Bob Bury

Private providers will win the telemedicine lottery

And so it begins, or perhaps I should say – continues; the car boot sale that is the NHS is gathering steam, as Dave’s mates circle to pick at its corpse (if nothing else, I mix a mean metaphor). Still, at least our leader, while he may have disappointed Mr Obama over Syria, is doing his bit to restore the special relationship by extending his largesse to American healthcare companies.

We mustn’t be unfair to Mr C, though – he is only responding to the realities of life as the leader of a political party, given that 13% of the Tory party income is derived from donations by the commercial healthcare sector.

These are especially worrying times for my fellow radiologists as, predictably, diagnostics is at the top of the bestseller list in the government’s pile-it-high-sell-it-cheap attempt to emulate the inefficient, expensive and relatively ineffective US healthcare system. That was always going to be the case, because everyone knows that radiology is just a scan and a report; no need for any personal interaction with the patient, and one radiologist is pretty much like any other.

Also, of course, with the exception of hands-on elements of the radiology service – interventional radiology – the specialty can easily be commoditised thanks to the wonders of teleradiology.

Once images are acquired they can then be directed, at the flick of a switch, to any cheap convenient radiologist, anywhere in the world, for reporting. That report can then be bounced back in real-time, and it’s just like having your own radiologist down the corridor. Except, of course, you don’t know the radiologist in question, and you can’t wander down the corridor to discuss a difficult case and arrange follow-up imaging, because the corridor’s in another country.

Also, you don’t know – how can I put this? – how good they are at their job.

Of course, we’ve been this way before. The previous government decided, (correctly) that PET/CT was a valuable new imaging modality which needed to be more widely available, but insisted (unwisely) that it must be provided by the private sector, initially using mobile scanners, and that the resulting scans should be reported remotely – in our case, in Spain – again, by non-NHS radiologists.

The result was inevitable because the main application of PET/CT is in the diagnosis and staging of cancers and in the assessment of response to treatment, oncologists would take the images to their ‘own’ radiologist who they knew and trusted to get their opinion. In other words, the NHS was paying twice for the same report, or in some cases, for two very different reports.

As it happened, the private company concerned were unable to make the image link to Barcelona work reliably (or, indeed, at all), and eventually HMG decided to cut out the middleman and let our own radiologists do the primary reporting (apologies if I have mentioned issues with the PET/CT procurement before).

This is not only a problem for radiology; it just so happens that teleradiology is better established than other aspects of telemedicine, but where we lead, others will follow. And it really is the Wild West (or more likely, East) out there.

The EC has dodged the issue of cross-border regulation of telemedicine services, with the consequence that the European Society of Radiology can make this slightly chilling statement: ‘In some Member States teleradiology is not designated as a medical act and it is therefore conceivable that the patient may have their images interpreted by an individual who is not specialist, and who may even lack a medical qualification’.

And that’s in mainland Europe: some images are being reported in much further afield in even less regulated environments. So if you thought I was wrong to raise the issue of the competence of teleradiologists earlier in this piece, think again.

And there you have it, thanks to Andrew Lansley and David Cameron, healthcare has become a lottery. Only for patients, of course – for private providers of healthcare, it’s a publicly-funded bonanza.

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2 Responses to “Private providers will win the telemedicine lottery”

  1. Malcolm Morrison says:

    “Never mind the quality, feel the width” springs to mind!

    I always thought that the most important thing in a radiology report was the radiologist’s signature!

    We are now subject to the ‘worship’ of Mammon! Our beloved bean counters “know the cost of everything; but the value of nothing”!

    I’ll bet that when they are ill they will want to be treated by a doctor who knows and ‘consults’ with colleagues they can trust.

  2. JM says:

    Some thoughts: if radiology reporting is done by staff based outside the UK, how are they to be appraised, regulated and revalidated? And who in our Trusts or the NHS takes medicolegal responsibility for the quality of remote radiology reporting? It will be interesting to see what happens if (or rather when) legal actions arise with this system.

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