1. Permanent Working Group of European Junior Doctors Telemedicine, Teleradiology and the European Health Services Directive a Junior Doctor Perspective Oliver Ertl Dept. of Radiology, Zentralklinikum Augsburg, Germany PWG Representative to the UEMS Section of Radiology

2. Telemedicine and Teleradiology  Radiology: first pictures transmitted in the 80ies, moderate results  nowadays: almost everything can be transmitted  primary use: peer-to-peer, collegial, quality improvement  meantime: other players, intention = ?

3. Telemedicine and Teleradiology

5. "The R-Bay project aims at establishing an online eMarketplace within the field of radiology, (...) i.e. to create a virtual and secure exchange set-up for the provision and consumption of radiology services based on market terms. The architecture of the R-Bay services consists of a portal, which hosts the eMarketplace function as a commodity brokering and exchange of radiology services. On the eMarketplace, providers will make their services available at a specified price and with standardized specifications, and the customers will buy the services via a trusted and secure network." "Structured reporting tool with automated multilingual translation“ (cited from http://www.rbay.org)

6. Telemedicine and Teleradiology Radiology as a commodity? Medicine as a commodity? is this „allowed“? is there a regulation?

7. Telemedicine and Teleradiology national level: very varying European level: no regulation yet but: The European Health Services Directive is underway.

8. Telemedicine and Teleradiology „The Health Services Directive aim is to optimize legal certainty regarding cross border healthcare under Community Law and to support the cooperation between the health systems of the Member States.“

9. Telemedicine and Teleradiology  Where should the reporting doctor be licensed?  How can it be assured that a failure to renew licensure or a withdrawal of licensure will be communicated?  "electronic fingerprint“?  legal pathways?  Do patients need to give informed consent about sending away their images?  What are the electronic substitutes for direct patient encounter?  How can patient records be made accessible remotely?  Quality control mainly relies on collegial feedbacks and on informal corridor encounters. What is the substitute for this in the teleradiology age?

10. Telemedicine and Teleradiology  Where should the reporting doctor be licensed?  How can it be assured that a failure to renew licensure or a withdrawal of licensure will be communicated?  "electronic fingerprint“?  legal pathways?  Do patients need to give informed consent about sending away their images?  What are the electronic substitutes for direct patient encounter?  How can patient records be made accessible remotely?  Quality control mainly relies on collegial feedbacks and on informal corridor encounters. What is the substitute for this in the teleradiology age?  Lobbying through the UEMS Section of Radiology and the European Society of Radiology (ESR)

11. Telemedicine and Teleradiology Current status:  Directive comfortably got through the vote after its First Reading in the European Parliament in late April.  It now goes to the 27 EU Health Ministers and then back to the European Parliament, further debate in autumn  It either could still be completely cancelled, or it could come into effect in member states in 2010

12. Telemedicine and Teleradiology

14. Concerns towards postgraduate training:  lack of cases on the referring site  primarily, insufficent exposure for residents  secondarily, deskilling of teachers, competence loss  more and more specialization on the providing site  „commoditive“ character  additional workload during call hours  legal responsibilities of residents?  appreciation of clinical course? feedback mechanisms?  „scattered“ and incompete learning experience  less and less hospitals completely covering all aspects  appreciate cases as a whole (from beginning to end)  patient responsibility, social skills, lack of direct contact  (...)

15. Telemedicine and Teleradiology  telemedicine should not be to the detriment of training, instead it should should benefit education (possibilities?)  hospitals which outsource clinical work must enable their residents adequate exposure through alternative pathways (rotations)  adequate teaching for dealing with the newly evolving aspects of telemedical patient care (background support).  definition of legal responsibilities  technical substitutes for doctor-doctor and doctor-patient communication.  background information available, "scattering" of learning experience reduced to minimum.

16. Telemedicine and Teleradiology Telemedicine is not just a cheap commodity for cutting costs and increasing third-party shareholder value. Instead, telemedicine is an highly sophisticated medical act which has great potential for improving quality of patient care as well as quality of postgraduate education. Thank you! comments and requests: mail@oliverertl.de