Teleradiologia, a sprawa polska Email
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Wpisany przez Marek Wesołowski   
Wtorek, 27 Październik 2009 13:28

Marek Wesołowski
26 października 2009

Projekty teleradiologiczne rosną jak grzyby podlewane deszczem pieniędzy unijnych, norweskich, polskich i innych.
To dobrze – nowe technologie zawsze w cenie. Musimy jedynie mieć dobre wyobrażenie o potencjale technologii, potrzebach i możliwościach rynku.

Polska jest krajem o prawie kwadratowym kształcie. Jest płaska. Żadne góry, morza czy inne naturalne przeszkody nie dzielą jej na części. Morze mamy na północnej granicy, góry na południowej, Wolin sobie jakoś radzi ze swoim odcięciem. Klimat też łagodny, żadna zamieć czy pożar buszu nie odcinają połaci kraju na dłużej niż kilka godzin.
Mamy spore nasycenie szpitalami. Choć z radiologami nie jest najlepiej, jednak jak nie u siebie to w bliskim sąsiedztwie zawsze znajdzie się dobry fachowiec od obrazów medycznych.
Odległości też nie największe. Po najdłuższej przekątnej z Ustrzyk do Szczecina, jakby się zaparł i nie zwracał uwagi na błyskające fleszami karmniki, można by dotrzeć w 10-12 godzin i 20 punktów karnych. Odległość między szpitalami nie przekracza 30- 40 kilometrów.
W tych pięknych okolicznościach przyrody marketingowo forsowane scenariusze użytkowania  teleradiologii nie mają zastosowania. Olbrzymie odległości do najbliższego lekarza w poprzecinanej fordami i skutej mrozem Norwegii, gdzie teleradiologia konkuruje z helikopterem, a przy gorszej pogodzie, w ogóle nie ma konkurenta w Polsce nie występują. Transport do najbliższego szpitala w Polsce jest łatwy i tani.

Czy to oznacza, że teleradiologia nie jest w Polsce potrzebna? To byłoby twierdzenie zbyt daleko posunięte. Trzeba jedynie dobrze zrozumieć możliwości technologii i realne potrzeby rynku.

Co da zastosowanie teleradiologii w Polsce?
Mamy dwie strony medalu. Zlecający  i wykonujący telekonsultacje.
Zlecający wykorzystując teleradiologię może:
  • podnieść komfort pacjenta, którego nie trzeba transportować,
  • obniżyć koszt i skrócić czas oceny zdjęć przez lekarza w innym ośrodku (nie trzeba wysyłać karetki ze zdjęciami),
  • tanio i szybko uzyskać drugą opinię i zmniejszyć ryzyko leczenia,
  • tanio i szybko kwalifikować do leczenia w specjalistycznym ośrodku (przesyłając dokumentację medyczną),
  • obniżyć koszty działania przez outsourcing konsultacji radiologicznych – szpital rezygnuje z własnego radiologa na rzecz firmy świadczącej takie usługi na odległość. Rezygnacja może być permanentna lub czasowa np. tylko nocne dyżury lub tylko w określonym zakresie wymagającym drogiego/trudno dostępnego specjalisty (np. neurochirurgia),
  • podnieść komfort pracy radiologa, który może w określonych przypadkach pracować z domu,
  • lepsza współpraca z pracowniami obrazowymi – możliwość odbioru wyników przez Internet.

Wykonujący telekonsultacje radiologiczne może:

  • uzyskać dodatkowe źródło dochodu,
  • uprościć i obniżyć koszty kwalifikacji pacjenta do leczenia u siebie (najpierw ocena przesłanej dokumentacji),
  • współpracować z lekarzami rodzinnymi i innymi jednostkami wysyłającymi pacjenta do pracowni radiologicznej. Teleradiologia pozwala na odesłanie zdjęć wraz z opisem do zlecającego.

Potrafię sobie wyobrazić różne scenariusze wykorzystania teleradiologii w tej samej jednostce.
Lekarza rodzinnego zlecającego badanie obrazowe  i odbierającego przez Internet wyniki, które za chwilę pośle do innej jednostki prosząc o zakwalifikowania pacjenta na leczenie lub w innym miejscu prosząc o drugą opinię.
Szpital, który nie ma radiologa na dyżurach nocnych i korzysta ze wsparcia innego szpital, z którym dzieli koszty dyżurów radiologa. I ten sam szpital, który w dzień konsultuje badania przychodzące z innych jednostek i wysyła badania obrazowe swoich pacjnetów do fachowej oceny w ośrodkach specjalistycznych.

W całości obraz ten przedstawia sieć wzajemnie połączonych zależności i jednostek, które raz są usługodawcą, by za chwilę być usługobiorcą. Ta sieć, dla dobra pacjenta, nie powinna mieć ograniczeń i wszystkie jednostki powinny swobodnie kontaktować się ze sobą i wymieniać obrazy medyczne i konsultacje.

Dzisiejsza polska teleradiologia nie wyszła poza najprostszy model połączeń punkt-punkt, które wiążą szpital z firmą wykonującą telekonsultację lub w najlepszym wypadku połączenie kilku ośrodków z jednostką specjalistyczną pomagającą oceniać przypadki.
Wszystkie instalacje są „sztywne” i zamknięte. Zlecający nie ma możliwości wyboru, do której jednostki wysyła, a konsultujący nawet gdyby chciał nie jest w stanie obsłużyć zlecenia przesłanego poza ustanowionymi połączeniami.

Powód jest prosty – brak standardu komunikacyjnego. Podstawowa infrastruktura informatyczna jest dostępna. Internet sięga wszędzie i jest wystarczająco szybki. Przesłanie danych obrazowych ze szpital A do B, C ,D ,itd. nie stanowi problemu.
Co więcej cyfrowy format zdjęć jest uzgodniony i używany – DICOM. Wszystkie maszyny diagnostyczne produkują obrazy w tym formacie i każdy może go bez problemu odczytać.

Brakuje standardu informatycznego opisującego całą usługę teleradiologiczną.
Jaką postać ma mieć elektroniczne zlecenie, a jaką opis radiologiczny odesłany po sieci?
Jak i gdzie mają się ze sobą komunikować zlecający i wykonujący telekonsultacje?

Poszczególne projekty teleradiologiczne realizowane aktualnie w Polsce budują rozwiązania bez jakiejkolwiek koordynacji. Wynikiem będą instalacje, które nie będę się potrafiły ze sobą komunikować i przez to ich funkcja będzie bardzo ograniczona i po pewnym czasie zarzucona.

Ujednolicenie sposobu komunikacji i wdrożenie jednolitego standardu danych, z którego będą korzystały wszystkie jednostki stworzy uniwersalną sieć telemedyczną.
Każdy będzie mógł z niej korzystać bez względu jakiego programu używa. To uroda standardu.

Mamy teraz najlepszą szansę. Szereg rozpoczętych projektów teleradiologicznych może przyjąć wspólny standard komunikacyjny.
Spróbujmy to zrobić i przeskoczyć resztę świata.

 

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