Brokerage mechanism proposal for teleradiology studies distribution Daniel Ferreira Polónia *a,b , Augusto F. da Silva a , Carlos M. Costa a , José Luís Oliveira a a IEETA, b Dept. of Economics, Management and Industrial Engineering, University of Aveiro, 3810-190 Aveiro, Portugal ABSTRACT The asymmetric distribution of PACS equipment and service providers across countries leads typically to the need to hire third party service professionals outside the institutions where the exams were made. In this paper we present a brokerage mechanism that puts customers and remote providers together in a seamless way. The proposed solution, asserted with a case study for the Portuguese national health system, addresses the problems that now impair the optimal provision of those services, enabling a more agile relationship between buyers and sellers, optimizing administrative work and complying with clinical and legal requirements under discussion in the European Union for the free movement of patients and professional health workers. In this document, the detailed process and technical description of the broker functioning is made, and the main benefits for the participants are also evaluated from a technical and economical point of view. Finally, in the discussion chapter, an assessment of the creation of a spot market for imaging studies is made and the integration with other similar markets is discussed. Keywords: Telemedicine, outsourcing, workflow optimization, brokerage, e-marketplace, PACS 1. INTRODUCTION Nighthawk radiology is the common term for reading of radiology studies outside the premises of the institution where the study was made. Using telematic resources, professionals properly trained and accredited are able to provide the referring physician with a written formal opinion, based on the performed radiologic or imaging exam, on the patient clinical history and, in some cases, other physicians’ opinion and/or information [1-3]. This trend in the provision of imaging services was caused by the shortage of skilled staff and the increase in the number of studies and images per study that led to an increase in the workload [4-6]. Another, not so immediate reason, was the unevenness between the distribution of imaging equipment that, in spite of availability and low operational costs, produces exams that require highly paid and trained radiologists to perform the analysis of the exam outcomes [7-11]. The solution found was to outsource the work to external providers, either within the country or outside the country, that could fill this gap and provide a quicker turnaround time for the exams [12]. This, of course, coupled with appropriate developments in the fields of telecommunications [13], and in the field of telemedicine with focus on teleradiology. The increase in interactions has developed the need to optimize the work of matching the requirements of those buying the services in the clinical institutions where the exam is performed and those providing them, in the remote workplaces, far from where the exam was done and where the patient is attended. This paper is organized in the following manner: Section 2 presents a case study of the Portuguese Health System, linked together with a broad description of the processes tied with the traditional service provision. From there, problems are identified and a solution is proposed, both from the technical and the process side, placing a brokerage mechanism in the system. Section 3 analyses the results of placing the mechanism in the system from the administrative, clinical and financial point of view. Section 4 discusses the benefits of the mechanism from the entities involved in the service provision, as well as it identifies further work. Finally, Section 5 concludes with a prospective view of how the insertion of a broker between the Buyers and Sellers can lead to the creation of a spot market for imaging studies. Medical Imaging 2008: PACS and Imaging Informatics, edited by Katherine P. Andriole, Khan M. Siddiqui, Proc. of SPIE Vol. 6919, 691906, (2008) · 1605-7422/08/$18 · doi: 10.1117/12.770753 Proc. of SPIE Vol. 6919 691906-1 2008 SPIE Digital Library -- Subscriber Archive Copy