TELERADIOLOGY CHARTER Professional Radiology Council - French National Council of Physicians The Professional Radiology Council (G4) contributes, at national and regional level, to the development of the teleradiology, and supports it as a form of medical practice in radiological patient care. The French National Council of Physicians is also involved in the ethical deployment of telemedicine. This form of practice was described in 2005 in the National Guidelines of the French Radiological Society developed jointly with the CNOM (French National Council of Physicians) and the G4 of radiologists. A first charter was drafted by the G4 in 2009 based on the essential principles of this Guide. UPDATED CHARTER - DECEMBER 2014 This new version, jointly endorsed by the G4 and the CNOM, covers the same principles but has updated the application, because of the legislative or regulatory developments and methodological productions of the HAS (French National Authority for Health), and those of the CNOM. 1. Teleradiology is organized by radiologists in cooperation with the other

physicians and healthcare professionals involved.

2. As specified in the French Public Health Code, the teleradiology

procedure is a medical act in its own right and therefore it is governed by medical ethics rules and good professional practice which are the two major elements for its quality and patient safety. It includes telediagnosis (or teleconsultation) and teleexpertise. Remote image transmission on a technical level, and teleinterpretation on a medical level, are only individual steps of teleradiology and do not sum up the complete teleradiology medical act.

3. The use of teleradiology is only justified in the interest of the patient if

radiological care by a radiologist present located nearby the patient is not possible. It must take interpersonal relationships between the patient, the local clinician, the radiologist or the radiographer into account. It must integrate all the technical requirements essential to the quality of the care.

4. The use of teleradiology must be justified and integrated into the organization of the care: • Teleradiology must enable the patient’s physician to offer high

quality radiological medicine via a teleradiologist; • Teleradiology should promote exchanges of knowledge and knowhow among the radiologists who use it (teleexpertise) • Teleradiology must not be used to justify the acquisition or renewal of imaging facilities without a radiologist. 5. The development of the teleradiology in France must be based, • For telediagnosis: on the networking of clinicians and radiologists in

a shared local context • For teleexpertise: on the search for the best radiological human resources for the patient.

6. The French Radiological Society is committed to refining its national

guidelines with the French National Auhority for Health (Haute Autorité de Santé, HAS), concerned Medical Societies, the National Council of the College of Physicians (Conseil National de l’Ordre des Médecins, CNOM), the French Ministry of Health and the General Directorate of the Supply of Care, the French Shared Healthcare Information Systems Agency (Agence des Systèmes d’Information Partagés de santé, ASIP) and industrial and institutional players involved in image transmission networks.

7. The radiologist. • The two aspects of teleradiology, telediagnosis and

teleexpertise, are complementary radiologist's usual practice.

practices

to

the

• Teleradiology, as a medical act, complies with all the quality

requirements and radiological steps of a patient's radiological medical care: ü Prior clinical examination carried out by the requesting physician ü Validation and justification of the examination requested ü Radiation protection for the patient and staff ü Performed by the radiographer under the responsability of a radiologist ü Analysis and interpretation of the examination by the radiologist ü Dialogue with clinicians and the patient ü Organization of the radiological staff ü Legal permits to practice in France.

8. The implementation of teleradiology in a region requires consultation with the Professional Regional Council of Radiology prior to submission and in accordance with the regulations in force, to the Regional Health Agency, for the drafting of a contract which must be referred for opinion by the Departmental Council of the College of Physicians, in compliance with CNOM recommendation 9. The contract must include1: • A protocol of good practices incorporated in a local radiological

plan specifying the relationship between radiologists and clinicians based on the national recommendations of the SFR (French Radiology Society), of the G4.

• The statement of obligations of the teleradiologist and the local

physician as well as his/her support staff, including stating how access to the patient's record is restricted, the direct communication between the teleradiologist and the issuing site as well as patient care procedures in the event of an emergency diagnosed on the first elements received by teletransmission. The conditions of the presence of a radiologist on site and the definition of the medical officials of the organization of the radiological team in contact with the patient are specified.

• The definition of the responsibilities of each partner to the

contract; the commitment of all the signatories of the contract in a quality assurance policy including audit acceptance (including in terms of teaching and research for teleexpertise).

• The patient's information and agreement for their teleradiological

care are necessary, as teleradiologist's identity. The either the radiographer, who by the teleradiologist, or examination.

well as their knowledge of the latter will be collected or provided by will conduct the examination ordered by the physician requesting the

• The

safety system for identifying the patient, respect for confidentiality, and the identity of the clinicians and radiologists must comply with the provisions of the French regulations.

• The means to ensure the protection of the secrecy of information

circulating in the computer system and among the providers that host it.

• A technical annex specifying the industrial or institutional

communication support and the commitment to maintenance and medical procedures in the event of a technical failure.

• A financial annex detailing the remuneration terms of the

radiologist in accordance with the French coding of medical procedures (Classification Commune des Actes Médicaux, CCAM) and the host of the image transmission network.

• A quality control annex: the indicators are specified, separated

into medical indicators for radiological care, and technical indicators concerning the teletransmission network.

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