Teleradiology: Coming of age?

Teleradiology has seen a boom in the wake of the COVID-19 pandemic, but mitigating risks and challenges in this sector is key to optimise its potential to enhance patient care

The immediate availability of diagnostic services, which plays a crucial role during medical emergencies accompanied by imbalance between the high demand of radiology services and available ratio of the healthcare professionals calls for the adaptation of services like teleradiology. Moreover, the potential of technology in healthcare has always excited the technology oriented and gen next of healthcare professionals.

Today, teleradiology helps in better utilisation of workforce, provides good quality metrics and accelerates speed and accuracy of reporting. This health tech mode of radiology played even a bigger role during the pandemic by reducing the load on healthcare professionals and transferring and sharing the reports and scans globally among the healthcare community.

However, the diverse nature of medical data, from records to images and live teleconsultations amongst others, results in a wide range of volume that must be managed. In addition, remote handling and transmission of medical data must face challenges such as medico-legal implications and data security including the non-availability of proper teleradiology infrastructure.

Talking about the role of teleradiology during the pandemic, Dr Harsha Rajaram, COO, Aster Telehealth, India and GCC said, “The biggest testament for teleradiology and its role was during the COVID pandemic. Like other healthtech solutions during the period, teleradiology became a pragmatic delivery mode and saw a significant adoption during the period. Radiology and teleradiology played a significant role in early pandemic in limiting the spread of the infectious, considering the sparse availability and time taken for lab investigation. In few places, radiology investigation was the only option available for screening, The sudden spurt increased the demand for teleradiology services by nearly 150 per cent, across the country especially for CT chest and Xray reporting. Many teleradiology providers emerged during the period and were able to deliver for this specific COVID needs. Artificial intelligence greatly helped in real time covid screening and reduce radiologist burnout resulting from this sudden spurt.”

How effective is teleradiology in India: Market status

As per Marketsandmarkets, “The teleradiology market is expected to reach $14.8 billion by 2026 from $7.3 billion in 2021, at a CAGR of 15.3 per cent during the forecast period of 2021 to 2026. Due to the outbreak of coronavirus globally, there is a sudden rise in the demand for teleradiology services. In 2021, teleradiology market reached to $7.3 billion.”

Vikram Thaploo, CEO, Apollo Telehealth explains, “The healthcare industry in India is witnessing sharp growth across various sectors, radiology being a prominent one. The world of technology and imaging is constantly evolving, opening up new avenues to a new world of innovations. According to TMR (Transparency Market Research), the worldwide tele-radiology market was valued at $2.6 billion in 2018 and is expected to grow at a CAGR of 16.9 per cent from 2019 to 2027.”

With a noticeable shift towards preventive healthcare from prescriptive healthcare not only in India but across the world, tele-radiology is further gaining significance as it allows faster and better dissemination of patient information to physicians. The COVID-19 pandemic has also catapulted the growth of tele-radiology services in India, emerging as a key solution to rapidly report the huge number of images generated. As India continues to face a severe shortage of radiologists, tele-radiology is turning out to be a viable option to act as a stuffing buffer”, he added.

The growth of this market is mainly attributed to the rising geriatric population and the subsequent increase in the prevalence of associated diseases; the increasing number of advanced imaging procedures and a shortage of skilled radiologists; advancements in teleradiology the increasing adoption of cloud-based solutions.

Stressing on the possible factors responsible for this sector’s growth, Dr Gur Prasad Vashisht, Director Radiology, Asian Institute of Medical Sciences added, “The rapid expansion of the information technology (IT) sector is one of the key reasons for the growth of the market in the country. Moreover, India is witnessing a considerable rise in the number of individuals suffering from cancer and osteoarthritis which is catalysing the demand for teleradiology in the country. Other factors such as social distancing and quarantine measures undertaken due to the coronavirus disease (COVID-19) outbreak are responsible for the increase in the utilisation of teleradiology in India.”

