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 patient,” he says, “and from the patient’s perspective, delivering what he or she wants—quality and accuracy, in a timely fashion, at an affordable price—is what we are here to do.” What’s Next Basu, who recently served as a White House Fellow under the Obama administration, cites economic pressure as a key trend that will drive the future of teleradiology. “In the future of health care, some critical threshold of size will be beneficial to physicians, medical centers, and patients,” he says. “As we look at a world with accountable-care organizations or bundled payments, in order to achieve the intrinsic benefits of these systems, you have to be large enough to play by that set of rules. In addition, in a world where reimbursements across health care are declining, size enables you to get economies of scale and increased efficiency.” Pyatt anticipates more small, local groups like his own linking, via teleradiology, to create cooperative networks. “We’re not at the end stage yet,” he says. “The trend for small groups will be for them to become part of larger networks, creating whole new models of delivering services. Those models are positive—they allow you to subspecialize.” Jennings concurs: “Teleradiology 2.0 extends technology between the practices so they can collaborate around the clock, and the ultimate extension of that is these practices becoming one. It makes sense, and it’s the best thing they can do for their clients,” he says. Ultimately, Basu sees more demand on the horizon for radiology—and more opportunity for practices to leverage teleradiology to grow. “We’re going to be seeing a lot more primary-care providers and physician extenders, and these clinicians really need the support of radiologists to know which tests to order, the implications of those tests, and the next steps in patient management,” he says. “There aren’t enough radiologists to match up there, which is where teleradiology can be very helpful. The core value of radiology is the best, most accurate, and most timely diagnosis of a patient’s condition, and that isn’t being lost—it’s being enhanced.”