4 April 2019
During a routine inspection
Telemedicine Clinic is operated by Telemedicine Clinic Limited. Telemedicine Clinic is a European based teleradiology company providing diagnostic reporting services day and night, throughout the year, to hospitals in the UK. It does not provide patient imaging services and does not have direct contact with patients. As a teleradiology service, it receives diagnostic images from hospitals, reports on them and sends the reports back to the referrer. For some clients it also justifies diagnostic imaging, which means radiologists evaluate the radiological examination proposed, for its clinical merit and appropriateness. It reports on images generated by magnetic resonance (MR), computerized tomography (CT), X rays, dual-energy X-ray (DEXA) and nuclear medicine.
The provider, Telemedicine Clinic Limited, is the UK branch of the company with an operations office in Theale, Reading, serving UK clients which are NHS trusts and independent health providers. Telemedicine Clinic Limited is owned by a diagnostic service provider based in Switzerland.
The Theale operations office receives images from health provider clients and allocates them to radiologists for reporting. The radiologists are supported to work remotely from their homes or from offices in Barcelona, Spain and in Sydney, Australia.
The service provides diagnostic image reporting services for the whole population.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 4 April 2019 at the operations office and we also phoned radiologists working remotely after the onsite inspection.
To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.
For diagnostic imaging services, we do not rate effective, and for teleradiology services we do not inspect or rate caring, as the service does not have direct contact with patients. This was the first time we rated this service. We rated it as Good overall.
We found the service was good:
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The service had enough radiologists and operational staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm. All staff completed a programme of induction, designed for their roles.
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Records of patients’ care and treatment were clear, secure and accessible to all staff involved in the diagnosis pathway via password protected systems. Patient data was pseudonymised and only retained for as long as necessary.
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Radiologists escalated unexpected or significant finding on reported images, kept clear records and asked for support when necessary. This included findings indicative of abuse. They applied the Ionising Radiation (Medical Exposure) Regulations guidelines when justifying X-ray diagnostic tests. The service followed best practice when justifying the use of contrast administration.
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The service managed patient safety incidents well and reviewed records for discrepancies. Senior radiologists or managers investigated incidents and shared lessons learned.
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The service supplied staff with suitable equipment, including workstations with monitors for all radiologists. There were systems to test and calibrate monitors, in line with the Royal College of Radiologists (RCR) guidelines for diagnostic display devices.
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The service provided care and treatment based on national guidance and evidence of its effectiveness. This included guidance issued by the RCR. Managers checked to make sure staff followed guidance.
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There was peer review and management review of radiological reports and findings were shared to improve outcomes for patients and for learning.
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The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held meetings with them to provide support and monitor the effectiveness of the service.
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Staff in different roles worked together as a team to benefit patients. Radiologists, other health staff, operational, IT and administration staff supported each other to provide a good service.
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The service planned and provided services in a way that met the needs of those using the service. It was available at any time of day or night, throughout the year so clients could access the service when they needed it, in line with their contracted arrangements. Turnaround times from referral to reporting were in line with agreed standards.
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The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
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There was a clear leadership structure that supported radiologists and operational staff.
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The service had a vision for what it wanted to achieve based on agreed values and objectives.
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Managers across the service promoted a positive culture that supported and valued staff, and created a sense of common purpose based on shared values.
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Telemedicine Clinic systematically improved service quality and safeguarded high standards of care through effective governance systems. This created an environment that promoted excellent clinical care. The service was committed to improving services by learning from when things went well or wrong, promoting training and innovation
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The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards
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Telemedicine Clinic had systems to identify risks, plan to eliminate or reduce them, and cope with both the expected and unexpected.
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The service engaged well with staff, clients and local organisations to plan and manage appropriate services.
However, we found the service required improvement in the following area:
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The provider did not have a registered manager for the service, which is a requirement of the service’s condition of registration with the Care Quality Commission. The applicant was in the process of resubmitting their application at the time of the inspection, but the service had been without a registered manager for over six months.
Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.