 Hello, welcome to the IM Global Telegrology and Quality Control Center. This center was established in 2012, based in Manila, Philippines as part of the Global MHD Support. It provides global radiology support and tele-radiology programs. It aims to standardize and optimize the quality of the radiology service worldwide. In this video, the tele-rad team will guide you through a virtual process and explain to you how this center supports different missions through different activities to optimize the quality of service worldwide. IOM Global Telegrology and QC Center has a team of five technical experts that serves the missions with technical support requests that range from PAX installation, configuration, troubleshoot and assist in configuring X-ray CRDR machines. The center is connected to 75 PAX nodes in different locations worldwide enabling access to tele-radiology. The center uses web-based tele-radiation developed in-house in collaboration with IOM ICT units. The application has built-in workflow engine to auto-distribute workload to available radiologists in real-time. It also has built-in reporting forms specific to the program type, namely US, Australia, Canada, New Zealand and IOM standard form that allows a radiologist to read the X-ray and download the report from the mission site in real-time. Our radiologists use diagnostic monitors with commercial image viewer remote eye to review images. Security and confidentiality is maintained with role-based access in the application. Microsoft Teams and Skype are used to communicate with missions in real-time. But also it directly supports the mission on radiology services like radiology guidelines, templates, tours, also provides training. It can be online, on-site and by organizing workshop. When we go to the mission we do audit visit to the X-ray units and based on the assessment results give feedback for improvement. Here at IOM Global Tele-Radiology Inc. center the team is working closely with its radiologist, technical team and medical support staff in planning the work schedule to ensure that the center provides adequate and efficient support to missions at all times. The center is also coordinating closely with respective departments such as HR, procurement, finance and legal team to ensure the equipment, services and licenses are timely updated. Also in coordination with various missions across the globe the team also conducts tele-radiology users training for panel positions, radiologists, nurses, radiographers and medical support staff. This is to facilitate fast coordination and smooth processing of cases daily. Most importantly as the center values continuous improvement of its services and its team members the center is doing its best to equip all team members with learning opportunities that will expand their knowledge and skills towards professional growth and of course further advancement of tele-radiology systems and its related technologies. One of the main programs provided by the center is primary reading where the X-rays are transferred to us and we read it real-time and the missions get the X-rays' reports in real-time. We are supporting currently more than 52 locations and we are networked more than 75 locations. I think they are enabled for tele-radiology service. This service is real-time, provided real-time and we are working hours per day, Monday to Friday and also Saturday and Sunday. This is to cover all the different times once we do it. IOM tele-radiology is connected to IOM and non-IOM locations globally. What differentiates us from other tele-radiology providers is that we give emphasis to technical preparation, training and support. During the technical preparation and planning we always do our best to customize our services to the needs of each mission in accordance with the IOM-ICT standards. We install packs in all the missions, configure the packs in the X-ray machine, pilot test the system, train the end users and provide continuous technical support. The X-ray images are replicated from the clinics in the mission to the tele-radiology center in less than 5 minutes. The radiologist reading is done right away using the tele-radiology system. All the while, the mission can monitor the status and progress of the study using the same system. The tele-radiology system starts the day for each mission with greetings and asking the focal person in the mission the expected case load on the Skype chat group. The chess X-rays are sent from the mission then initially received in the tele-rad pack system and will replicate in the tele-rad application given it satisfies the set criteria. The tele-rad system automatically assigns chess X-rays to each radiologist on duty for interpretation. In e-medical cases, Australia, Canada and New Zealand, the tele-rad assistants compress and uploads the chess X-ray die-com file in the in-house system which automatically renames and compresses the file with name and e-medical ID. It is very important to cross-check biodata for discrepancies. Same is done for chess X-rays uploaded by the mission. Tele-rad report is then downloaded in the tele-rad application and carefully transcribed to e-medical. Once done and completed, the ready for interpretation box is ticked to inform radiologists that the case is ready for e-medical submission. Upon e-medical submission, the radiologist takes the submitted box and completeness and correctness of e-medical submission is checked. For UK refugees, US and other cases, it is read in tele-rad application only. UK TB e-med grant cases are also read as is in the UK TB S application. Upon confirmation from the mission that all cases are sent, an Excel summary of process cases are then generated in the tele-rad application. It is then applied to the working file and sent via e-mail with a case count summary. We are tasked with interpreting chess X-ray images on a daily basis. We utilize a system that automatically assigns cases to all radiologists on duty. To access a case, we go to the main tab and we click on a particular case. Once we click on the particular case, an image would appear on the screen with a corresponding reporting form. Once the