D.3 Recommended Elements of a Teleradiology Agreement.pdf

Revision 06/01/2022 Page 1 of 2

RECOMMENDED ELEMENTS OF A TELERADIOLOGY AGREEMENT

Depending upon the scope of the teleradiology plan, agreement, or contract, consider including each of these points:

1. Dates, days of week, and hours of day of service.

2. Types of studies, expected volume.

3. Names of teleradiologists. Level of training. Credentials and privileges at facility providing service, license. If resident provides services, training program and VA-privileged attending radiologists who will provide supervision. Requirement that contractor will not substitute other teleradiologists for privileged ones named in contract.

4. Nature of reports, whether preliminary or final. Performance time for notifications, reports, and report verification, as relevant to the types of studies to be read. Performance time for STAT studies and how they are identified. How timeliness will be monitored. Policy for communication of results and for direct communication of urgent results, as applicable to the scope of contract.

5. Standards for accuracy and completeness of reporting. Teleradiologist peer-review mechanism.

6. When there is no in-house radiologist at the requesting site, how the teleradiologist and technologist will be notified that a procedure needs to be done. Policy for approval of emergency procedures. Who supervises procedures and how. Who sets protocols. How the technologist confers with teleradiologist, if applicable, to discuss patient specific concerns and modifications to protocol. Depending on the types of studies specified in the contract, how patients are evaluated prior to procedure, and how written informed consent is obtained.

Who starts IV lines and injects contrast and how is this supervised. What physician supervises contrast injection. Who monitors critically ill patients, if applicable.

7. For both routine and emergency studies, how teleradiologist is informed that a study needs to be interpreted.

How the reason for study (history), and other medical information is provided to the teleradiologist. Who transmits images to the teleradiologist. If demographics exceptions must be corrected before studies may be forwarded from PACS, who performs this task. Who selects prior comparison studies, how will they be selected, and how will they be sent to the teleradiologist. If transmission was unsuccessful, or if additional prior studies are required, whom the teleradiologist will contact to have additional studies sent. (Some of these steps may not be necessary if the teleradiologist access images by remote log-on.)

8. How clinicians will discuss the appropriate ordering of studies with the teleradiologist, if relevant to the nature of the contracted service. How the teleradiologist contacts the ordering physician to clarify the reason for study. How the teleradiologist notifies the clinician of an urgent finding, and how will this be documented. If clinician can not be contacted, what is the fall back plan for communication of emergent results. How clinicians will contact the teleradiologist to find results or clarify preliminary interpretations.

Revision 06/01/2022 Page 2 of 2

9. How the dictation will be transcribed and by whom. How report text will be up-loaded into VistA. How the teleradiologist will verify reports.

10. How the requesting facility will record names of patients and time that each interpretation was requested, images sent, and names of reports received.

11. How names of responsible individuals, duty rosters, call-schedules, and contact numbers will be kept current. How sudden changes in assigned personnel or contact numbers will be communicated.

12. The QA process by which deficiencies in timeliness and report accuracy will be corrected. How the teleradiologist will participate in QA activities, including complication review.

13. Whether contractor must carry malpractice insurance. Whether teleradiologist agrees to participate in claims defense.

14. The contingency plan for equipment or network malfunction. How all parties are notified of down-time.

Individuals responsible to correct the deficiency, and how are they contacted.

15. How parties are notified if the teleradiologist is ill or can not be available.

16. Where reports will be stored. Where images will be archived.

17. If contractor or teleradiology facility provides image archival services, how archive will be monitored for completeness and integrity. Requirement that studies are indexed according to patient name, SSN, and VistA case number. Responsibility for moving patient images to another archive when the contract is terminated.

18. Who will provide teleradiology and/or network equipment. If contractor provides equipment, minimum standard requirements. Approval of any compression schemes.

19. Where interpretation will take place. VA security directives, including secure firewalls, isolation of networks, security and privacy training and rules of behavior. Method of secure electronic transmission. Use of an approved gateway, such as 1VA VPN. Compliance with access rules, including authorization and logging of audit trail. Responsibility for timely application of security patches to operating systems, firewall, and antiviral software. Requirement for BAA. Agreement to erase or destroy patient information at end of contract.

20. Requirement to not forward studies or reports to third parties. Names of any subcontractors, and prohibition from using other subcontractors unless authorized in advance. Method to monitor whether work was actually done by the contractor if relevant (for example, unannounced phone calls to confirm teleradiologist is on duty).

21. Requirement for pre-award inspection of contractor’s facility.

RECOMMENDED ELEMENTS OF A TELERADIOLOGY AGREEMENT