Establishing the R-Bay website where radiologists can trade their services has been a technological success but a cultural and language divide has restricted it to local development
Claus Duedal Pedersen
Project Manager, OUH Odense University Hospital, Denmark
Peder Jest MD
Director, OUH Odense University Hospital, Denmark
European health systems are under heavy pressure from many sides. Chronic patients are a growing group and are already the main ‘big spenders’ in health systems today. Another big issue is the recruitment problems in the health and social sector. General care personnel are scarce, but also certain medical specialties such as radiology, psychiatry and oncology are lacking expertise.
As the prospect for recruiting sufficient personnel only gets bleaker, given the wider imbalance between capacity need and available resources, the situation will, in the near future, become very serious. At the same time, the financial contribution to the healthcare sector does not match these challenges. From the political standpoint, there is much focus on controlling and containing expenditure in the public sector while at the same time enacting stipulations in areas such as waiting list guarantees. The general conception is that better health provision should be possible for the same amount of money.
High expectations are emerging from the general public as well as the political sphere. Furthermore, the consumer mentality is applied to the public health arena and citizens require fast diagnosis and treatment, coherent courses of treatment, involvement, access to their data, control and the highest quality at every level.
The need for innovative solutions
With this level of pressure from all sides, current and future health systems are forced to re-organise and re-engineer the provision of their services. Consequently, healthcare managers must look to flexible and resource-saving solutions or systems that support optimal utilisation of personnel, technology and costs.
Hospitals around the globe are working extensively with innovative eHealth and telemedicine applications as a strategic method for optimising resources and providing better health services to patients. The eHealth and telemedicine portfolio covers a wide range of different services and applications. Examples include:
- An online interpreter service through a videoconference system.
- Electronic band aids for remote monitoring of heart patients.
- Remote expert consultations of diabetes and heart patients, and expert assessment of initiation of thrombolysis treatment for stroke patients.
- Home-hospitalisation of acute exacerbation patients with chronic obstructive pulmonary disease (COPD) that receive care and treatment from hospital specialists through an online video interface and measurement devices.
The potential in teleradiology
Another example of innovation in healthcare is the use of teleradiology as a means of overcoming scarce resources that are especially serious in this field. Images are easily sent to and from distant locations and, as a consequence, teleradiology has in recent years gained substantial ground among healthcare providers.
Teleradiology in itself is not a new solution, but given the new technological possibilities, many hospitals are deliberately outsourcing larger parts of their imaging production to help overcome lack of resources at a time when personnel are scarce and waiting lists continue to grow. The market is also witnessing more remote reporting companies and clinics entering the arena and providing remote and cross-border services.
Consequently, as the market, opportunities and number of users grow, demands for efficiency, flexibility, cost containment and, not least, quality increase. One of the main constraints on teleradiology in its traditional form is that it is characterised by point-to-point connections. As customers’ needs increase and change over time, this becomes a problem because the set-up is rigid and limited. Each customer and provider relationship has its own technical set-up, connection and administration process which makes multiple relationships resource-demanding.
An eBay for radiology
R-Bay was a project part-funded by the European Commission under the DG INFSO/eTEN programme co-ordinated by the region of Southern Denmark through MedCom. The project was launched in August 2007 and ended in May 2009. R-Bay builds partly on the Baltic eHealth project and was a link between different public and private organisations that together wanted to create a smarter and simpler solution for integrated image exchange, storage system and brokering service. In a real-life clinical environment, the partners in the project decided to test a brokering solution for a virtual marketplace for radiology services where providers and customers could meet using an existing and running eConsultation portal as infrastructure.
The inspiration for the brokering portal came partly from eBay − hence the name − where the portal is reliable, with a secure infrastructure, for parties to meet and trade commodities with each other. Like eBay, the R-Bay portal does not trade radiology services itself, but rather enables others to sell or buy reporting, second opinions or other services in a simple, flexible and trustworthy way. The key element of R-Bay is the interpretation service such as remote viewing, reporting and second opinion, but the portal also offers support services such as image storage, advanced processing tools, automated structured reporting translation and training functionality.
What makes R-Bay unique compared with traditional teleradiology services is that it operates via a single point of contact. A health provider only needs to establish and pay for the connection to the portal and not to the different hospitals, reporting companies or clinic with whom the hospital wants to exchange images. Secondly, R-Bay provides a brokering service, which contains online contracts, billing systems, quality assurance and identification management systems. This adds unique value to the system and streamlines processes for the users − not only the clinicians who work on the diagnostic side, but also for the technicians and the administrative personnel − as a common solution is used regardless of who is at the other end and how many people are involved.
For a hospital, it means that it can use the service in a way that suits the organisation and its needs while at the same time having a constant and current overview of the situation and conditions in the market, as R-Bay equals transparency. The portal can be used for managing capacity problems in one diagnostic area or in a certain period of time by utilising available resources within another hospital or clinic and in another region or country. R-Bay will enable the hospital to streamline processes through the departments involved while at the same time providing a flexible solution for managing the capacity problem.
The R-Bay experiences
The outcomes of R-Bay were dependent on the results obtained in the project. The real-life clinical pilots, as well as the extensive legal and security work that was carried out, produced a substantial amount of knowledge and experience, which would determine the future of R-Bay.
Was it Utopian to imagine an online portal for trading imaging services like commodities, where there were no borders and limits for the utilisation of the pool of resources across Europe and capacity, needs and skills determined the market? Or was it actually possible to launch a service such as R-Bay on the European market and trade imaging services as commodities?
Our conclusions, listed below, show that the answer was somewhere in between:
- There is no European system for licensing and authorisation of professionals.
- Language is a critical issue.
- Reimbursement schemes for eHealth and telemedicine services are not in place in many countries.
- Overall, there is no European legal framework in place for the above problems. This complicates the case for an eMarketplace and a flexible many-to-many system that transcends national borders in Europe.
- Culturally, we are still some time away from an environment of trust in cross-border services and in the business model.
- However, the notion of an eMarketplace is progressing in the respective communities (healthcare providers and system providers) and outsourcing of image diagnostics is growing.
- The traditional employment pattern in radiology is in a state of flux, with experts leaving fixed employment contracts and offering their services on consultancy-based terms. This will increase the need for functional, flexible and efficient models.
Since the end of the R-Bay project, we have witnessed local consequences, such as implementation of R-Bay in a local context, whether it be at an institutional, regional or national level. In Estonia, a national R-Bay portal has been established that brings together all hospitals. A regional portal for radiology is on its way in the region of Southern Denmark where R-Bay has also served as inspiration for the establishment of a Holter portal (heart rhythm monitoring) used by the region’s hospitals. The R-Bay concept has been exported to the UK where it will be implemented in several institutions. Other project partners are using the experiences they gained from R-Bay to develop their own system and obtain new markets, whether these are healthcare institutions or system vendors.
Re-engineering radiology for the future
There are many examples of how innovation and applying technology in certain areas can change the provision of health by improving work processes, cross-sectoral and multidisciplinary collaboration, utilisation of resources and patient care. When faced with challenges, innovation is considered the key to unlocking the situation by improving the organisation and its services or products through change. We have presented here just one solution that has the potential to re-engineer the field of radiology. R-Bay is a service that can meet the users’ current and future demands for access to extra diagnostic imaging resources in a way that streamlines processes and is user-friendly, flexible, based on market terms and, not least, ensures high quality.