Large-Scale Teleradiology and Evolving Virtual Imaging Service in South Korea

Objectives: Teleradiology is one of the earliest successful telemedicine applications that has fueled the digital transformation of radiology services. It started as a point-to-point service for a single department. Now, there is a growing need for an enterprise-wide radiology platform involving multiple radiology departments with many different information technology infrastructures as radiology services are consolidating and reorganizing. The article aims to review the evolution of the country-wide virtual radiology platform supporting many different radiology departments throughout Korea and discusses technical and management lessons learned in the process and identify new requirements. Methods: Research materials are based on reviews of publications on teleradiology, telemedicine, picture archiving and communication systems (PACS), digital transformation, and internal engineering and management documents of Hesel Clinics, the developer of the system, over the past 20 years. We also reviewed the aspects of health care systems in Korea that played an important role in digital transformation and teleradiology. Results: The Korean enterprise imaging platform is fully operational and growing. Certainly, the Digital Imaging and Communications in Medicine (DICOM) standard in radiology is foundational technology enabling teleradiology and PACS, but it is insufficient for enterprise platforms. Conclusions: For an enterprise imaging platform, one must integrate information from multiple subsystems such as PACS, radiology information systems, and electronic health records from many heterogeneous radiology departments with varying workflows. Data standards need to extend beyond DICOM, and standard tools for system integration are needed.