Distributed Care: Inside the VHA’s National Teleradiology Program
The Veterans Health Administration (VHA) launched its National Teleradiology Program (NTP) in 2007 as part of a broader initiative to leverage telehealth for expanded health care access and lower costs. “Initially, NTP was started to address the shortage of radiologists in the VHA,” says Colleen Passmore, administrative officer with the VHA National Teleradiology Program in San Bruno, California. “The goal is not only to address the internal needs of the VA, but to improve patient care. It’s a new VA, and we’re very excited to be a part of it.” In August 2010, the NTP began offering after-hours, night, weekend, and holiday coverage in addition to daily coverage for VA facilities without in-house radiologists. The program currently serves 43 VA facilities across 17 Veterans Integrated Service Networks (VISNs), which are divided up by geography; there are 21 VISNs nationwide. The program has been such a success that it has nearly doubled in size every year since it began providing services in 2009; Passmore reports that the NTP expects to be serving 22 additional facilities by the end of this year, close to half of the VA health system.Infrastructure and Organization In providing teleradiology services to its many facilities nationwide, the VHA benefits from a shared informatics infrastructure; all facilities operate behind a common firewall, enabling client facilities to send studies to the NTP’s four offices around the country through gateways. “We have a gateway at every facility linked to their PACS," says Passmore. "Patient studies are automatically uploaded and sent to the large central NTP server, from where they can be viewed and interpreted by any of the 4 NTP reading centers located throughout the U.S. NTP radiologists then read the imaging study and dictate their interpretation via speech recognition software. The report then goes back to the referring facility and directly into the local facility’s electronic patient record system within seconds." To ensure critical test results were getting to referring providers in a timely manner, the NTP developed a callback system, but quickly found that additional support was needed. “We put a team in place—we call them flight controllers, although officially they’re known as program specialists,” Passmore says. “They make sure studies are complete and ready to be read by our radiologists, and they also connect our radiologists with the referring providers.” In a geographically distributed system like the VHA, this can be a complex undertaking; for example, Passmore says, a reading radiologist in San Bruno could be trying to reach a physician in Atlanta with the help of a flight controller in Durham, North Carolina. “Out of the 662 calls we made last quarter, it took us an average of 6.3 minutes to get hold of referring physicians,” Passmore says. “In some cases, that may be faster than it would take an on-site radiologist in a darkroom to physically locate the physician.” Robust Offering As Passmore’s knowledge of quarterly data on critical results delivery indicates, the NTP has a strong focus on quality assurance (QA); the program’s administrators meet every three months to go over data including turnaround times, client satisfaction surveys, accuracy of interpretations, performance improvement, and more. The program’s most recent QA meeting revealed that average turnaround time for a routine study is less than eight hours, while average turnaround time for a stat exam is under 45 minutes. Of note is the fact that NTP radiologists have national privileges within the VA by an arrangement made with The Joint Commission.
The office of the VHA National Teleradiology Program.Meanwhile, the NTP answers to a governance board composed of leaders in the radiology field, and performs internal peer review on a regular basis; a mechanism also exists for facilities to report findings the NTP missed. “There’s a lot of oversight. It’s very robust QA, very thorough, and we take it very seriously,” Passmore notes. “It’s not just providing services to the facilities—it’s making sure we’re getting a quality report to every veteran.” That, of course, includes veterans in remote or underserved areas of the country; VHA facilities have faced the same recruitment challenges as rural hospitals when it comes to radiology. “At NTP, we have some incredible radiologists, who were subspecialty trained at Stanford, Duke, and UNC, and we’re able to attract those physicians to our four facilities,” Passmore says. “Then, a veteran in rural America could have a study done on a mobile MRI and still have a Stanford-trained radiologist read it for him.”
The office of the VHA National Teleradiology Program.When the NTP began providing night, weekend, and holiday coverage for VHA facilities, some of them experienced fewer recruitment challenges, Passmore notes. “The amount of radiologist vacancies in the VA has decreased since the beginning of last year,” she says. “We’re finding that NTP plays a role in that, because we’re taking on some of those tough shifts, making those positions more desirable.” Provider Satisfaction Passmore says the NTP gets high marks from the VHA facilities it serves. “NTP has been huge in helping to improve efficiencies in the local facilities,” she says. “The feedback we get is amazing—the facilities comment on the quality of the reports we turn out, and we’ve had some indicate that their oncologists request the reports be read by us.” Going forward, she sees the program continuing the rapid pace of expansion it has set in the past three years. “I would love it if one day we could support every facility in the VHA,” she says. “We want to be the radiology choice for these facilities, because of the quality of service we provide and because of what we’re doing to improve access to care. The VA is changing and improving, and we’re proud to be part of that.” Cat Vasko is editor of HealthIT Executive Forum.
The office of the VHA National Teleradiology Program.
The office of the VHA National Teleradiology Program.