When Telemedicine Does Deliver!. Donoso-Bach L. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. When telemedicine does deliver!
Lluís Donoso-Bach, Barcelona/ES
Professional Organisation Committee
Chairman and ESR Executive Council member

2. The ICT situation in Catalonia
Information
Our vision
Information • Telemedicine applications:
Systems and
clinical
Systems
information
processing • Telediagnosis (27 centers)
• Radiology 66,7%
Connectivity,
interoperability, Security
telemedicine • Pathology 12,5%
• Others 20,8%
• Teleconsultation (20 centers)
• Dermatology 43,8%
• Cardiology 18,8%
• Pediatrics 12,5%
• Telemonitoring of chronics (8 centers)
• Diabetes 37,5%
• HTA 25,0%
• EPOC 12,5%

3. • Teleradiology has a number of well-defined
benefits which have already become
established and recognised .
• There are however many potential pitfalls,
especially if teleradiology moves from its
present highly specific role to a general
method of service delivery.

4. Benefits
• For those communities which lie at a considerable
distance from a major centre and where there is
insufficient work to justify the appointment of local
radiologists.
• Images of complex problems can be transmitted to
major tertiary centres for evaluation and advice.
• Tertiary centres can decide whether a patient needs
transfer from the smaller hospital to the tertiary
centre for treatment without unnecessary
discomfort and disruption for the patient.

5. Benefits
• To provide emergency reports on images where the
local centre does not have sufficient radiologists to
provide a 24hour cover.
• Improved continuing professional development.
• Permits users to view images in different locations
simultaneously for the purpose of discussions.

6. Real and Potential Problems
 Communication
• Clinic-radiological communication
• Team Working
• Linguistic Problems
• Wording of report and clinical impact
 Access to Previous Examinations

7. Real and Potential Problems
 Downstream Costs
 Quality Control:
• Learning from mistakes through
participation in radiological
discrepancy/error meetings
• It is difficult for teleradiology services to
have a proper feedback of the outcome
and undertake satisfactory audit of their
reports.

8. Real and Potential Problems
 Legal issues:
• The registration of the reporting doctors.
• Appropriate CME
• Properly trained
• Abide EU Health and Safety legislation
• Medico-legal liability
• Consent
• Jurisdiction
• Patient Confidentiality
• To comply with Euratom directive

9. Telemedicine Communication
COMMUNICATION FROM THE COMMISSION TO THE
EUROPEAN PARLIAMENT, THE COUNCIL,
THE EUROPEAN ECONOMIC AND SOCIAL
COMMITTEE AND THE COMMITTEE OF THE REGIONS
on telemedicine for the benefit of patients, healthcare
systems and society
Brussels, 4.11.2008
COM(2008)689 final

10. Telemedicine Communication
 Aims of Telemedicine Communication:
• Bringing legal clarity
• Solving technical issues and facilitating
market development
• Building confidence in and acceptance
of telemedicine services

11. Telemedicine Communication
ESR Position:
• Teleradiology is a medical act in its own right
• Establish accreditation criteria for teleradiology
providers that are homogenous throughout the EU
• Emphasis on the importance of delivering high-quality
healthcare to the patient
• Cost savings must not come at the expense of quality
or safety – international standards needed – careful
monitoring of service providers

12. Telemedicine Communication
ESR Position:
• The regulation of telemedicine and teleradiology
should be the responsibility of the member state
where the patient undergoes the imaging procedure
or telemedical referral
• Legal clarity
• Full information of patients & informed consent
• Importance of interoperability and standardisation

13. Development of teleradiology
LEGAL:
ESR stresses the importance of bringing clarity.
A legal framework related to teleradiology and
common to all Member States would pave the way to
the trusted development of teleradiology as a medical
practice

14. Development of teleradiology
TECHNOLOGY:
Having the relevant ICT infrastructures (e.g. broadband
availability for all) with consistent attention to the
implementation of measures aimed at ensuring
respect for the right to protection of personal data.

15. Development of teleradiology
ORGANISATION:
The introduction of teleradiology into clinical practice
requires re-engineering of clinical pathways, medical
protocols and management of human resources, with a
noticeable impact on the overall healthcare-delivering
system (both public and private).
The ESR agrees that all stakeholders (including patient
associations) should be alerted to the potential as well
as the pitfalls of teleradiology.

16. www.myESR.org