Consistency still eludes teleradiology use in France

2013 10 28 11 33 02 309 French Flag Button 200

Results of research conducted by the French Radiology Union Council (G4) across its regional branches reveal operational differences in teleradiology setup and delayed implementation in different areas of the country.

The research presented at the recent national congress of the French Society of Radiology (Societé Française de Radiologie [SFR]), the Journées Françaises de Radiologie (JFR), described how the telemedicine plans of all regional health agencies (Agences Régionales de Santé [ARS]) include a teleradiology component. Most of them pertain to stroke response and out-of-hours emergency care, but some are more comprehensive, and their implementation is further advanced than others.

Radiologist involvement in the conception and the implementation of projects varies across France. Around 20% of regional G4 branches said they are not sufficiently involved in these projects, according to the authors, SFR Teleradiology Group members, Dr. Jean-Philippe Masson, a radiologist at Clinique Montréal, Carcassonne and vice president of France's telemedicine society (ANTEL), and Dr. Alain Rahmouni, the head of radiology and medical imaging at Hôpital Henri Mondor, Créteil.

Dr. Jean-Philippe Masson is vice president of France's telemedicine society (ANTEL).Dr. Jean-Philippe Masson is vice president of France's telemedicine society (ANTEL).
Dr. Jean-Philippe Masson is vice president of France's telemedicine society (ANTEL).

Differences also include the legal structure of teleradiology services, which across 14 regions ranges from private or public sector healthcare cooperation consortia to economic interest consortia, with 12 regions planning a shared regional PACS project and a long-term archive planned in half of regions, they noted in last Tuesday's edition of the daily congress newspaper, Le Quotidien des JFR.

Remuneration for teleradiology also is variable, according to the research. In a third of cases, remuneration is per act, with mixed remuneration (basic tariff plus supplement per act) in 20% of cases, and an on-call payment in 10% of cases. In the remaining cases, reimbursement has not yet been decided.

In nearly 20% of regions, only the initial investment for teleradiology has been guaranteed, and both initial investment and running the service through subscription to teletransmission services are accounted for in only 10% of regions. The other responses show teletransmission financing has not yet been finalized.

In addition, ARS teleradiology project implementation is very slow. Only five regions have begun implementation so far in 2013. The majority are spreading implementation between 2014 and 2016. The causes of the delays are cited as economic, notably incomplete financing of reliable and high-performance teletransmission and archiving tools, as well as the difficulty in establishing legal structure. Furthermore, the G4's recommendations are not well known by the ARS and hospital management, which is confirmed by calls for telediagnostics offers from radiologists outside the region and a lowering in the remuneration of radiological acts.

"Sometimes teleradiology organizations reduce themselves to distance telereporting," the authors wrote. "Some regions use the mixed remuneration method which falls short of professional recommendations (www.g4-radiologie.com)."

In light of this research, the G4 recommends that radiologists and regional G4 branches should be heavily involved in their regional ARS telemedicine projects. Moreover, the regional G4 branches must support local radiological medical projects in order to remove technological, legal structuring, financing, and remuneration obstacles. Finally, all radiologists must use the national G4 recommendations so that teleradiology acts are considered as medical radiological acts and radiologists do not end up limited to distance "telereading," the authors stated.

Teleradiology projects that have been built by radiologists in every sector of the region help to complement the "bottom-up" strategy that the G4 has always supported, according to the union. The role of the regional G4 branches alongside the ARS is vital for avoiding a slide toward commercial or "low-cost" teleradiology, and above all is necessary for removing the existing obstacles and speeding up implementation, according to the authors.

The report referred to two teleradiology pilots. Firstly, a telemedicine pilot project in Lorraine using methods piloted by the ARS has failed to satisfy everybody, with the result that certain radiologists have withdrawn from the scheme. It would seem that an "up-bottom" -- rather than "bottom-up" -- approach has prevailed in this pilot region, they noted.

Secondly, despite challenges in the Languedoc-Roussillon project that stemmed from the need for heterogeneous teleradiology across a vast geographical area and the subsequent difficulty in assessing concrete needs, the project that is legally defined as a private-sector consortium, has generated great satisfaction among stakeholders. The reasons for this include the cohesion between public and private radiologists and a convergence of ideas and activities that involve radiologists, operators, and clinicians. This year sees the start of emergency telediagnosis in neuroradiology.

Although teleradiology is one of the five priority areas of telemedicine implementation in France, regional implementation is difficult and hampered for the most part due to finance, the authors concluded. Strong involvement of radiologists through the regional G4 branches is indispensible for defending quality guaranteed by the G4's recommendations in any solutions offered.

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