By Trevor Bromley

When “phoning it in” is a good thing: remote reading in radiology

The pace of technological advancement continues to accelerate. Rather than each new discovery reducing the ability to find the next big thing, it is leading the way. Consider this timeline of years relevant to teleradiology: 1876, 1895, c. 1930, 1971, 1973, 1983 and 1993. Those years correspond respectively to the first telephone call, the first X-ray, the first official accounts of telemedicine (done by radio to and from the ship The Queen Mary), the first email sent over the precursor to the Internet, the first mobile phone call made, the adoption of the DICOM standard, and the introduction of the modern DICOM systems.

The power of telemedicine

Sprinkled throughout that list of years were numerous advancements, but it’s only been in the last few decades that the power of telemedicine and more specifically, teleradiology, has gotten its due. The early history required the dedication and faith of visionaries with the strength to stand against detractors until the medical community recognized the potential. It required the perfect storm of technology, financial interest, medical know-how and forward-thinking legislation and regulation. It also required open minds and an understanding that “never” is a word that should seldom be used when talking about the potential benefits technology might deliver.

For instance, less than a decade ago, many healthcare technology experts anticipated that FDA approval of mobile devices for readings would be many years in the future (if ever). To be fair, the resolution mobile devices provided at the time was not on par with what one would find in a hospital. Today though, the technology held in the palm of one’s hand surpasses the capabilities of that found in some healthcare settings in the early '90s, and readily available mobile devices are nearly at the point that the images they’re providing are as detailed as what the naked eye can discern.

Regulators are realizing this and are finally embracing the potential of mobile devices in regard to teleradiology. As a case in point, EBM Technologies, which received FDA approval for the use of its software paired with the iPad Pro for all reading except mammography. The technology is here, and it is being deployed in the field.

The implications of mobile reading:

Addressing costs

So what does the evolution of mobile reading mean? According to William Pan, founder and CEO of EBM Technologies, “I don’t think it’s an overstatement to say it will revolutionize medicine. With healthcare costs continuing to rise at unsustainable levels, any cost-curbing opportunities are welcome, and remote reading does have the potential to reduce costs.” Remote reading using an iPad Pro is a fine-tuning of cost reductions. Consider the investment a hospital would need to make for a traditional medical-level display – in the area of $4,000 and up. An iPad Pro, which is about one-fifth the cost at $800 and EBM’s Rad@ software is $1,200. So for $1,800 they can provide FDA-approved, medical-level displays for remotely reading everything except mammography at this time. This is to say nothing of facility space requirements for larger reading stations and the physicians that also occupy that space. These costs must also be factored into the equation.

Cutting the tether: efficiency gains and workstyle / lifestyle options

Remote reading also can cut the tether of the doctor to a physical location, providing a number of benefits for the doctor as well as for the hospital. On the doctor’s side, he or she has greater ability to choose where they live (as long as they can get high-speed online access). There’s potentially greater flexibility with their work schedule as well. Their work setting can be finely customized to their personal preferences and their workday can start and end reading imaging exams instead of starting and ending their day with a commute.

For hospitals, remote reading gives the facility access to a wider pool of qualified professionals. This can be especially important for rural hospitals, which already struggle with staffing due to the small population to tap into. Smaller hospitals also have a challenge of having enough work to justify a full-time radiologist. That challenge is compounded when they need the expertise of someone in a subspecialty. They may instead have to make arrangements to share a radiologist with other area hospitals. But the scheduling of reads can be much easier if, again, the commute time for the radiologist is removed.

Of course, a hybrid model is also possible, with a doctor splitting his or her time between on-location and remote reads. And even for facilities with dedicated in-house professionals, the ability to consult with colleagues is elevated through the use of high-quality displays on mobile devices like iPads.

Up until fairly recently, remote access was a challenge due to low connection speeds and even the comfort level doctors had of seeing images on a smaller screen. As society settles into technology through everyday interaction, the comfort level increases. EBM’s Pan believes that the proliferation of consumer technology has gotten physicians, especially younger ones, more comfortable with new, mobile devices. “Our users adapt very rapidly to reading on the iPad Pro, whether viewing on stands or holding it in their hands while on their feet. Working with mobile devices has become more routine, as has working remotely. We believe that with this FDA approval this kind of reading in radiology and beyond will become the standard.”

Investigating the options: vendor neutrality, superior software

If your facility is considering the adoption of teleradiology, it’s important to carefully investigate the options available. For instance, will you have images being read that were captured by equipment from a number of manufacturers? If that’s the case, a vendor neutral solution like EBM’s is probably a must-have. How intuitive is the program? Can it be used on readily available and fairly inexpensive hardware (like an iPad)? Does the company providing the software have a good reputation and do they provide strong customer support?

It’s also possible you don’t need to go it alone with researching tele-solutions. If you’re sharing the services of a doctor with another hospital or hospitals, splitting up the research and discussing as a group (your facility, the other facility or facilities and the teleradiologist) to figure out the remote solution that will work best for all. It may take some time to get definitive answers to all those questions, but the time spent in preparing and planning is almost always less costly (both in minutes and dollars) than the time spent correcting a mistake.