Teleradiology models traditionally have been structured so that medical centre sites with inadequate radiology specialist staffing forward imaging studies electronically to sites with either excess radiology staffing capacity or subspeciality services. This asymmetrical, "one-way only" model lacks flexibility in real world situations where medical centres' capability to provide consultation services can vary from day to day. A more sophisticated and efficient model for teleradiology that allows dynamic, bi-directional transmission of imaging studies would be a very useful tool for solving work flow load-balancing issues. This new model would maximally leverage radiologist resources regardless of location or particular local work demand.
Nearly two years ago, UPMC began using an innovative approach to teleradiology at the medical system's 19 tertiary, speciality and community hospitals. The new work flow model, created by Paul Chang, M.D., director of radiology informatics at UPMC, creates a true co-operative community with a different paradigm. Each radiologist at UPMC is electronically linked to a global system that provides access to all cases across all radiology departments throughout the health system.
The symmetrical model creates a system of load balancing where individual physicians complete their local patient cases first, then can review and service any remaining cases in the system. Physician work flow is therefore maximally leveraged, regardless of location. This is in contrast to traditional telemedicine models, designed as hub-and-spoke work flow systems, that frequently have increased the caseload gap that exists between large central medical centres and smaller community hospitals.
"The traditional, asymmetrical method of distributing the radiology caseload has resulted in an uneven distribution of resources, creating a logjam of cases at some centres while leaving radiologists at others underutilized", stated Dr. Chang. "The new UPMC model was developed to take advantage of a two-pronged approach of improving patient care and increasing training opportunities among physicians, creating a win-win situation where everyone benefits."
By augmenting UPMC's Stentor image distribution model with the new sophisticated work flow engine, UPMC saw a three-fold rise in productivity and cost savings of approximately $7 million in its first year. The new work flow model is being used at Wright-Patterson Air Force Base to link AFMS sites and improve service. By working co-operatively, physicians across the AFMS network can assist each other via a standard approach of training and take advantage of constant educational opportunities. Patients in turn will benefit from improved quality of care.
"This new work flow model is going to be an invaluable tool to the military overall, beginning with the Air Force", stated Lt. Col. Todd Carter. "In terms of mission-readiness, this system doesn't miss a beat. Now, Air Force doctors not only will have the opportunity to improve their quality of delivering patient care by seeing a diverse range of cases, but they also will become interchangeable, literally, when they need to be."
The UPMC/AFMS teleradiology initiative was made possible by the Integrated Medical Information Technology System (IMITS) programme, a partnership between UPMC and the Department of Defense. IMITS was created in large part due to a decline in both private and military sectors of specialists, essential for the accurate diagnosis and treatment of medical conditions in radiology and other fields. In January 2002, UPMC and AFMS joined forces to develop an advanced technology system to ease the transition to telemedicine in the military.
"We are excited to see this initiative launching with the Air Force", stated Dan Drawbaugh, chief information officer of UPMC. "Since the initiation of the IMITS programme, the primary goal has been to assist the military as it improves its medical capabilities, and this teleradiology initiative does just that."
The University of Pittsburgh Medical Center (UPMC) is a non-profit, comprehensive academic health care system affiliated with the University of Pittsburgh Schools of the Health Sciences. Their combined mission is to provide quality patient care, educate the next generation of health care professionals and advance biomedical knowledge through basic and clinical research.
UPMC is considered the leading integrated health care delivery system in western Pennsylvania and one of the largest in the United States. UPMC has more than 37.000 employees, making it the largest employer in western Pennsylvania. With a network of 19 tertiary, speciality and community hospitals, located in both rural and urban settings; 225 physician practice offices throughout western Pennsylvania; and several nursing, personal care and long-term care facilities, its services represent the full continuum of care.
The Air Force Medical Service works in close co-ordination with the Assistant Secretary of Defense for Health Affairs, the major air command surgeons, the departments of the Army, Navy and other government agencies to deliver medical service for more than 2,57 million eligible beneficiaries. Beneficiaries include active duty, family members and retirees, during both peacetime and wartime. The AFMS consists of approximately 42.000 officers, enlisted and civilian personnel, plus an additional 20.000 members assigned to the Air Force Reserves and the Air National Guard. The AFMS has an annual budget of approximately $5,9 billion and runs 74 military treatment facilities, including five medical centres.