With advances in technology, increasing broadband speeds and availability of pre-caching on picture archiving and communications systems (PACS) workstation software, there has been an increase in the home reporting of backlogs for GPs and accident and emergency and plain X-rays.
Potential benefits of flexible home working include:
- A less disruptive or stressful environment
- Being more suitable for some radiologists
- Encouraging full-time radiologists to undertake additional reporting
- Attracting radiologists living remotely who do not want to move
- Being more cost effective than using third party reporting companies
- Easing pressure on limited office space within the department.
Designing and managing home working
When setting up the home-working environment, the aim should be to replicate as closely as possible, the conditions, equipment and systems that are available within the department. Factors for consideration include:
- The speed and security of the internet connection (ideally 100mbps)
- Workstation and display – taking into account cost and efficiency, the optimum set up would include 3 display monitors
- Download speeds
- List management, report entry and alerting
- Additional clinical systems
- Desktop integration between the radiology information system and the image viewer
- Additional software for word processing etc
- Maintenance, repair and software support
- Use of voice recognition software if this is available in the department
- Indemnity cover for the home reporting radiologist
- Insuring equipment against loss or damage.
Home working contracts tend to be based on volume of work rather than time, and it is advisable that this is separate to any contract for work within the department. Specific contractual negotiation and some on site programmed activities may be necessary to facilitate supporting professional activities such as continuing professional development (CPD).
It is essential that HRRs maintain their skills and knowledge in the same way as a radiologist working within the department.
Requirements for annual appraisal and GMC revalidation are the same for HRRs as for radiologists working within the department and may require financial support from the trust for HRRs working significantly less than full time to attend relevant scientific meetings, audit etc.
Learning from discrepancies meetings (LDMs)
HRRs should try to attend at least 50% of LDMs, either in person or via video or teleconferencing. Any discrepancies arising within an LDM from an HRR’s reporting should be notified confidentially to the HRR.
Security and responsibilities
HRRs are responsible for making sure that equipment is secure from physical damage and that data is secure from unwarranted access. Image data should be deleted regularly (preferably daily). Storage of cases for CPD or audit may be held as agreed with the clinical governance/audit lead at the trust.
The HRR must adhere to trust protocols in the event of unexpected urgent or significant findings
HRRs should be aware that working from home may affect tax, home insurance and mortgage arrangements.
Potential disadvantages to home working
While there are many potential benefits to flexible home working, there are some disadvantages as outlined below:
- Encouraging a shift of radiological manpower away from radiology departments.
- De-skilling of radiologists doing predominately remote reporting.
- Capital outlay and higher running costs.
- Quality assurance issues – difficultly maintaining CPD, attendance at LDMs, peer review.
- Equipment maintenance – more difficult to access the equipment.
- Contractual issues – home reporting does not fit easily into the 2003 contract.
- Loss of contact between HRR and colleagues within the department.