This one as required elements as well including communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge, medical decision making of high complexity during the service period, and a face-to-face visit within 7 calendar days of discharge.
This policy basically allows the required face-to-face component of both services to be provided through telehealth!
There are some other exciting things that are being finalized. First is the regulatory definition of “rural HPSA” for determining eligibility for Medicare telehealth originating sites. It will include HPSAs in rural census tracts (so it is consistent with rural as defined by ORHP). There is actually a useful tool that you can download that will help providers determine their geographic eligibility for Medicare telehealth services. It’s called the Medicare Telehealth Payment Eligibility Analyzer and can be found at http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx
They are also finalizing a provision so that geographic eligibility for an originating site is established and maintained on an annual basis. This makes things consistent with other telehealth policies.
So things are always looking better for telemedicine!
What’s New in Teleradiology?
Teleradiology has been around for quite a while and is rather established and quite widespread. So what could possibly be new? Surprisingly there is a lot of research still be conducted in teleradiology and at the recent RSNA (Radiological Society of North America) some interesting studies were presented.
First – a bit about RSNA for those who have never attended. It is the largest radiology meeting in the world and is approaching its 100th annual meeting! It is always held the week after Thanksgiving and always in Chicago at the McCormick Center – and it fills the entire building ! This year there were over 54,000 attendees from all over the world (130 countries), with 40% from outside the US. 5207 attendees were trainees – residents for the most part but a few medical and graduate students as well. There were 662 exhibitors (105 first time vendors) utilizing 43,675 square feet of space! If you have never been it is an amazing experience – it can take the whole week just to visit all the vendors. Bring your sneakers!
A relatively new option for those who cannot attend is the Virtual Meeting. There are two lecture rooms set aside with dedicated broadcasting equipment and a variety of lecture topics are presented (CME available too!) throughout the meeting. This year 5690 people from around the globe participated virtually! 46% of the Case of the Day diagnoses were submitted virtually! The program itself had 238 refresher courses, 89 collaborative multi-session courses, 2,775 scientific sessions and 2,223 education exhibits (both electronic and traditional hardcopy.
So what was new in teleradiology? Going mobile! There were a number of studies assessing the feasibility of using tablets and SmartPhones for diagnosing images. For example, Seong et al. “Is the teleradiology consultation using a smartphone with mobile PACS helpful when an on-call radiology resifdent is not confident about the presence of appendicitis?” compared CT scans read by an in-house abdominal radiologist, an on-call radiologist (both using a commercial mobile PACS) and 2 off-site abdominal radiologists using iPhones. The iPhone readers actually performed better than the on-call radiologist! Mahmood et al. “How good is the iPad for detection of pneumothorax on chest x-ray? Diagnostic performance of radiologists and emergency medicine physicians” found that accuracy was 95% for detecting pneumothoraces with the iPad vs 97.4% for the PACS monitor (p = 0.03) and radiologists did better than ER physicians. The differences were mostly due to poorer detection of small pneumothoraces. So – still some limitations.
An interesting study by Yun et al. “The use of mobile devices for specimen mammography interpretation: feasibility study” compared analyses of specimen radiographs (images of tissue removed during surgical removal of cancer to determine if all the margins are clear) and found that diagnoses made with a Nexus10, Galaxy Note and iPad were comparable to those made with a 5 Mpixel display! This suggests that interpretation of these images could be done much faster reducing time in surgery for patients.
What else was talked about? Quality and security – which are very common telemedicine issues were common topics. Eigles et al. “Enhancing turn-around-time (TAT) on stroke protocol head CT reports via continuous quality improvement (CQI) methodology in a busy teleradiology practice reduced the number of delayed cases by implementing CQI to no more than 1 per month (delayed = > 15 minutes TAT). David Hirschorn organized a Radiology Informatics Series on Mobile Computing Devices and covered such important topics as platforms & security, global market analyses, how to develop & create mobile apps, bandwidth & integration for apps, security systems, and display quality.
Finally, globalization of teleradiology was often discussed attesting to the reach of technology and mobile devices around the world. Rehani et al. developed a survey (“Making imaging around the world better: global survey of radiologists in 10 countries”) to assess imaging needs and local opinions about how to effectively improve imaging in developing countries. The survey can help radiologists wanting to initiate humanitarian efforts to improve imaging services. Obviously there are lots of new directions and options for teleradiology today.
Stay tuned for updates after the 2014 RSNA meeting!
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