Leadership and management in quality radiology

The practice of medical imaging and interventional radiology are undergoing rapid change in recent years due to technological advances, workload escalation, workforce shortage, globalisation, corporatisation, commercialisation and commoditisation of healthcare. These professional and economical changes are challenging the established norm but may bring new opportunities. There is an increasing awareness of and interest in the quality of care and patient safety in medical imaging and interventional radiology. Among the professional organisations, a range of quality systems are available to address individual, facility and system needs. To manage the limited resources successfully, radiologists and professional organisations must be leaders and champion for the cause of quality care and patient safety. Close collaboration with other stakeholders towards the development and management of proactive, long-term, system-based strategies and infrastructures will underpin a sustainable future in quality radiology. The International Radiology Quality Network can play a useful facilitating role in this worthwhile but challenging endeavour

Data infrastructures and digital labour : the case of teleradiology

In this thesis, I investigate the effects of digitalisation in teleradiology, the practice of outsourcing radiology diagnosis, through an analysis of the role of infrastructures that enable the transfer, storage, and processing of digital medical data. Consisting of standards, code, protocols and hardware, these infrastructures contribute to the making of complex supply chains that intervene into existing labour processes and produce interdependent relations among radiologists, patients, data engineers, and auxiliary workers. My analysis focuses on three key infrastructures that facilitate teleradiology: Picture Archiving and Communication Systems (PACS), the Digital Imaging and Communication in Medicine (DICOM) standard, and the Health Level 7 (HL7) standard. PACS is a system of four interconnected components: imaging hardware, a secure network, viewing stations for reading images, and data storage facilities. All of these components use DICOM, which specifies data formats and network protocols for the transfer of data within PACS. HL7 is a standard that defines data structures for the purposes of transfer between medical information systems. My research draws on fieldwork in teleradiology companies in Sydney, Australia, and Bangalore, India, which specialise in international outsourcing of medical imaging diagnostics and provide services for hospitals in Europe, USA, and Singapore, among others. I argue that PACS, DICOM, and HL7 establish a technopolitical context that erodes boundaries between social institutions of labour management and material infrastructures of data control. This intertwining of bureaucratic and infrastructural modes of regulation gives rise to a variety of strategies deployed by companies for maximising productivity, as well as counter-strategies of workers in leveraging mobility and qualifications to their advantage

Telemedicine Pre and Post Covid-19: Lessons for Commercialisation Based on Previous Use Cases

Telemedicine used to be slow, difficult, expensive and widely neglected by doctors and patients. COVID-19 changed everything; telemedicine is entering a period of rapid economic and business growth. This paper discusses the reasons for change in telemedicine over the last 20 years, through real-life medical technology projects, telemetry, ehealth and health IT. Our methods are based on the analysis of telemedicine projects we have implemented and characteristic historical data.  The results of our investigation demonstrate a clear increase of significance in telemedicine in the present and near future. We envision the evolution of mobile phones to personal telehealth monitors.  Prior to COVID-19, market penetration and economic factors of telemedicine evolved slowly and in an uneven manner on a global scale. Many of the projects remained active only as long as the grant or corporate or national support was provided. The age of novel globally spreading infectious diseases, exemplified by COVID-19, has created an unusual, different setting. Recent pandemics and epidemics have changed global economics significantly and generated a new motivation and a new market with a projected trillion-dollar market value. Post COVID-19, regular and periodic epidemics and pandemics are expected to continue to occur. This will generate an enormous global market for isolated high-tech services, including telemedicine and telemetry

Telemedicine for improving access to health care in resource-constrained areas : from individual diagnosis to strengthening health systems

