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

Goal b 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.

Rationale I b 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

Rationale II b Evaluation of various program components will help us with: Determine the success of the programDetermine the success of the program Make changes necessary to improve the programMake changes necessary to improve the program Schedule radiologists to cover casesSchedule radiologists to cover cases Update the teleradiology hardware/software componentsUpdate the teleradiology hardware/software components

Teleradiology Sites b There are 4 sites in Arizona supported with dedicated teleradiology systems 2 are located within Tucson2 are located within Tucson – Tucson VA Hospital – Kino Community Hospital 2 are located in East Central Arizona2 are located in East Central Arizona – White River – Springerville

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

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

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

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

Case Records b Cases are logged in with the following information: Patient namePatient name Referring site nameReferring site name Modality (e.g., CT-Head)Modality (e.g., CT-Head) Number of imagesNumber of images DateDate TimeTime

Analyses b The following 3 aspects of the program were evaluated: Case demographicsCase demographics Radiologist satisfactionRadiologist satisfaction Case turn-around timesCase turn-around times

Cases b Over 1500 teleradiology cases have been reviewed since May 1997 b On average, 95 cases reviewed each month b Percent cases from each site: 45% cases from Tucson VA45% cases from Tucson VA 25% White River25% White River 19% Kino19% Kino 11% Springerville11% Springerville

Case Volume

Case Modalities

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

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

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      > 50  1-10      > 50 3) What types of cases do you generally read?  CT  MRI  US  NucMed  Bone  Other  CT  MRI  US  NucMed  Bone  Other 4) How would you rate the quality of the teleradiology images?  Excellent  Good  Fair  Poor  Excellent  Good  Fair  Poor 5) How would you rate the friendliness of the teleradiology system?  Excellent  Good  Fair  Poor  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  Much better than clinical  Better than clinical  Same as clinical  Lower than clinical  Much lower than 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  Poor image quality  Not enough images  Not enough clinical history

Number of Cases Read

Image Quality

System Friendliness

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

Unreadable Cases b 26% of respondents said there were cases they could not read 72% had poor image quality72% had poor image quality 14% did not have enough images14% did not have enough images 14% did not have enough clinical history14% did not have enough clinical history b In CT poor image quality related to inability to window/level images

Turn-Around Times b All cases have log-in date & time b All cases have date read, but not all have time read b “Wet read” turn-around time Mean = 4.8 hoursMean = 4.8 hours SD = hoursSD = hours Min = 0.01 hoursMin = 0.01 hours Max = 527 hoursMax = 527 hours

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