Medico-legal issues in Teleradiology

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Medico-legal issues in Teleradiology

• Aditya Daftary
• Teleradiology Solutions

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Teleradiology

• Needs no introduction
• Teleradiology is a means of electronically
  transmitting radiographic patient images and
  consultative text from one location to another

http//www.radiology.uiowa.edu/MoreRAD/Teleradiol
ogy/Tele.html
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Goals of Teleradiology

• Providing timely consultative and interpretative
  radiologic services
• Making radiologic consultations available in
  medical facilities without on-site radiologic
  support
• Facilitating radiologic interpretations in
  on-call situations
• Providing subspecialty radiologic support as
  needed
• Enhancing educational opportunities for
  practicing radiologists
• Promoting efficiency and quality improvement
• Providing interpreted images to referring
  providers
• Supporting telemedicine
• Providing supervision of off-site imaging studies

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Medico-legal Issues in Teleradiology

• The good news
• A lot of it is still unclear
• The bad news
• Were dealing with lawyers!

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Conceptually simple

• Imaging data acquired at one site
• Network transmits images to a server
• Data can be reviewed and interpreted at a remote
  site
• Report generated and transmitted electronically
  back to the parent site

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Many a slip.

• Qualification
• Liability and Insurance
• Radiologist duties

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Qualification

• Varies
• Country (US, Singapore, UK)
• State
• Institution
• Law can be a little vague
• Best to be safe full qualification in geographic
  area and institute for whom one is interpreting

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Qualification

• Medical board certification
• USMLE/LMCC/recognized MBBS
• Specialty qualification
• ABR/RCPS/FRCR
• Subspecialty qualification
• Certificate of added Qualification (CAQ)
• Licensure
• Credentialing
• CME

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Medical Liability Insurance Why?

• Establishment of a physician-patient relationship
• No case examples, but probably YES
• You are being consulted and you are getting paid!
• Jurisdiction for accountability
• Where do you get prosecuted? Texas or India?
• May not be teleradiologist, but definitely parent
  hosp/group
• UK-Europe Primary/alternative site
• No case examples
• Not too many people going to put themselves on
  the line for you!

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Liability Insurance

• Covers one against possible litigation
• Find someone willing to insure off site/off
  country reading not much experience
• Will look at all qualifications to assess risk
• Costs increase with time
• On site group to get clearance from their insurer
• Teleradiologist must have coverage
• Terms of coverage must be very clear

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Medical Liability Radiologist

• The teleradiologist is as liable as any other
  radiologist in the given setting
• Technical issues
• Interpretation and misses
• Communication

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Medical Liability Technical

• Much of this is now redundant, but there are a
  few areas
• Image acquisition
• Digitized radiographs
• Unsupervised ultrasound
• Patient motion
• Contrast
• Image transmission/viewing
• Some modalities not DICOM compliant (PET)
• Acceptable compression ratio for emergencies
• Appropriate viewing stations mammography,
  radiographs, MPR need
• Patient privacy, data encryption
• Preliminary versus final read

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Medical Liability Interpretation and
Communication

• Teleradiologist has a duty to communicate as
  effectively as any other radiologist
• Typical communication by written report
• Reports to include
• Patient demographics, procedural details,
  relevant findings, impression (unless short)
• Preliminary reports
• Time sensitive, limited by absence of prior etc
• NOT complete reports
• Must provide information to deal with immediate
  care

http//www.acr.org/s_acr/bin.asp?CID541DID12196
DOCFILE.PDF
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Medical Liability Interpretation and
Communication

• Non routine communications
• Situations
• Findings needing immediate intervention
• Discrepant from prior report
• Unexpected, but serious findings
• Direct conversation best others (fax, pager.
  email etc) less reliable
• Must be documented

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Medical Liability Minimizing Error

• Preliminary reports to include relevant issues,
  small details not necessary
• Call when in doubt/something seen later
• Ask for additional/repeat imaging as needed
• Recommend appropriate clarification studies
• Everyone misseshave a good QA system in place

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Summary

• Teleradiology is an excellent empowering
  technology which enhances patient care
• Legal issues on teleradiology are still vague
• A safe strategy is the best strategy
• Do not compromise patient care (primum non
  nocere)
• Appropriately qualified radiologists
• Clear contracts and insurance a must to cover
  liability issues
• Efficient communication in a clinical setting
• Quality assurance programme
• A very friendly lawyer!

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Questions?