In many developing countries there is an acute shortage of trained medical specialists. This does not only hamper individual patients’ access to medical diagnostics but furthermore limits the development of health systems because a major role of the specialists is the provision of continuous medical education of health care personnel. The rapid development of information and communication technologies has enabled radically new forms of virtual collaboration at a distance. So-called telemedicine enables us today to transmit knowledge to the patient rather than to only transport patients to the centres where the knowledge is available; this has promising implications in particular for remote and under-served areas. Initiated by a request from a Swiss surgeon from Solomon Islands, a project for supporting the hospital in Honiara, capital of Solomon Islands, with pathology diagnoses was started between Honiara and the Department of Pathology in Basel in 2001. After a successful start this pilot project found broad interest, and the Internet platform that had been developed was soon utilised by projects from other countries and medical disciplines. Thus, questions arose about the diagnostic accuracy of such remote diagnoses as well as about their acceptance and impact on the local health care system. The work presented here was initiated on this background. It analyses the applicability of telemedicine in the context of resource-constrained areas and in particular the possibilities to extend its impact from improving individual diagnosis towards strengthening health care systems. A central part of this project was the development of iPath, an Internet- and email-based telemedicine platform, which facilitates medical consultations, knowledge exchange and continuous education on a global scale. A particular emphasis was put on the applicability and accessibility for users from developing countries with limited infrastructure and network connectivity. The complete software was released under an open-source licence in order to allow unrestricted reuse for other institutions. The diagnostic accuracy of this form of telemedicine was studied in two projects from the field of pathology. A retrospective review of over 200 glass slides from each project revealed complete diagnostic concordance between the telemedical diagnosis and review diagnosis in 69% and 85% respectively. Clinically relevant discrepancies were found in 8% and 3.3% of all examinations. Selection of images by the non-expert and communication were found to have the greatest impact on diagnostic accuracy. Both factors can be addressed by training and organisation of workflow. In comparison to submitting material for pathological examination by courier, the turn-around time could be reduced from weeks to days or hours. Besides the more rapid availability of diagnosis, telemedicine enabled a direct dialogue between the surgeon and the pathologist and thus facilitated an implicit permanent medical education. The educational aspects of telemedicine were studied within the scope of a tele-dermatology project in South Africa. Distance collaboration with a dermatologist empowered a general practitioner based in a rural area to diagnose and treat a majority of patients with dermatological problems. Besides the direct benefit of saving the patients the cost of transportation to visit the dermatologist, the general practitioner could strengthen his own diagnostic skills under direct guidance and quality control of a specialist. As a consequence he will be able to treat more patients locally, close to their homes and families. The whole project was implemented within the local health system in order to facilitate a future inclusion of other primary care facilities. Regional telemedicine networks play a major role to ensure relevance and acceptability of consultative and educational telemedicine. Within the scope of the Ukrainian Swiss Perinatal Health Program a telemedicine component was included, and it was found that the use of regional language as well as inclusion of the regional specialists are important for the acceptance of telemedicine and should not be neglected in a era of globalisation. The presented results demonstrate that save and reliable telemedicine can be implemented with limited resources. Telemedicine is suitable in particular to strengthen existing international collaborations and to support professionally isolated medical specialists. Regional collaboration and inclusion of regional specialists are desirable if telemedicine shall help to strengthen health care systems. The application of telemedicine should not only focus on providing care to individual patients, but should explicitly incorporate skills development and capacity building of primary care staff. Organisation of work flow and communication have been found to be the most challenging task for the implementation of telemedicine networks. Resources must be invested not only in technology but more importantly in training and organisation. Utilisation of existing technological infrastructure is advisable wherever possible and greatly reduces the complexity of providing support and maintenance. The presented telemedicine platform provides an efficient tool for the organisation of interdisciplinary, regional and international telemedicine networks. We hope that the unrestricted availability of the software developed during this project will enable other institutions to utilise it for their own purpose and that they will thus be able to allocate resources on the organisation of workflow rather than technology

An informatics model for guiding assembly of telemicrobiology workstations for malaria collaborative diagnostics using commodity products and open-source software

