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What are the Considerations in Using Teleradiology to Address Shortages & Wait Times in Healthcare?

Executive Summary

With the population aging and the increased prevalence of chronic disease, the demand for healthcare specialties to diagnose, treat and manage various conditions will continue to grow. Wait times for diagnostic tests and access to many subspecialties have been a concern of health systems globally. Teleradiology is the transmission of radiological patient images, such as x-rays, CTs, and MRIs, from one location to another for the purposes of sharing with other healthcare providers. It differs from traditional radiology only in that the receiver of the images is not in the same physical location as the patient. It is being increasingly used in many different settings to improve efficiency by addressing the lack of adequate staff to provide radiological coverage and the lack of expertise in this specialty.

 

New models of teleradiology are emerging, including outsourcing the technology to other countries (often to India - more information on this perspective can be found here) and homegrown models based on hospital/physician partnerships with vendors and/or other care providers. Each has cost, quality and regulatory implications that should be considered. Click here for further background reading that outlines some of the economic and legal implications associated with teleradiology when it was considered an emerging technology. Other interesting insights from an organizational learning perspective can be found in this article. The ACR Task Force on Teleradiology Practice developed a White Paper that proposes comprehensive best-practice guidelines for teleradiology that includes recommendations regarding future actions. Strategies with respect to waiting time reduction include:

  • Consider using a teleradiology vendor to offer 24/7 comprehensive coverage and thoroughly research the risks and benefits of various offerings; 
  • Utilize a partnership approach with a preferred vendor and/or other care providers;
  • Access sub-specialty coverage via teleradiology and allow general on-site radiologists to focus on standard cases;
  • Consider technological architecture and workflow management issues.

 

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Consider Using a Teleradiology Vendor to Offer 24/7 Comprehensive Coverage

Teleradiology is well established in healthcare, with on-call emergency reporting being used in over 70% of U.S. practices. Teleradiologists who provide after-hours (nights, weekends, holidays) services are often called “nighthawks.” In addition to cost considerations, there are regulatory standards that must be considered with respect to your jurisdiction. For example, the qualifications of personnel, equipment standards, storage of clinical records, licensing, liability and quality control are some issues that require consideration when selecting vendors. An example of such standards is available here from the Canadian Association of Radiologists. Generally, good practice is that a written report is required for each and every patient radiologic study. This can be a preliminary interpretation or a final report that may be conducted by an in-house radiologist at the same location the patient was tested at. Many of the larger teleradiology vendors offer 24/7 services and aim to replace traditional in-house radiologists, which has been the subject of much debate in the medical community. For example, there are some concerns that radiology is being commoditized by focusing only on report delivery and generating case volumes to improve financial bottom lines. In addition to regular radiology readings, many vendors also offer stat readings, phone consultation, IT and marketing support to clients. When selecting a vendor it is important to assess your organizational requirements and existing resources. Using data to assess current volumes over specific days of the week and hours of the day is important in order to develop a business case for 24/7 teleradiology coverage. The traditional model of having on-site, local radiology capability may better serve some communities, while outsourcing this capability may better serve others. Assessing strengths, weaknesses, opportunities, and threats (SWOT) of each model is a useful first step. Barriers to teleradiology can include technological requirements, regulation, licensing requirements, billing, reimbursement issues, security and liability issues. Further reading on security issues with respect to Veteran's Affairs teleradiology contracts may be useful for organizations considering use of this technology. Also, a case report on Georgetown University Medical Center provides additional information regarding project planning with respect to quality assurance and security issues in teleradiology.

Utilize a Partnership Approach with A Preferred Vendor and/or Other Care Provider

There are a number of considerations when determining whether your organzation should partner with a vendor. Some of these may include exploring new ventures with other hospitals including any plans for further development and expansion. A partnership approach can also lessen cultural change whereby on-site groups may be more comfortable when shared interests are made explicit. Further discussion on some of these issues can be found in a White Paper developed by one such vendor and provides some useful insights. A case study that profiles the achievements of Prince Edward Island in reducing wait times for diagnostic imaging via a teleradiology partnership with Nova Scotia can be found here. A second case study using teleradiology in general practice for access among island residents in the Netherlands is also of interest since it imporved access and reduced costs to patients and health insurance companies.

Access Subspecialty Coverage via Teleradiology and Allow General on-site Radiologists to Focus on Standard Cases

Coverage for subspecialities (e.g., musculoskeletal, cardiovascular) is problematic for some radiology practices (approximately 23.4% in a recent study). Utilizing teleradiology in this regard can help to fill that gap, particularly for smaller facilities or those with limited budget for trained in-house specialists. While teleradiology can help to fill a growing need for efficient access to a limited supply of radiologists, there are some limitations to the technology such as those procedures that require the physical presence of an on-site radiologist (e.g., GI barium study, abscess drainage). 

Consider Technological Architecture & Workflow Management Issues

The major components of a teleradiology system include: a picture archiving and communications system (PACS), a radiology information system (RIS), and a reliable and secure high-speed connectivity between the remote sites. Standards for imaging and procedures for security and contingency strategies are also important aspects. One important trend in this area is cloud architecture, whereby images can be stored in virtual data centers, freeing up offline server space in hospitals and other healthcare organizations. Workflow management software is also an area of future growth whereby images can be shared seamlessly to available radiologists in real-time on tablets and smartphones. 

We are interested in generating some discussion on this topic - please check out our Digital Healthcare Community of Practice and join the conversation.