Teleradiology: Images of an Improved Standard of Medical Care?
Nayar, Vivek, Rutgers Computer & Technology Law Journal
Teleradiology, a subset of telemedicine, is "a means of electronically transmitting radiographic patient images [X-rays, CT scans, etc.] and consultative text from one location to another." (1) In theory, teleradiology allows a radiologist to remotely diagnose images anywhere in the world from a phone or Internet connection. As a result, a nascent international outsourcing industry has formed, providing inexpensive and efficient diagnoses of images (2) sent by American medical groups. (3) Despite this growth, regulatory entities have not embraced offshore teleradiology because of the sensitive and private nature of the transmission data, the potentially life-threatening consequences of a mistaken diagnosis, and jurisdictional issues affecting a patient's legal recourse. This note argues that despite these legitimate concerns, the benefits of offshore teleradiology and other forms of telemedicine may increase the overall standard of medical care available to underserved and rural communities. Telemedicine may improve this standard by providing critical access to medical specialists in areas where no specialists practice, at a cost significantly lower than U.S.-based physicians. Impeding the growth of teleradiology, however, is a collection of professional organizations, federal and state statutes, and medical negligence laws that have decreased the incentive for domestic medical groups to implement telemedical protocols. While the general purpose of this regulatory collection is to protect healthcare consumers by upholding and enforcing the highest standard of medical care possible, this note argues that the regulations are too broad and unfocused. A more flexible approach by regulators may allow for and promote the use of telemedicine as a means of providing underserved and rural communities with a similar level of access to medical care as that found in urban medical centers throughout the U.S., while still protecting patients against sub-standard medical practices. The increased implementation of teleradiology and other forms of telemedicine may also create a type of "disruptive innovation that can transform traditional processes" to create benefits not currently anticipated or foreseeable. (4)
Part I of this note defines teleradiology, discusses the differences between the onshore and offshore teleradiology models, and describes some of the potential benefits of teleradiology. Part II describes the current condition of rural medicine, arguing that the paucity of medical specialists in underserved and rural communities is due to a combination of government policies within the past fifty years and personal choices by physicians graduating from medical school. Part II also provides examples of current teleradiology practices in a rural medical context. Part III discusses impediments to the growth of offshore teleradiology, including the recommendations of professional medical organizations, state and federal statutes, and medical negligence law. Part IV argues that government policy should endorse teleradiology and recommends changes to current state licensure and medical negligence law.
I. WHAT IS TELERADIOLOGY?
"Telemedicine" is the use by medical practitioners of "telecommunication to diagnose and treat a patient." (5) Teleradiology, a subset of telemedicine, "is a means of electronically transmitting radiographic patient images [X-rays, CT scans, etc.] and consultative text from one location to another." (6) Teleradiology is a natural subset of telemedicine because radiologists have increasingly replaced traditional analogue film with digital imaging technology. (7) Advancements in data storage, data transmission and increased bandwidth have allowed radiologists to sit at a given workstation anywhere in the world and "send, receive and manipulate any digital information from imaging studies at the click of a button or turn of a dial." (8) This technical sophistication has enabled the growth of medical outsourcing, (9) where medical groups send delegable components of health care treatment to other countries. …