Teleradiology in the Middle East is still a new-emerging field that has not been yet fully explored. Many people in the field of radiology practice know about teleradiology and are aware of the possibility of transmitting the radiological images over distance to be read and interpreted but only few have been really involved in teleradiology work as the whole teleradiology market in the Middle East is still newly budding, especially on the commercial level. Over the past few years, multiple healthcare facilities throughout the region of the Middle East have been moving towards the implementation of EMR and PACS systems turning their workflow environment to be paperless and depending more and more on the technology to achieve better healthcare service to their patients. Along with that change, many hospitals and healthcare providers have been exploring the other possibilities these systems can provide them to help in solving many problems they used to have including the increased demands for imaging procedures with shortage of radiologists and also the need of many medically underserved areas to get radiology service along with other medical services.

A lot is being said about telemedicine, ehealth, electronic medical records, health informatics, healthcare technology advacements and its use in medicine.  Telemedicine as a profession and as technology is increasing in the Middle East.  You will see many emerging companies who are offering telemedicine services, teleradiology services and other teleconsultation options in the Middle East.  While thinking of all this, I really sometimes ponder on whether we are running after the technology and leaving the "medicine" behind? Whether the distribution of efforts in e-health/technology and the actual patient care and medical service availability is balanced?

Voice recognition (VR) software has been gaining popularity among physicians in recent years.  Many developers of VR software claim that their products have advanced so much that they are now a viable alternative to conventional transcription services.  Because of the importance of rapid turnaround times in radiology, many radiology departments and radiology groups have tried adopting voice recognition technology as an alternative to conventional radiology transcription services in an attempt to shorten turnaround times and cut costs.  Most radiologists who have used voice recognition technology don't deny that it can be an alternative to radiology transcription, but at what cost?

A lot of advances have come about in the field of medical transcription since its beginning as an allied health profession concerned with reporting and keeping the medical records of the patients. Changes included huge development in the dictation/transcription equipment's with replacement of the regular cassettes and manual typewriters by digital recorders and computers and along with the revolution of the medical data digitalization and Electronic Medical Records (EMR) systems, tremendous advances have come about in the transcription management systems and in having them integrated in the Hospital Information System (HIS) which had a deep impact on the protocols and procedures of medical transcription.

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The quality of healthcare is an important parameter by which to gauge any society's progress.  Indeed it has a prominent effect on any population's quality of life. That is why governments and policy makers in developed countries have spent billions of dollars to build healthcare systems that can provide quality healthcare to the largest portions of the population, and it worked. Now most developed countries have healthcare systems that provide excellent healthcare to the great majority of their populations pretty effectively, though not always cost efficiently. But what does any of this have to do with telemedicine? The answer: a lot.  When deciding whether to allocate resources to develop telemedicine technologies and adopt telemedicine programs, policy makers often compare marginal benefit and marginal cost: the expected benefit from telemedicine programs compared to current systems versus the resources needed to bring about these benefits. Often times, this comparison was not in favor of telemedicine.  When comparing telemedicine to their existing healthcare delivery systems, decision makers in developed countries often decided that the added benefits were not worth the required investment.  As a result, little resources were allocated to the development of more effective and affordable telemedicine solutions and the costs of using existing solutions remained high.

One of my colleagues has asked me this question before and left me pondering which came first, PACS or Teleradiology?  What I mean is, was Teleradiology/medical images transmission a goal by itself so developers kept looking for a mean to achieve it and they figured out that this should be the PACS; or was the main purpose to create a filmless environment and after creating the PACS they figured out that it can be web-based so can allow images transmission.  In my opinion, the reason why some people are still asking this question especially in the Middle East is the idea that PACS and Teleradiology are inseparable and impossible to exist without being together which is not correct.  PACS is not only for Teleradiology and Teleradiology can be made possible without using PACS, it's just that simple.  Of course having a web-based PACS system would provide the ideal environment for Teleradiology including image transmission, accessibility and archiving, but still Teleradiology can be made possible using workstations and DICOM viewers which can lower costs of the whole process to meet the budgets of healthcare providers in the Middle East.

10 years ago, many modality suppliers was selling a workstations with some storage space and image manipulation capabilities. Many hospitals had workstations--1 for MR, 1 for CT, 1 for NM, 1 for Fluroscopy, 1 for CR etc etc. Many vendors then started selling some server space alongwith workstations----MiniPACS. Radiologists had to move from workstation to workstations if they wanted to report on digital images. Film packets were the only way of providing a full imaging history in one place, as modality workstations created imaging data silos.