Points of view of Dr Élisabeth Parizel, radiologist, head of department, former chair of CME, project leader for the CANSSM and HOSPITALOR imaging services grouping.

In the former mining area of East Moselle (Freyming-Merlabach-Saint-Avold region), the T-LOR application has provided a centralized round-the-clock medical imaging service, via teleradiology, since April 2010. In two years, this application has become essential to the provision of care in the region, with over 3,000 teleradiology procedures carried out.

1995: initial trials

T-LOR is the result of several years of co-operation between the care team at Freyming-Merlebach hospital and Nancy University Hospital (CHU). The first trials to transmit scanned images over the telephone network were carried out in 1995 by Professor Picard's neuroradiology team, and it took two hours to send 24 images from a head CT scan over a 64 Kbit/second line! The emergence of high-speed internet has reduced transmission times by a factor of nearly 100, and has made it possible to incorporate teleradiology into the range of care offered. In the current severe shortage of radiologists, this possibility is well-timed. It means that radiology expertise is always available, so that high-quality management is constantly available. The availability of radiology 24 hours a day, 365 days a year is an important decision-making tool in the management of patients who arrive as emergency cases, or of inpatients whose clinical condition is deteriorating.

2007-2010: adjustment and implementation of the product

T-LOR uses the DIAMER solution, published by Expertise-Radiologie and Global Imaging Online, and which is used by the Lorraine telehealth GCS. In 2007 and 2008, a specifications document was produced, and a call for tenders was launched, and the solution was made available from mid-2009. A year of "live" trials enabled gradual development of the functionality of the tool in order to bring it into line with real-life requirements, in particular ease of use and reliability. This also enabled procedures to get into a stride, and meant that users of this new tool could be trained.

April 2010: full service begins

The tool was first operational and incorporated into care pathways in April 2010. This teleradiology solution meant that the skills of practitioners working in three sites in Freyming-Merlebach and Saint-Avold could be centralized. On-call radiologists provide remote diagnosis using dedicated equipment, which is connected to the network. The following staff are involved: the emergency physician or neurologist, the technician who is with the patient and the teleradiologist who interprets the images and sends a diagnosis via a secure system. At the end of February 2012, when the system had been active for 22 months, T-LOR had provided over 3,000 investigations. The time between the clinician's request and the return of the radiologist's report is at most 20-30 minutes for an urgent brain scan, and 40 minutes for an urgent abdominal imaging report. These times are satisfactory for clinical practice.

A solution that relies on good practice

The patient's consent is sought by the requesting doctor. Patient safety during the investigation is ensured by the physical presence of the requesting physician in the investigation facility. Traceability of procedures is guaranteed via features of the system and a strict division of responsibilities. The solution adheres to G4 quality standards. If any technical problems occur, there is cover 24 hours a day from an on-call team from the Lorraine telehealth GCS, which can provide help at any time.

Possibilities for the future

The two years of experience with T-LOR show that the application has achieved its initial objectives (providing on-call coverage by radiologists over several sites), and also that it has transformed the lives of on-call doctors, as it means that they no longer have to travel in emergencies, and that they have a degree of freedom about where they work, as long as they can be contacted and can connect to the network.

This new tool is currently being rolled out across the whole region, by gradual addition of partner sites. New applications are being considered: regional PACS, permanent cover for stroke care, remote consultation for stroke victims, and care in prisons. The age of telemedicine is only just beginning.

About...

T-LOR is a project to implement a central teleradiology solution for healthcare facilities, and is managed by a health co-operation grouping (GCS) for telehealth in Lorraine.

Extract from the ASIP Santé's Annual Report 2011. [8]