teleradiology: technology and innovation supporting improvement

Teleradiology: Technology and

innovation supporting improvement

Seven-Day Services supporting

Improved Outcomes in Prevention

and Early Diagnosis

The Hotel Russell, Bloomsbury, London

4th March 2013

Problems

•DGH radiologists on call

•Immediacy of reports – brain

and heart attack centres

•Back Log

•Unreported films

•Computer generated Junk

Report

•Poor RIS connections

•HL7 in/out

•Growth of radiology CT/MR

•24/7 hospitals

•Sub specialisation

•Radiographer reporting

•“Counting”

Solutions

•Hammersmith/Charing Cross

Solution

•“Usual” method

•Watford method

•Separate radiography from

radiology

Solutions

•How many should you

report

•Cricket example

•Gishen Ready Reckoner

05/0

3/20

13

6

Bowling averages

Sir Wes Hall

Competition Test

Matches 48

Runs scored 818

Batting average 15.73

Top score 50

Wickets 192

Bowling average 26.38

Best bowling 7/69

Batting and fielding averages

Sir Leonard Hutton

Mat Runs HS

Test 79 6971 364

First

Class

513 40140 364

Average

56.67

55.51

Batting and fielding averages

Sir Denis Compton

Mat Runs HS

Test 78 5807 278

First Class 515 38942 300

Average

50.06

51.85

Gishen’s Ready Reckoner

Is your work output sufficient?

Average no. of

cases for the

year

Checking

SpR

report CT/MR Cardiac MRUS Reporting Intervention Complex

Super

complex Neuro Coil

Per hour 100 100 40 100 600 40 20 10 5

Barium Nuc Med PET CT

SPECT

CT / LT

Therapy Screening Sympto

60 100 40 5 600 200 40

KEY

* Assume you work 40 weeks in the year (leaving 12 weeks for leave, study leave, illness, meetings, machine breakdown or non function)

* You are contracted to work 30 clinically related hours (+3 hours [10%] for private work)

* Use your work output and calculate 'value for money' ie does 33 hours of timetabling per week, match your yearly statistics?

* Example - you are expected to do an aaverage of 2.5 CT or MR reports per hour -average 2.5 CT or MR reports per hour

Therefore: 1 hour x 40 weeks is 2.5 x 40 = 100 reports

So: If you report 500 CT and 400 MR scans (900) this is equivalent to an average of 9 hours of work per week

during your year's work. Average salary per consultant including on costs to Trust +120,000 per year

Breast

Sypto+U/S+biopsy

� 3000 CT reports = 30 hours of timetable per year

Average salary of consultant and all the added costs = £120,000pa

∴ Divide 3000 into £120,000 = £40 ∴ Divide 3000 into £120,000 = £40 ∴ Divide 3000 into £120,000 = £40 ∴ Divide 3000 into £120,000 = £40 per scanper scanper scanper scan

� Now add in the total time spent on MDTs for each of the medical staff to get your grand total of clinical

hours worked.

A maximum of ¼ of your weekly

hours for MDT activity

Still maybe short on

reporting capability?

•Four options:

�Increase staff

�Locums

�Insource

�Outsource

What department can produce a consultant report on an A&E

examination within 30 minutes at 0300hours on a regular basis?

NONE ?

Possible in a digital outsourced world

It is not sending films out of

your department, rather

bringing in a reporting

resource into your

department

Just like a locum

radiologist with

resilience

In-sourcing –vs- Outsourcing

Misses the point

Embrace outsourcing and it

becomes in-sourcing except

not confined to the bricks and

mortar of a hospital

Virtual Reporting

Network

Radiologists’ perception of

clinicians

•Need to know us

•Like us

•Respect us

•Have relations with us

•Give feedback

•Ask us questions

•Get advice from us

Clinicians perception of

radiologists

•Use radiology departments and

radiologists like toilets – use the first

one available

•No loyalty

Clinicians perception of

radiologists

•What do I get in return for

sending you the case?

•Don’t need your advice

•Someone to practice lies on

•Will desert radiologist at first

opportunity as suits them

THE NEW WORLD

•Phone

•Email

•Twitter

•Facebook

COSTS OF SETTING UP AN

INSOURCING

AND OUTSOURCING

PRACTICE

•Secretariat

•Accommodation, heat lights,

electricity…..coffee

• Timetables, holidays, sickness

• Statistics

•Tenders and Pricing

•Distribution of money

•Innovation and replacement of

equipment

•Development

•Premises

•Manager

•IT and IT Links

•Voice recognition

IT maintenance

IT Update

IT goes down – who

repairs/response time

•Telephone and answering

•Secretariat

•Complaints and resolution

•Double reporting

•Cleaning services and toilets

•All radiologists of a single

department involved (ha ha –

joke! ) )

•Radiology jealousy

•Vendettas

Teleradiology is not the

enemy

Like any

newborn

it needs to

be

nurtured