Teleradiology 2.0: A Decade of Evolution

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Pat Basu, MD, CMORobert Pyatt, MD, a radiologist with Chambersburg Imaging Associates in Pennsylvania, recalls well the decision that his practice made to contract with a teleradiology group, almost 10 years ago. “We started with teleradiology in the fall of 2002,” he says. “Before then, we would be up all night reading cases. Then, life got a lot better—we would only work until midnight, the teleradiology group would take over from midnight to 6 am.”

Today, Pyatt sees much broader potential for the load balancing in radiology services made possible by technology, especially in his specialty area of breast imaging. “We’ve had trouble recruiting radiologists to this state, and younger radiologists aren’t going into mammography as much,” he notes. “Mammography is going to be a valuable future specialty for teleradiology here (and in other parts of the country).”

Rick JenningThis experience mirrors that of many practices nationwide: Teleradiology, which began as a way to give busy radiologists a break from an unrelenting on-call schedule, has grown into much more, according to Pat Basu, MD, CMO of Virtual Radiologic (vRad), Eden Prairie, Minnesota, which celebrates its 10th anniversary this year.

“We find ourselves in a time of incredible emphasis on quality, increased access, and lowered costs,” he says. “Teleradiology, with its ability to match medical supply and demand, has helped meet that need.”

In his 1877 History of a Crime, Victor Hugo (1802–1885) wrote, “One resists the invasion of armies; one does not resist the invasion of ideas” if their time has come. Basu says, “The ability to deliver excellent quality and increased access, with a much more effective distribution of costs, is an idea whose time has come.”

Evolution of Teleradiology

Basu attributes teleradiology’s rapid growth in the past decade, in part, to the rapidly mounting capabilities of advanced imaging technology. “It’s incredible that 15 years ago, many of the modalities we now consider routine were not really used at all,” he says. “Radiology has replaced a lot of unnecessary surgery and has decreased costs through quicker, more accurate diagnoses, and that’s helped teleradiology provide great value as well.”

Rick Jennings, CTO of vRad, echoes this observation, noting increased demand for subspecialists to read particular studies. The need for subspecialized interpretation has driven increased use of teleradiology, enabling practices to supplement their local expertise as necessary.

“We’re now in what we call teleradiology 2.0,” he says, “which is characterized by final interpretations at all hours, with as much work done in the cloud as on the ground. Teleradiology 2.0 says your on-site radiologists are always needed for interventional procedures and discussions with physicians, but a large number of the studies typically read in the reading room can be read more efficiently by getting them to the right physician, wherever he or she is.”

Pyatt notes that in the past decade, emergency-department admissions at night have increased, alongside an increase in the use of CT for triage. “More and more emergency departments are being used from midnight to 6 am, and they’re using more imaging in the emergency department,” he says. “We do so many CT angiograms at night, and the technology has made it easy for the physician to get a fast, reliable answer.”

He adds that another factor driving the use of teleradiology has been lifestyle—specifically, the lifestyle sought by young radiologists emerging from medical school. “For us, teleradiology helps with recruiting—letting new radiologists know that they won’t have to be up all night. From the patient and medical-staff perspectives, teleradiology means better service and better quality,” he says.

As the facility of load balancing between teleradiologists and on-site radiologists has increased with improved technology, new business models for the practice have emerged. “With reimbursement declining, the only way a radiology practice can remain competitive for its hospital customers is to be more efficient,” Jennings says. “This technology enables radiology groups to read more studies per radiologist per year. They’re able to overcome the reimbursement pressures while improving service and quality.”

As Basu adds, improving the economics of imaging in this way also improves patient care, aligning radiology groups with outcomes-based goals being set by payors and government. “The ultimate person we’re serving is the