Transitioning to 24/7 coverage

Practice Model: Teleradiology

Anjali Agrawal, MD Senior Consultant, Teleradiology Solutions

Adjunct Faculty, Baylor College of Medicine, Houston

Joint Secretary, Society for Emergency Radiology

Teleradiology-Evolution

• Digitization of radiology images –transformed radiology practices, and made teleradiology feasible

• Evolved rapidly hand-in-hand with the internet in the 1990’s

• PACS and ease of image transfer and sharing promoted acceptance. “Teleradiology shifted from being a technical curiosity to a clinical tool”*

• Today, 50% of hospital based radiology practices utilize teleradiology service providers in addition to hospital to home use

* Thrall JH. Teleradiology: two edged sword or friend of radiology practice? J AM Coll Radiol.2009 Feb; 6(2)

Teleradiology-Thriving Practice Model

• Fuelled by shortage of radiologists, increasing imaging volumes, demand for subspecialized reads

• Imaging has become a central part of modern medicine

• Different lifestyle expectations of radiologists -”Controllable Lifestyle”

– Outsourcing reads during uncomfortable work hours makes practices more lucrative

Hillman BJ. International teleradiology and new workforce expectations. J Am Coll Radiol. 2005 Feb;2(2):103-4

Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical

students. JAMA 2003;290:1173-1178

Teleradiology-Friend or Foe?

• From whose perspective? – US based general radiologist

• Big practice

• Small practice

– US based specialized radiologist / teleradiologist

– Patient

– Hospital

– ER staff

– Global radiologist

Teleradiology-Patient’s Perspective

• Quick availability of radiological services 24/7

• Access to specialty radiologists from anywhere

• Probably, better pricing

Pros

Cons

• In unregulated environments, quality assurance can be a concern

• Reduced communication between clinical team and radiologist may happen

Teleradiology: Radiologist’s friend

• A blessing for smaller practices

• Subspecialty opinions in groups where there aren’t any

• Improved lifestyle

• Ability to take your work anywhere

Teleradiology: Radiologist’s foe?

• Reduced exposure to emergent cases

– Unhealthy for personal academic growth

– Reduced role and connectivity within organization

• Reduced revenues may become a consideration in coming years

• Commoditization and consolidation of Radiology???

Boland GWL. Teleradiology coming of age: Winners and Losers. AJR2008;190:1161-1162

Teleradiology- Driving commoditization of Radiology?

• Commoditization only if the client radiology groups or hospitals fail to recognize the intrinsic quality associated with radiology services

• Once commoditized in the eye of the client, financial pressures to provide low prices will further commoditize radiology, setting up a vicious cycle

• Reduced quality standards, poorer patient care, and overall discontent

Boland GWL. Teleradiology for Auction:The Radiologist Commoditized and How to Prevent it. J Am Coll Radiol. 2009

Leung DPY, Dixon AK. Clinicoradiological meetings:are they worthwhile? Clin Radiol 1992;46:279-80

Commoditization: a state where a product has minimal intrinsic quality attributes and can be bought similarly from many equivalent vendors

Getting the best from teleradiology towards 24/7 coverage

• Teleradiologists

– Stringent QA process-review of reports and regular comparative audits

– Precise pathways of communication of urgent or unexpected findings

– Availability to on-site clinical staff: contact phone number

– Maintenance of certification, licensure, credentialing, adherence to all regulations

QUALITY IS NOT AN ACT. IT'S A HABIT.

Getting the best from teleradiology towards 24/7 coverage

• Radiology groups – Evaluation of external teleradiology services on

quality

– Active feedback and dialogue with teleradiology providers

– Active engagement with clinical and educational programs

– Maintenance of skills in emergent radiology

Conclusion

• Teleradiology is a good practice model for 24/7 coverage

– Patients benefit

– Radiologists can have improved lifestyle in certain situations without compromising their role either as a doctor’s doctor or a patient’s physician

– Adherence to QA and self regulation can prevent potential commoditization related ills

Conclusion

Synergy and appropriate use can enhance and optimize radiology services

Dr. Anjali Agrawal is a consultant radiologist to Teleradiology

Solutions, where she heads the Delhi Operations of the

group. She graduated in medicine from the All India Institute

of Medical Sciences followed by Radiology training at AIIMS

and the Baylor College of Medicine, Houston, Texas. She is

actively involved in the American Society of Emergency

Radiology and is one of the founder members of the Society

for Emergency Radiology in India.

About Dr. Anjali

Anjali Agrawal, MD

anjali.agrawal@telradsol.com