The following topic is not just a concern of mine personally as a medical professional. All of you will experience some of its consequences in the near future.
Telemedicine is a rapidly evolving and developing profession and business as part of the globalization and is a priority for the EU. This is also reflected in the document Commission services priorities for ICT standardization in 2009, where the first sectoral item is eHealth.
The development of the eHealth market has shown great potential to contribute to the European economy, but this development is currently hampered by a lack of interoperability and standardization across systems.
Most of the contributors here are well aware of the effects of globalization and the opening up of a market or a sector, but for medical professionals and for many patients/customers there might be surprises to come.
There are still areas where technical and infrastructural issues need to be addressed but I would rather discuss other issues.
Teleradiology (point-to-point communication of radiographic images from one location to another for the purposes of interpretation or consultation ) as a special form of telemedicine is a good example to study the pros and cons of a pan-European eHealth solution and the effects of a global market. And the good news is that we don’t have to invent the wheel! We can investigate what has been happening in the US for the last two decades.
In the 90’s, the primary benefit of teleradiology was to enable radiologists to stay at home out-of-hours while covering emergencies for their own hospital. The other expected benefit was to bring remote radiologists into virtual contract with areas of need (underserved rural areas, specialist opinion etc.). The last ten years seen a massive growth by radiologists as well as by managers for several reasons. Approximately 60% of hospitals in the US now outsource their out-of-hour radiology service. Two major drivers behind the scene are the exponentially increasing number of investigations and images to be reported and the rapid advances in information technology and communication bandwidth with ever decreasing costs.
Ten years ago, most believed that teleradiology could be a vehicle for improving patient care, but few foresaw the threat it has become to radiologists and radiology services in some of the countries. Tom Friedman, a New York Times reporter, who visited a teleradiology service provider in India working for US hospitals, concluded that anything that can be digitized can be outsourced, including radiologists. The costs for radiologists services will go down and the profession will be commoditized (have a quick look at www.telerays.com; www.r-bay.com). Protectionism kicked in and several professional bodies are trying to debate and “regulate” this process now, but it is too late to stop. It happens very much in the same way as it has happened in many other industries. Months ago there were some points made on brain drain. It is a huge opportunity to benefit from this trend. High quality, experienced Central European radiologists, who can return home, and work for many hospitals, earn better than as staff member. But will it stop here? What else will happen in health care? Will this improve quality or just reducing costs? How will cross border health service within the EU work? Will outsourcing continue outside of the EU?
There are many things and aspects to consider and this is the time to do so as the Council is working on eHealth and Article 16 in these days to develop a policy in these fields.
Here are some arguments to start you thinking:
Pros: services for remote areas, specialist opinion availability, waiting list management, reduced costs, decrease brain drain, availability 24/7, availability wherever you are within EU
Cons: standard of care, licensing, liability, jurisdiction, language, patient-doctor meetings, doctor-doctor discussions, training of juniors, support of staff, developing new services – just to mention a few.
As most of the writers of this blog are coming from business background I am sure they have their own experience and opinion on this as it happened before to many other industries. Will it be similar? Are there special aspects in health service? What else will happen? What can doctors and patients expect? Have your say!
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