Dr Sunil Narayanaswamy, Consultant Radiologist, BGS Gleneagles Global Hospitals, Bangalore also highlights that, “Teleradiology like every other branch of telemedicine, owes its birth to imbalance between demand and supply. Up until very recently, teleradiology was only used in emergencies. But with the advent of accessible and affordable internet, this practice has begun to spread very fast and wide. It is as easy to send images as it is to send emails that have attachments. There are now computer programs that are dedicated specifically to the transmission of radiological images. These developments have subsequently resulted in teleradiology turning into a significant medical practice, and it continues to grow in importance.”

Sharing his insights on the teleradiology market, Sunil Thakur, Partner, Quadria Capital said, “Digital tsunami is rapidly revolutionising healthcare, albeit in different ways and stages, across the world and especially in high tech adoption countries like India. Among the many segments of healthcare that are pacing up on this digital highway, teleradiology is one segment that has a substantial potential to achieve deepest impact both in terms of attending to high unmet need as well as to support supply side in the most consistent and wholesome way.”

The teleradiology segment in India has grown upwards of $350m growing at 15 per cent pa, thanks to both global and local demand. It is mainly dominated by x-rays with 40 per cent followed by CT at 35 per cent and MR at 25 per cent. The Value proposition and service offerings straddles all the way from simple workflow management, to scan reads to supporting training, population health management, second opinion going all the way to deep tech anchored by sophisticated AI. Each of the services have varying degree of manual intervention and that’s what defines the product sophistication. That said, to a very large extent, the success of teleradiology will depend on how it integrates with and supports the radiologist”, he added.

Weighing the pros and cons

As per industry experts, the advantages of adopting a teleradiology in Indian healthcare system is way more than its disadvantages except few like data privacy and availability of enough teleradiology solution providers in the Indian market and sometimes miscommunication and confusion in terms of analysing the final diagnosis in the process of a scan going through the acquisition, storage, transfer, and final view.

Also, since teleradiology is technology dependent, if the internet is down at the hospital, telereporting cannot be done. This could result in a delay in diagnosis and treatment.

Stressing on the pros of teleradiology, Ayanabh DebGupta, Co-founder & Jt. Managing Director, Medica Group of Hospitals said,Teleradiology allows ordinary radiology hospitals to submit complicated pictures to larger medical institutes for review. Furthermore, clinical radiologists can obtain a second opinion from a specialist without transporting the patient, reducing patient suffering, and enhancing service delivery efficiency. It also plays an important role in enhancing service to rural areas and can ease the present radiology deficit by giving access to specialised radiologists in locations where healthcare inequalities exist. An MRI done on a cutting-edge scanner in India costs a few thousand rupees, which is substantially more in US money. At these prices, having an Indian radiologist report outsourced scans might provide a major financial benefit.”

Dr Roshan Shetty, MD, DMRD Radiology and Director Pinnacle Imaging explains that,Teleradiology in India has been done mostly for CT scans, MRIs, and sometimes for X rays. It is not used in sonography as it is operator-dependent. In essence, teleradiology is being used to fill the gap between demand and availability of in-person diagnostic services. It is used in case of emergency when a good-quality radiologist is unavailable. Therefore, this last-minute resort is predominately used in tier 3 cities and its peripheral areas. The situation is entirely different in metros and tier1 cities, where radiologists are clinically connected with the patient and conduct proper investigations of a patient’s medical history.”

It’s difficult to get high-quality services through this technology which, although has been used in India for over 2 decades, is less accurate than a physical radiology inspection. Those performing teleradiology is also not as highly qualified as a clinical radiologist. That being said, its most important advantage is how it reduces the burden of case inspection for any senior radiologist. That advantage has made India a solid supporter of US-based radiologists, as teleradiology provides the first round of scanned data to those experts. On the other hand, excessive use of teleradiology is rendering young radiologists, who want to work on CT scans and MRIs, unemployed. Many hospitals install their own teleradiology machines, for which a clinical radiologist misses every assignment that teleradiology covers”, he added.