image is uploaded on the screen, we check for the bio data to make sure that this image belongs to the patient that we should interpret. And then we also check for the image quality as this would affect our interpretation of the image. In non-garden variety cases for which additional images are needed for clarification of a finding, we are able to request so through the same tele-radiology software so that the mission could immediately perform the desired request. For any case that needs discussion or further investigation, or any queries from particular mission's panel physician, we discuss the cases with supervising radiologists and address their concerns accordingly. Communication is real-time with Skype. A peer review and quality control system is present to make sure that the highest quality diagnostic work is done. One of the global activities that we do is second opinion service. When we say second opinion service, when the panel physician or radiologist from the missions have any query about just an excellent report, they will send us an email to review or give our second opinion. When we get that, we will import the image from the local mission packs and duplicate it in global packs, then it will be cued in the tele-radiology application and tagged as second opinion. After that, we will review the image and if there is any, we will ask for additional view. If not, we will complete the report, download the PDF report and send that by email. We will give this with one hour as well. We also run a quality control program using tele-radiology. This system is semi-automatic, complex, linking different systems with automatic sampling of the image from local mission fetching the primary reading from MHD's system called MIMOSA and we read the x-rays here and the system compares, analyzes the data and based on the results we give feedback to the user optimization of the quality of tele-radiology service. IUM global tele-radiology center does quality control of 15% of US cases from IUM locations. The systems inter-operates between multiple systems linking local mission packs, global QC packs, mission MIMOSA systems and tele-radiology QC applications. During the technical preparation we assess and coordinate the tele-radiology QC system requirements to the mission. We configure sampling schedule of chess x-ray images from the local mission packs and report extraction from the MIMOSA system. We train the users on the tele-radiology QC system and its regeology process before we go live the QC process. The QC process involves multiple steps and during the QC process there is a continuous technical support monitoring and troubleshooting of issues. The regeograph selected from our partner locations were queued for review by QC1 radiologist. I review the chess x-ray assigned to me and submit the reports using the corresponding chess x-ray reporting form in the tele-radiology QC application. The QC system generates a score based on the degree of discrepancy between the readings of the QC1 radiologist and the primary radiologist. Those with significant discrepancy namely grades 3, 4 and 5 are again queued for review by the QC2 radiologist. The other activities that I do is as quality control monitoring radiologist where when there is a discrepancy between quality QC1 reading and the primary radiologist and there are significant discrepancy it will come to QC2 radiologist. Then as a QC monitoring radiologist I will review the reports and the image of both primary and QC2 radiologist. If I agree with the QC1 radiologist the system will again auto-calculate the score and it will be the final score to be sent to the focal radiologist in the mission. And also if I agree with the primary radiologist the system will recalculate the score and it may not be sent for focal radiologist review. We work a lot on improving our quality of service internally. We review 5% of the X-rays for internal monitoring and in France if there is and we give feedback and review. We have also another new pilot program called Pre-Review. 10% of the X-rays are re-read by a secondary radiologist before finalizing the report. We have policies and SOPs in place for all terredology processes including addressing if there are any issues. And the radiologists are asked to consult any difficult cases before finalizing the report and we have regular image review session with all our radiologists to learn from our mistakes on collected image. The other activity we give at the center is consultation our consultant radiologists if they have any queries on the findings, if they have any question on what type of additional to give or if there is any queries on how to classify the findings from the different reporting formats they come and consult and it is a center salute to consult before finalizing the report if there is any query. Every day after every shift 5% of the cases interpreted in the center were randomly selected and reviewed for internal monitoring. If a selected case needs an additional view for clarification or if the interpretation itself requires revision, the mission is immediately notified. A feedback mechanism is also in place to inform the primary radiologist of the revision. The center also works on different other global partners we share we do research work and use it for our performance but also for sharing our experience and collaborating with our global partners in the sector representing IOM. Delirad produces regular statistical reports for both the primary reading and QC reading. This data is generated from Delirad SQL reporting systems. State is used to validate and analyze data for billing, performance monitoring, sharing of experience or other decrees from the missions. In addition, the center also does surveys and research collaborations with global partners. Advances in technology system and infrastructure and the different global support programs and services provided by the center has been highly acknowledged by the resettlement country governments and global partners and has put IOM in a competitive place. The center would like to continue the expansion the quality of service and support is providing and contributing.