Quality of Outsourced Radiology Assured

10 Mar 2006, The Straits Times

Question

Name of the Person: Dr Si-Hoe Cheng Kit

Quality of Outsourced Radiology Assured

Wanted: Infrastructure to harness digital imaging 

THE Ministry of Health (MOH)'s initiative in outsourcing radiology reporting and the various letters in the Forum require further comment. 

Singapore has world-class radiologists and enjoys state-of-the-art imaging facilities. However, the infrastructure to fully utilise the power of digital imaging and remote reporting is inadequately developed. 

Each hospital has had to develop its own systems. This has resulted in financial wastage from duplication of effort, fragmented service delivery and inefficient use of manpower. Radiologists have been asking for improved information technology and network support for the proper organisation of workflow, but have been told that it costs too much to make changes. 

This contrasts with the private sector, where efficiency is fueled financially, enabling patients to be scanned and results delivered quickly. This is remarkable as the private sector is serviced by only 30 per cent of Singapore radiologists. 

If the Health Minister were to spend his budget of $2.3 million locally, the inherent problems could be addressed. For example, a central imaging database with integrated nationwide teleradiology and high-speed network to link satellite X-ray facilities (e.g. polyclinics) to reporting hubs (e.g. hospitals, private X-ray clinics, local teleradiology reporting centres). 

Contrary to Mr Paul Chan's belief in a free global market ('Outsourcing is the right way to cut costs'; ST, March 4), the quality of radiological care is highly controlled in various countries, especially in the US. Interpretation of radiological examinations is permitted only by radiologists who are US board-certified, state licensed and have US-accepted malpractice insurance. Hence it is American board-certified radiologists in India who are providing teleradiology. 

The outsource foreign radiologists must possess qualifications and training equal to those of Singapore radiologists, as well as maintain equivalent continuing medical education. Can MOH ensure rigorous audit of these foreign radiologists, review their specialist accreditation bi-annually and ensure patient data protection? It would be wrong to apply double standards in the name of cost saving. 

Singapore radiologists need to be given the support and to be allowed the administrative control neceQualityssary for them to provide timely, quality care for their patients. If we want 'more, better, faster' then we have to be willing to invest adequately, appropriately and locally.

Reply

Reply from MOH 

Quality of Outsourced Radiology Assured 

1. In "Wanted: Infrastructure to harness digital imaging." (ST, Mar 10), Dr Si-Hoe Cheng Kit urged the Health Ministry to invest in more medical imaging infrastructure. We will. Satellite x-ray facilities in the polyclinics are digitally linked to reporting hubs in the major hospitals. The recent $2.3 mil investment was partly to establish a picture archival and communication system (PACS) among the public hospitals. In time, relevant diagnostics information will be accessible in all wards and clinics in a seamless way. This will benefit the patients. 

2. Dr Si-Hoe raised the issue of the quality of out-sourced radiological care. As a radiologist, he is aware that local radiology centres are allowed under the Private Hospitals and Medical Clinics Act to outsource examinations (or part thereof) to any foreign entity that is accredited by an approved body. The accreditation process is to ensure that the quality of the outsourced service is at least comparable with local standards. The local entity however remains accountable to the Health Ministry for the standard of its services, including those that are outsourced. It would have to ensure the outsourced quality is sustained through regular audits. 

3. Going forward, the Ministry intends to carry out randomized, double-blind quality tests on radiological readings, regardless of whether they are performed in Singapore or overseas. This is the best way to ensure that our patients receive quality care, comparable to international benchmarks.