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Case Volume, Response Times & User Satisfaction With a University-Based Teleradiology Program

Case Volume, Response Times & User Satisfaction With a University-Based Teleradiology Program. Elizabeth Krupinski, PhD, Kevin McNeill, PhD, Theron Ovitt, MD, Michael Holcomb, Kreg Lulloff Presented at The American Telemedicine Association Conference April 18-21, 1999 Salt Lake City, UT.

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Case Volume, Response Times & User Satisfaction With a University-Based Teleradiology Program

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  1. Case Volume, Response Times & User Satisfaction With a University-Based Teleradiology Program Elizabeth Krupinski, PhD, Kevin McNeill, PhD, Theron Ovitt, MD, Michael Holcomb, Kreg Lulloff Presented at The American Telemedicine Association Conference April 18-21, 1999 Salt Lake City, UT

  2. Goal • The goal of this project was to evaluate the teleradiology component of the Arizona Telemedicine Program in terms of patterns of usage, turn-around times, and user satisfaction.

  3. Rationale I • The University of Arizona Department of radiology has operated an active teleradiology program for over 2 years as an integrated component of the Arizona Telemedicine Program

  4. Rationale II • Evaluation of various program components will help us with: • Determine the success of the program • Make changes necessary to improve the program • Schedule radiologists to cover cases • Update the teleradiology hardware/software components

  5. Teleradiology Sites • There are 4 sites in Arizona supported with dedicated teleradiology systems • 2 are located within Tucson • Tucson VA Hospital • Kino Community Hospital • 2 are located in East Central Arizona • White River • Springerville

  6. The Network • 3 of the sites are connected to the University Medical Center via the high-speed (T1) Arizona Rural Telemedicine Network (ARTN) • 1 site (Tucson VA) uses dial-up service

  7. Viewing System • The receive station in the Department of Radiology at the University Medical Center is an IVIEW PRO 2.1 from Lumisys Corp. (Sunnyvale, CA) • Images are viewed on a 1024 x 768 color monitor

  8. Services Provided • Specialty consultations • Over reading of cases • Backup coverage when rural radiologists are out due to illness or vacation

  9. Who Reads the Cases • Cases are read by radiology residents when the cases first come in • The residents provide a “wet read” for the rural sites (fax or call) • Cases are over read by the board-certified radiologists & fellows • Radiologists provide the final report

  10. Case Records • Cases are logged in with the following information: • Patient name • Referring site name • Modality (e.g., CT-Head) • Number of images • Date • Time

  11. Analyses • The following 3 aspects of the program were evaluated: • Case demographics • Radiologist satisfaction • Case turn-around times

  12. Cases • Over 1500 teleradiology cases have been reviewed since May 1997 • On average, 95 cases reviewed each month • Percent cases from each site: • 45% cases from Tucson VA • 25% White River • 19% Kino • 11% Springerville

  13. Case Volume

  14. Case Modalities

  15. Images • 44% of all cases are CT- head followed by 14% CT-abdomen • Number of images per case: • Mean = 25.58 • SD = 24.10 • Minimum = 1 • Maximum = 242

  16. User Satisfaction • A survey was developed to assess who is reading the teleradiology cases and how satisfied they are with the teleradiology system • 17 faculty, 1 fellow and 6 residents responded to the survey

  17. The Survey 1) Have you read any cases using the UofA teleradiology system?  Yes  No 2) About how many cases have you read?  1-10  11-20  21-30  31-40  41-50  > 50 3) What types of cases do you generally read?  CT  MRI  US  NucMed  Bone  Other 4) How would you rate the quality of the teleradiology images?  Excellent  Good  Fair  Poor 5) How would you rate the friendliness of the teleradiology system?  Excellent  Good  Fair  Poor 6) How would you rate your confidence when reading teleradiology cases?  Much better than clinical  Better than clinical  Same as clinical  Lower than clinical  Much lower than clinical 7) Have there been any teleradiology cases you were not able to read?  Yes  No 8) Why were you not able to read any cases?  Poor image quality  Not enough images  Not enough clinical history

  18. Number of Cases Read

  19. Image Quality

  20. System Friendliness

  21. Diagnostic Confidence * All types of cases, compared to film reading

  22. Unreadable Cases • 26% of respondents said there were cases they could not read • 72% had poor image quality • 14% did not have enough images • 14% did not have enough clinical history • In CT poor image quality related to inability to window/level images

  23. Turn-Around Times • All cases have log-in date & time • All cases have date read, but not all have time read • “Wet read” turn-around time • Mean = 4.8 hours • SD = 34.05 hours • Min = 0.01 hours • Max = 527 hours

  24. Discussion • Overall the radiologists are satisfied with the teleradiology system • Diagnostic confidence is about the same as film but is lower when image quality is compromised • Turn-around times are quick compared to FedExing film images

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