Emphasising on the cons, Dr Nikhil Kamat, Senior Consulting Radiologist and Head of Department of Radiology, Jupiter Hospital says, “The other side of teleradiology brings to the fore the concerns about protecting sensitive patient information from miscreants. While it is HIPAA compliant, there is always a possibility of confident data being leaked when transmitting data electronically. Radiology practice needs to adequately assess and address the security risks to protect patient names and other sensitive identifying information that can be accessed by unauthorised individuals. Besides the risks of leakage of patient data, teleradiology might face an uphill task to be accepted by physicians who find it hard to understand and embrace new technology. Also, some facilities with a high attrition rate may find it difficult to dedicate time to training their staff in various components of teleradiology. Tele-radiology from remote areas or studies done in emergency hours that may be performed without supervision of radiologist – may not be optimum. Medico-legal aspects in such and other situations of tele-reporting also need to be addressed. Providers need to work closely with their medical imaging vendors to find ways to make this industry innovation work in their favor.”

Dr Sanjeev J Mudakavi, Consultant-Radiologist, Manipal Hospital Millers Road considers small markets and lack of board-certified radiologists as one of the major hurdles for Indian teleradiology market. He said, “For Indian teleradiology, the main open markets at the moment are the US, Singapore, and UK. English-speaking nations and those where the cost difference makes financial sense are the ones that are most likely to look to outsource teleradiology. Few countries meet these requirements, and certain European nations, as well as New Zealand and Australia have succeeded in leveraging their advantages to establish themselves as outsourcing hubs.”

Due to the significant variations in pay between India and the US, radiologists who pursue board certification there may be reluctant to return. The handful that does return may do so for reasons related to their “Indian” ideals, their way of life, or their families. “

Need of the hour

While India is making great strides in strengthening its healthcare system and services, the weakest link that continues to disrupt the improvements is the unavailability of specialised manpower. Teleradiology is already proving its worth in terms of number of advantages it can offer to Indian radiology system. The need of the hour is to engage with public sector healthcare organisations in a PPP model to ensure the smooth implementation of teleradiology in India.

Talking about the need of the hour, Dr Nitin P. Ghonge, Senior Consultant, Department of Radiology, Indraprastha Apollo Hospitals highlights, “In the present era of Evidence-based Medicine, Tele-radiology services should be in sync with the clinical profile of the patient and should be integrated with the tele-consultations. Tele-radiology services should not only be confined to generating a piece of paper without any correlation with the clinical background. Tele-radiology services should address the clinical problem, address the diagnostic dilemma, and serve the purpose of providing direction to the healthcare delivery in a more comprehensive manner. Most of the present tele-radiology services are not fulfilling these requirements and should be more inclusive in approach. As with clinical radiology practice, tele-radiology should have a ‘patient-centric’ approach and ‘problem-solving’ attitude. Tele-radiology services of the future should essentially include ‘direct online consultation’ between the patient and the Radiologist. This will ensure that the image interpretation is appropriate and the diagnosis is more precise and clinically relevant.”

Thaploo added, “The need for tele-radiology services is quite evident considering the severe unavailability of trained radiologists in the country. It is the need of the hour to support healthcare institutions that lack qualified radiologists through tele-radiology to create a positive impact on healthcare delivery and in turn, strengthen the healthcare system of India. If tele-radiology services are provided following proper regulations and rules, with a sole focus on quality, it has the potential to provide tremendous value to the healthcare industry and the public overall.”

Dr Narayanswamy suggests, “The modern practice of radiology involves several different healthcare professions working as a team. Teleradiology utilises standard network technologies such as the internet, telephone lines, wide area network, local area network (LAN) and the latest high tech being computer clouds. So, it is imperative to have quality and affordable technology available at the most remote parts of the country. Adequate care should be taken to avoid loss of quality of radiological images / information during transmission or display. Communication lines should be robust, easily accessible and the subject of a mutual contractual agreement. Provision to access clinical information of the patient including lab investigations, previous imaging etc. helps in delivering quality and clinically relevant reports by the teleradiologist.”

digital healthdigital scanningradiologyteleradiology
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