Preliminary experience with an orthopedic teleradiology service at the Alaska Native Medical Center

The orthopedic service at the Alaska Native Medical Center (ANMC) in Anchorage provides comprehensive orthopedic care to 103,000 Native or "First Nation" peoples in the state of Alaska. From its base at ANMC, a 140-bed general hospital, the service provides outpatient services, inpatient services including surgery, and telephone consultation services to 10 regional medical centers, 15 subregional clinics, and 20 village health centers distributed over a wide geographical area. These outlying centers are staffed by 108 full- and part-time primary care physicians, 74 primary care advanced practice nurses or physicians assistants, and 456 Community Health Aides. In providing telephone consultation service, the current version of "radio clinic," a frequent challenge arises in interpretation of verbal descriptions of x-ray findings. Our primary care clinicians, while highly trained, cannot be expected to interpret x-rays at the same level as a specialist. Discrepancies occur in communicating radiographic detail. This can result in either delayed or unnecessary transfer of patients, inappropriate travel to regional medical centers or home villages, or simply suboptimal medical care. Fortunately, computer technology has evolved to a point at which quality x-ray images can be transmitted relatively inexpensively. This paper will describe our preliminary experience with such a system.