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Proceedings Paper

Model for collaboration: a rural medicine and academic health center teleradiology project
Author(s): Mark A. Van Slyke M.D.; Douglas F. Eggli; Fred W. Prior; William Salmon; Gregory Pappas; Fred Vanatta; Warren Goldfetter; Said Hashem
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Paper Abstract

A pilot project was developed to explore the role of subspecialty radiology support to rural medicine sites over a long-distance network. A collaborative relationship between 2 rural radiology practices and an academic health was established. Project objectives included: (1) Does the subspecialty consultation significantly change diagnosis patterns at the rural site? (2) Is there value added as measured by improved clinical care or an overall decreased cost of care? (3) Can a collaborative model be economically self-supportive? (4) Does the collaborative model encourage and support education and collegial relationships? Two rural hospitals were selected based on the level of imaging technology and willingness to cooperate. Image capture and network technology was chosen to make the network process transparent to the users. DICOM standard interfaces were incorporated into existing CT and MRI scanners and a film digitizer. Nuclear medicine images were transferred and viewed using a proprietary vendor protocol. Relevant clinical data was managed by a custom designed PC based Lotus Notes application (Patient Study Tracking System: PaSTS) (Pennsylvania Blue Shield Institute). All data was transferred over a Frame Relay network and managed by the Pennsylvania Commonwealth sponsored PA Health Net. Images, other than nuclear medicine, were viewed on a GE Advantage viewing station using a pair of 2 X 2.5 K gray scale monitors. Patient text data was managed by the PaSTS PC and displayed on a separate 15' color monitor. A total of 476 radiology studies were networked into the AHC. Randomly chosen research studies comprised 82% of the case work. Consultative and primary read cases comprised 17% and 1% respectively. The exercise was judged effective by both rural sites. Significant findings and diagnoses were confirmed in 73% of cases with discrepant findings in only 4%. One site benefited by adopting more advanced imaging techniques increasing the sophistication of radiology services. The primary value for the referring sites was the added confidence provided by the subspecialty overreads. An educational value was recognized by all. In conclusion, the networking of rural health care sites to an AHC subspecialty radiology practice was successful primarily in increasing the diagnostic confidence at the rural site. Other benefits included: education; increased rural imaging and an opportunity to provide primary interpretation when the rural radiologist is not available. However, the rate of rural generated consultation was low (17%) and is unlikely to support the costs of a high speed network. To support, rather than replace, rural radiology requires a lower cost network and a mechanism for payment for these services.

Paper Details

Date Published: 1 May 1996
PDF: 9 pages
Proc. SPIE 2711, Medical Imaging 1996: PACS Design and Evaluation: Engineering and Clinical Issues, (1 May 1996); doi: 10.1117/12.239268
Show Author Affiliations
Mark A. Van Slyke M.D., The Pennsylvania State Univ. (United States)
Douglas F. Eggli, The Pennsylvania State Univ. (United States)
Fred W. Prior, The Pennsylvania State Univ. (United States)
William Salmon, Pennsylvania Blue Shield (United States)
Gregory Pappas, Pennsylvania Blue Shield (United States)
Fred Vanatta, Wayne Memorial Hospital (United States)
Warren Goldfetter, Wayne Memorial Hospital (United States)
Said Hashem, Lockhaven Hospital (United States)

Published in SPIE Proceedings Vol. 2711:
Medical Imaging 1996: PACS Design and Evaluation: Engineering and Clinical Issues
R. Gilbert Jost M.D.; Samuel J. Dwyer III, Editor(s)

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