Remote Reading: Teleradiology Makes for Smooth Operators

 When it comes down to it, teleradiology is an enabler. The possibilities of remote reading can make a small enterprise with one radiologist seem like it has a much larger staff, nearly around the clock. This makes for faster, better care for patients and referring physicians, as well as a competitive business advantage.

Technology has made remote image reading easy. A facility acquires the images and sends them to PACS. If a remote read is needed, either the images are transmitted via a secure line or the radiologist on the other end accesses it via the host PACS. Depending on urgency, the reports can be back in 10 to 30 minutes, an hour, a couple hours, or a single day. Most teleradiology companies also make their radiologists available by phone for questions, and will call regarding any abnormalities found. The technology and service are not the issue. The question is: how can this service improve or maintain your workflow regardless of the time of day?

No interruptions

Using remote reading services has become a real world radiology necessity, basically. Only now will do when it comes to acquiring and reading images. It’s getting to be that you can’t operate without it. The reasons are not rocket science. As Laura A. Hotchkiss, MD, of Spokane Radiology Consultants, of Spokane, Wash., points out, you need teleradiology if you want to maintain staffing or do any physician recruiting, or just plain let a radiologist get a night’s sleep or take a vacation. “I don’t really think you can recruit without a nighthawk service anymore because radiology has become a 24-hour service and people expect instant imaging and instant answers,” she says.

Spokane Radiology Consultants reads for two hospitals in Spokane, Deaconess Medical Center and Valley Hospital and Medical Center. So, they have plenty of images coming their way. They have contracted with NightHawk Radiology Services for fill-in or off-hour coverage — for as many as 30 studies a day.

Sometimes NightHawk is called in so they can do something as simple as have staff meetings. “The hospital doesn’t stop. That’s the only way to have everybody at the meeting,” she says. In these cases, the full staff meeting is planned for end-of-day, and Nighthawk takes it from there.

There’s never a time that a radiologist isn’t available during Spokane’s hours of operation. The NightHawk service is dynamic enough so that if one radiologist is busy, the studies are forwarded to the next available radiologist with hospital privileges, Hotchkiss says.

In the case of Premiere Scan, an independent, privately-owned, imaging center providing MRI and CT services to physicians in San Jose, Calif., Virtual Radiologic Consultants provides not only back-up for general radiology studies but also multiple specialties such as virtual colonoscopy as well as TOS (thoracic outlet syndrome).

Through remote reading, they “can offer a community of physicians and patients different specialty types of scans and have the appropriate radiologist doing the reading. Virtual Radiologic has the appropriate type of expertise to meet the protocols to effectively give readings,” says Shiela Galupo, Premiere Scan’s marketing manager.

Though in Premiere Scan’s case remote reads are done on both general and subspecialty images, the point is the same: hiring off-site radiologists to remotely read keeps their workflow running without a hitch.

“We have the ability to use VRC if our primary medical director is unable to do a stat read during the day,” says Galupo. She adds that “occasionally we get stat reads in the evening hours because we are open so late and we need to have the ability to either do an emergent wet read with a turnaround time of 10 minutes or a stat read within 30 minutes.” This gives them fast turnaround even after hours.

Some facilities, like 407-bed Baptist Hospital East that serves Louisville, Ky., look to keep the radiology staff, particularly the technologists, cranking on the many CT studies they do each day rather than bogging them down with the 3D reconstructions that many of their referring physicians request. Hiring 3DR Inc., a teleradiology provider in Louisville that specializes in 3D reconstructions, has been a big time and cost savings option.

“It’s very time-consuming to do this in-house, not to mention the cost of the workstation with the software to do the 3D, and then the time for a technologist to sit at the workstation and do it,” says Pam Colburn, director, Department of Radiology.

Considering they do 50,000 CT scans yearly, there’s a big potential to save a lot of time. The referring physicians get the reconstructions in good time, and the staff isn’t drained. The process simply includes sending the CT images to 3DR over a secure line, and within a few hours the 3D reconstructions are complete and sitting back in their PACS along with the original images. No reports are required, Colburn says, because the referring physicians do their own interpretations.

“A lot of vascular surgeons use this service during surgical planning for stent placement. And we’ve had some orthopedic surgeons interested in it to help them with surgical planning,” she says. The physicians who are directly associated with the hospital have access to the PACS, while the physicians who do not have access can view them via CD or print film. In the case of vascular surgeons, they are able to pull the images up on workstations in the hospital’s surgical suite, she adds.

Leveling your playing field

Monroe Hospital, a small physician-owned 32-bed upstart hospital in Bloomington, Ind., which opened last October, has been given a big boost from its teleradiology provider, placing it in a much better position to compete than it would be otherwise. NearMed, an Indianapolis, Ind.-based teleradiology company offers what amounts to radiology-in-a-box to help cover the ultrasound, MRI, CT, and other general radiology studies they produce — amounting to about 1,000 studies a month.

They have two service contracts with different branches of NearMed, providing Monroe Hospital with a Philips iSite PACS, PACS administration, an on-site radiologist, and teleradiology services including some subspecialty reads as well.

“I have to say that being the director of a new start-up with so many pieces to think about, it’s been a wonderful partnership to have NearMed,” says Karla Kenefake-Hymans, director of diagnostic imaging. It’s been a huge help “that they are taking care of everything, even the integration to our RIS” and other systems, and bringing on board the radiologist for on-site coverage and handling the PACS administration, she adds.

NearMed presents a pricing model that makes it affordable for smaller facilities to get PACS and get the physicians they need to read all types of studies any time of day. You can pick and choose which NearMed package you want, Kenefake-Hymans says.

The supplied on-site radiologist from NearMed works from 8 a.m. to 5 p.m. Monday through Friday. Otherwise, their general studies are read by India-based Teleradiology Solutions, with a small number of subspecialty studies and over-reads performed by Ervington Radiology, based in Indianapolis. Eventually, NearMed will take on the bulk of the teleradiology services in-house. It’s not been totally ideal, because some of the general studies come in a little later than promised, but overall it has worked quite well. Kenefake-Hymans emphasizes that no matter which company is reading the studies, the radiologists are hospital credentialed.

Though not all hospitals and imaging centers lean on their vendors for this much, the basic premise is often the same. In the radiology world, with so many facilities pinched for time, money, and personnel, remote-reading services are clearly helping them offer continuous patient care through workflow that is never interrupted. And as Hotchkiss says, sleep is a good thing, too.


Remote reads to go
Proscan Imaging, a teleradiology provider with 30 imaging centers nationally, has something different in mind when it comes to remote reading. They offer an upload tool on their website that enables physicians to submit single images to them for over-reads, second options and primary reads, says Dan Braga, PACS administrator.

“The most beneficial use so far has been in acquiring previous studies from outside facilities. Normally, we would have to call and have a CD shipped, whereas now we just have them upload the CD using our secure web product,” says Braga.

The service recently provided help to some imaging facilities damaged by tornadoes in Florida. “They were without internet access for almost a week, however they were able to burn CDs and take them offsite to a location with internet access and upload to us using the web tool,” says Braga.