<p>Abstract</p> <p>Background</p> <p>Deficits in clinical microbiology infrastructure exacerbate global infectious disease burdens. This paper examines how commodity computation, communication, and measurement products combined with open-source analysis and communication applications can be incorporated into laboratory medicine microbiology protocols. Those commodity components are all now sourceable globally. An informatics model is presented for guiding the use of low-cost commodity components and free software in the assembly of clinically useful and usable telemicrobiology workstations.</p> <p>Methods</p> <p>The model incorporates two general principles: 1) collaborative diagnostics, where free and open communication and networking applications are used to link distributed collaborators for reciprocal assistance in organizing and interpreting digital diagnostic data; and 2) commodity engineering, which leverages globally available consumer electronics and open-source informatics applications, to build generic open systems that measure needed information in ways substantially equivalent to more complex proprietary systems. Routine microscopic examination of Giemsa and fluorescently stained blood smears for diagnosing malaria is used as an example to validate the model.</p> <p>Results</p> <p>The model is used as a constraint-based guide for the design, assembly, and testing of a functioning, open, and commoditized telemicroscopy system that supports distributed acquisition, exploration, analysis, interpretation, and reporting of digital microscopy images of stained malarial blood smears while also supporting remote diagnostic tracking, quality assessment and diagnostic process development.</p> <p>Conclusion</p> <p>The open telemicroscopy workstation design and use-process described here can address clinical microbiology infrastructure deficits in an economically sound and sustainable manner. It can boost capacity to deal with comprehensive measurement of disease and care outcomes in individuals and groups in a distributed and collaborative fashion. The workstation enables local control over the creation and use of diagnostic data, while allowing for remote collaborative support of diagnostic data interpretation and tracking. It can enable global pooling of malaria disease information and the development of open, participatory, and adaptable laboratory medicine practices. The informatic model highlights how the larger issue of access to generic commoditized measurement, information processing, and communication technology in both high- and low-income countries can enable diagnostic services that are much less expensive, but substantially equivalent to those currently in use in high-income countries.</p

E-health and e-welfare of Finland - Check point 2015

The new e-health and e-welfare strategy in Finland aims to support the renewal of the social welfare and health care services and the active role of citizens in maintaining their own well-being. The means include the development of knowledge management and increasing the provision of online services. The overall structural changes taking place in Finnish health and social care will also influence information and communication technologies (ICT). The report provides information about the change in the services and the service system brought on by ICT over time. The report illustrates the status in 2014 as compared with the strategic outcomes and objectives set on ICT to support performance and renewal of social welfare and health care. The results are condensed from four surveys for a comprehensive view: availability and use of ICT in health care as well as in social care, usability of the systems for physicians, and citizens´ use and anticipations. These are accompanied by a review of Finnish health care system and ICT development. For the international reader, the report provides an overview of progressive nationwide activities towards better e-services in Finland

ERM Annual Report 2013: Monitoring and Managing Restructuring in the 21st Century

[Excerpt] The 2013 annual report from the European Restructuring Monitor (ERM) presents a retrospective of over a decade of measuring the impact of large-scale restructuring activity in Europe. It summarises restructuring trends based on a restructuring database that includes details of over 16,000 large-scale restructuring events – each generally involving at least 100 job losses or gains. In particular, the report focuses on comparing activity in the pre-crisis period (2003–2008) with the post-crisis period (2008–2013) in order to identify changes in the prevalence of different restructuring practices, and to show which sectors have been disproportionately affected, in employment terms, by the global recession. The report also includes a critical assessment of all ERM activities including the two newer policy-oriented databases: public support instruments and restructuring legislation. Finally, the report places the spotlight on the phenomenon of offshoring, charting the decline in offshoring activity by European firms since the onset of the crisis

International trade in services and services co-production: An investigation into the nature of services and their political economy consequences on international trade.

Goods and services are bundled together in economic analysis, which largely considers them to be similar despite contrary empirical evidence. Services have been largely absent from international political economy literature, so current explanations of international trade in services liberalisation and integration leave a lot to be desired. Using the WTO framework of the four modes of service supply, this thesis provides a comprehensive analysis of international trade in both healthcare and accountancy services. This empirical investigation sheds light on services' patterns of internationalisation and the relationships between different modes of trade. It finds that services differing from each other in many aspects are nevertheless intemationahsing following similar patterns and particularly through commercial presence. The empirical findings of this study are supported by an enquiry into the nature of services. They form the basis of the development of the theory of services coproduction, whereby the services output is jointly created by producers and consumers and/ or goods under their control. Co-production creates an inherent proximity constraint between producers and consumers, which is explained through the Services Production Trap (SPT). Co-production and the SPT have significant consequences for international political economy. Examination of firms' response to the SPT shows that accountancy firms developed a particular organisational model based on a network of partnerships that has been highly successful for internationalisation. In addition, this model furthered accountancy firms' economic and political influence in shaping and leading the exceptional case of an international private governance regime in financial and reporting standards. Further political economy implications which are considered in this study include international trade in services liberalisation and protection, multilateralism and preferential trade, as well as European integration