Teleradiology has come a long way from its origins in the 1980s, when physicians would snap a photo of a film and transmit the image across telephone lines. Remote review, once a last-resort option, is now a commonplace service employed by hospitals and practices alike to handle stat cases at night or difficult subspecialty cases.
Particularly in the past year, however, nagging questions have arisen that might give those practices that use these services pause: Does a practice that avails itself of off-site coverage leave itself vulnerable to a Trojan-horse attack by the teleradiology provider? Will the practice be subjected to greater legal liability? Does it erode the service that a radiology practice provides the hospital?
In an interview with ImagingBiz.com, the president of one hospital-based radiology practice put the above concerns in context and maintained that a good teleradiology provider can, in fact, improve service to the hospital.
Leonard Berlin, MD, FACR, chair of radiology, Rush North Shore Medical Center, Skokie, Ill, says, “If I got an involved or complex neuroradiological study, in the old days, I’d have to pack the films up and mail them to someone. Now I can send them in 3 minutes and get a consultation. When I do that, I’m offering a better service to my local hospital.”
Berlin says that, initially, the benefits of teleradiology were felt mostly by Rush’s radiologists. This is a familiar story to practices that got in on the ground floor. “We were an early customer of NightHawk,” he says, referring to NightHawk Radiology Services, Coeur d’Alene, Idaho. “At the time, we were looking around, and they were the only ones in the business. The other companies didn’t have track records yet.”
Right away, contracting with a teleradiology provider took pressure off the group’s radiologists and gave the practice leverage in competing for new staff. “It provides a more comfortable practice situation for the radiologist, because in the morning he or she is awake and bright and cheery: theoretically, more accurate,” Berlin says. “It also is easier to recruit a radiologist when I tell him or her I have NightHawk coverage,” he notes. “That’s a competitive advantage. We have a very well-trained radiologist doing wet reads. With NightHawk, you know they will be read by someone who knows what they’re doing.”
With improvements in connectivity, teleradiology companies have moved into final reading and daytime subspecialty services, also a boon to practices, Berlin says. Not only can the radiologist read with greater confidence by gaining immediate access to a subspecialty radiologist, but the practice is able to provide greater breadth of subspecialty expertise.
The Price of a Good Night’s Sleep
Berlin’s group is part of a 240-bed, community-based hospital in an academic system; the practice consists of eight radiologists. From 9 PM to 7 AM every night, NightHawk takes over while the radiologists get some much-needed rest. “Overnight, the studies are sent to NightHawk in Australia for preliminaries, and when we come in the morning, we provide the permanent reads,” Berlin says. “We pay NightHawk out of our pockets.”
Is that fiscally harrowing? Not when procedural volumes are constantly on the rise, Berlin says. “We probably average three or four cases a night,” he notes.
“Volume has grown, and it grew as a result of teleradiology,” Berlin states. “Whatever minimal guilt the doctors may have felt about waking the radiologists up in the middle of the night, they don’t have now. Our bill runs about $100,000 a year, which works out to $12,000 or $13,000, pre-tax, for each radiologist during the course of the year. We consider that money well spent.”
This is not to say that teleradiology services come without hazards of their own. Quality assurance (QA) is always an issue when contracting with outside providers. “We do our own QA, obviously, and NightHawk does it, too,” Berlin says. “We run about 1% to 2% discrepancies between the temporary reading and the permanent reading, which is consistent with our own readings and within national averages. Fortunately, we’ve never had a situation where there’s been injury to a patient.”
It is, however, conceivable that a misreading could be catastrophic, Berlin notes. One example is a subarachnoid hemorrhage. “The worst-case nightmare would be the patient who has a subtle, inconspicuous, or barely discernable bleed in the brain, the NightHawk radiologist reads it as normal,