The Radiologist As Ambassador: Integrating On-site and Off-site Reading at Lima Memorial

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Daniel SchultzWhen Daniel Schultz, DO, accepted a position with Radisphere (Cleveland, Ohio, and Westport, Connecticut) five years ago, he was particularly excited about the prospect of a combined on-site and off-site radiology practice. “I saw it as a way to practice my specialty, but also to rely on my colleagues to cover their areas of expertise,” he says. “With everyone working together, we can give high-quality service to smaller hospitals, and patients will receive the highest possible quality of care. I thought this vision was ahead of its time, and I believe in it even more strongly now.” Schultz is board certified and fellowship trained in body imaging; he serves as clinical director of general and interventional radiology for Radisphere at Lima Memorial Health System (LMHS) in Ohio. “Most of what I do as a Radisphere on-site radiologist is similar to what a radiologist in a traditional practice does,” he notes. “What’s really different is that if I am busy doing a procedure, the studies that need to be read on a timely basis are sent out for a remote radiologist to read. You always have someone watching your back.” Consultation Connection A critical component of Schultz’s role at LMHS is facilitating radiologist consultations with hospital physicians. LMHS is a licensed 300-bed facility with approximately 50 radiologists on staff via Radisphere’s network, including neuroradiologists, musculoskeletal radiologists, and emergency-department radiologists, along with those trained in body imaging and women’s imaging. “This is an excellent working model because no community hospital would ever have this degree of expertise available to it via standard radiological practice,” Schultz notes. The on-site radiologist helps connect referring-hospital staff physicians with these off-site radiologists when necessary, and is available to consult with physicians throughout the day, Schultz says. “Over time, you develop strong professional relationships with the physicians in the hospital. Often, they’ll come down to go over a case in person—be it one that I read or one that my colleagues read,” he says. “Consulting with physicians is a significant part of the job of the on-site radiologist.” When subspecialty expertise is needed, Schultz can help connect the referring physician with the subspecialty-trained off-site radiologist who read the study, and software tools can be used by all three parties to go over the images in real time. “If I had a musculoskeletal case with a bone lesion and the orthopedic surgeon came down for consultation, I could call the musculoskeletal subspecialty radiologist and—within a few minutes—have a consultation where we’re all viewing the same case at the same time,” Schultz says. “It’s a true, real-time consultation amongst the three of us.” Additional Responsibilities
 Consultation on completed imaging studies is only one piece of the on-site radiologist’s role, however. Schultz helps physicians with radiology-related questions dealing with dose reduction and utilization management. “We actively work to educate the physicians and the technologists on how to use the modalities we have at our disposal in the most efficient way,” he says. “It’s part of our role as an ambassador to the medical staff.” For instance, Schultz might suggest an ultrasound in lieu of a CT for a given diagnostic scenario, like potential fluid collection in the patient’s thigh. “We work hard at making sure patient imaging is appropriate,” he says. “To that end, we concentrate on decreasing both the number of times we have to use ionizing radiation and the dose. Sometimes, there’s nothing that will more clearly define a pathology than a high-quality CT, but if it becomes apparent that another modality would be more appropriate, we will make that suggestion to our physicians.” Efforts to educate physicians on dose management are ongoing. “It’s very important because of the long-term cumulative effects of radiation dose,” Schultz says. “We are continually monitoring to make sure patients aren’t getting more radiation than is required. We want to increase the physician staff’s level of awareness related to radiation exposure.” Schultz also spearheads ongoing initiatives aimed at utilization management. As an example, he cites workup protocols for pulmonary nodules. “A patient often will have a small lung nodule that could be of benign etiology. It does, however, need to be followed,” he says. “There is a logical approach to dealing with these nodules based on the recommendations of the Fleischner Society.1 Instead of bringing the patient back for multiple short-term imaging follow-up visits, we follow the established guidelines.” In doing so, he says, “We significantly decrease the number of times a patient has to be imaged, and those efforts are being approached across multiple disease entities to manage utilization and radiation exposure better.” Schultz concludes that the model of an on-site radiologist working in tandem with off-site subspecialists is here to stay. “We have a large group of off-site subspecialty radiologists to refer to and extract their knowledge and wisdom, and I do that readily,” he says. “The Radisphere radiology practice model in a community-hospital setting is excellent and will become progressively more popular and sought after in the years to come.” Cat Vasko is editor of and associate editor of Radiology Business Journal.