Your mission is to implement a prototype decision-support information system for a private company working with self-employed radiologists. Following the implementation of a successful pilot experiment in Syldavie, your company has decided to acquire a management tool to develop its business throughout this region.
Prerequisites
After familiarizing yourself with the following information:
Context
Teleradiology “enables doctors who are in direct contact with patients (“local practitioners”) to obtain the opinion of a radiological practitioner located remotely from the site on which the radiological examination has taken place (“teleradiologist”)” (Conseil Professionnel de la radiologie française – G4).
Two remote medical procedures are possible:
- telediagnosis: diagnosis resulting from the different imaging examinations performed remotely by a radiologist;
- tele-expertise: exchange of opinions between radiologists, e.g. when a local radiologist, who is in contact with the patient, wishes to obtain the opinion of an expert remote teleradiologist in order to:
- provide guidance for the performance of the most appropriate examination in light of the clinical situation;
- carry out a second interpretation of the images, and improve and/or confirm the diagnosis.
Syldavie (a fictitious French region) is one of the three pilot regions in which the Healthcare Directorate of the French Ministry of Health has decided to establish a system ensuring continuity of care in teleradiology. This scheme, put in place between 2012 and 2015, has developed a service offering of significant medical and economic interest, addressing a problem of medical demographics concerning the provision of radiological care. Three teleradiology services are performed:
- continuity of care: patients treated outside working hours (8 p.m. to 8 a.m., Sundays and public holidays),
- activities scheduled during working hours,
- deferred interpretation.
At the end of 2015, this corresponded to more than 30,000 annual interpretations carried out by public and private organizations in the region (10% in the context of continuity of care). A technical support department guarantees the efficient, 24-hour-a-day operation of the platform, and an organizational support department ensures that the platform is operated in such a way as to treat patients in strict compliance with the regulatory framework and the code of professional ethics. This remote medical platform simultaneously enables the transmission of images, storage, monitoring, reporting, and invoicing for the entire network. This system has been rolled out to 11 institutions including the 8 requesting sites.
The implementation of an organizational structure for remote medical imaging has medico-organizational impacts and medico-economic consequences at several levels:
- the imaging department;
- the healthcare institution, because the radiology department plays a central role (e.g. exerting an influence on the duration of hospitalizations, waiting times for appointments, utilization rate of different imaging procedures, etc.);
- the healthcare territory by promoting collaborations.
Stakeholders
Several stakeholders are therefore concerned:
- ARS (French Regional Health Agency), which is in charge of the regional implementation of health policy, and its financing;
- GCS (Health Cooperation Consortium) for e-health in the Picardy region, which is the regional contracting authority for remote health projects;
- your client, a private company bringing together self-employed radiologists and providing “a remote primary interpretation service for medical images”, incorporated into the regional platform.
- healthcare institutions, “a distinction is made between the ‘requesting’ structure, i.e. the reception services of accident and emergency departments, and the ‘performing’ structure, namely the radiology departments in which the radiology experts are based. The healthcare professionals operating in this context are emergency physicians and radiographers for the requesting structure, and medical radiologists for the performing structure” (Programme régional de Télémédecine, ARS, 2012);
- medical radiologists for institutions, medical teleradiologists for public and private institutions, and other healthcare professionals;
- the assessor in charge of performing the medico-economic evaluation and assessing the social and organizational impacts.
Expression of needs
A consultant from your consultancy has conducted preliminary interviews with your client, in which it was decided to produce a dashboard to enable the management of the client’s business at the regional level. As the company is not yet present throughout the region, the main target user is the operational director, whose needs are expressed below.
“One priority for the day-to-day management of the company’s activities is compliance with report submission deadlines. The public service delegation will only be renewed if these deadlines are met. It would therefore be beneficial for the management tool to enable us to measure deadlines (minimum, maximum, median, average … to be decided) according to different situations: the doctor concerned, times: within or outside regular times, and type of procedure concerned. What we are particularly interested in is knowing whether a situation is exceptional (e.g. following a sudden increase in flows of procedures) in order to improve the organization of our human resources, or whether a situation is chronic (and therefore related to a recurrent context or person). Our current target is a deadline of one hour for traditional imaging and five hours for high-technology imaging, but we would like to further reduce these time-frames.
Another key issue is the maximization of our earnings. Given that we cannot choose the procedures in which we intervene, we must always be ready to respond to the demand and therefore have the appropriate staff available at the right time. We have two means of doing this at our disposal: by recruiting teleradiologists (either paid per procedure, or employed as permanent salaried staff), or by adapting schedules. We would therefore require a dashboard enabling us to observe seasonal phenomena according to the types of procedures, times, and days of the week.
Finally, we possess little information about our teleradiologists’ profiles, and having an overview of their past year of availability and of the types of procedures on which they have intervened would help us to organize our operations, such as knowing which ones are systematically used during critical periods (high number of procedures) and which ones could be asked to intervene a little more frequently or at other times. It would also be beneficial to be able to compare a teleradiologist’s activity with that of his or her colleagues… not individually, but overall. It remains to be seen whether an overall score would be useful; the teleradiologist’s profile may also change over the year. But we need benchmarks.”