Remote Reading Services: Answering the Call for Better Quality & Lower Cost
On the nightshiftRather than staffing a full-time radiologist to work the night shift, Lake Forest Hospital in Lake Forest, Ill., uses NightHawk Radiology Services from 10 p.m. to 7 a.m., a shift which can be “extremely busy or extremely slow,” says Joshua McElroy, manager of imaging systems and support. Each year, the 215-bed facility conducts about 200,000 patient studies.
NightHawk performs preliminary reads of patient exams that are faxed back to Lake Forest within 24 hours—30 minutes in urgent cases.
Remote reading, according to McElroy, allows for a “high-touch level of service” without burdening the facility with costs that stem from employing a full-time radiologist during the “unpredictable overnight shift.”
Howard P. Forman, MD, professor of diagnostic radiology and epidemiology and public health at the Yale University School of Medicine, suggests that cost concerns are a “major driver” behind the spread of teleradiology.
While Forman is resistant to the idea that teleradiology—rather than the use of outside radiologists—should become integral to the delivery of healthcare in the future, he acknowledges that with the economic downturn many facilities will need teleradiology to operate 24/7 and keep off-hours staffing costs in check.
“The service picks up at [10 p.m.] and that allows the radiologists not to have to be on-site all the time,” says McElroy. During the process, patient images and paperwork are forwarded in DICOM format from the Lake Forest PACS to the NightHawk PACS for review. Next, a preliminary read is conducted by a teleradiologist and made available to the physicians via fax and a secured web site. The documents are then scanned into the PACS where the next morning a Lake Forest radiologist conducts a final interpretation of the exam.
Quality also is a key consideration in adopting remote reading services. With a staff of 10 radiologists at two N.J. facilities, LibertyHealth Systems—comprising the 350-bed Jersey City Medical Center and the 100-bed Meadowlands Hospital in Secaucus—utilizes Imaging On Call for its overnight radiology needs.
Seven days a week, between 11 p.m. and 7 a.m., teleradiologists provide preliminary reads. Edward Poon, MD, chairman of radiology at LibertyHealth Systems says adopting these services was focused on quality, rather than costs.
While Forman suggests that exam turnaround times are a concern, some providers are receiving reports in less than an hour. Teleradiologists complete about 210 of LibertyHealth’s reports per month, approximately 50 per week. Because all the cases sent remotely are emergencies, Poon says that turnaround times of the reports are “quick” and typically delivered to the treating physician in less than a half hour.
To ensure quality of the overnight reads, Poon says his facility’s in-house radiologists perform double reads of all cases interpreted overnight by the teleradiologists. “Every case is essentially peer reviewed,” explains Poon, adding that the reading services and reports tend to be “very accurate.”
Adding on teleradiology for LibertyHealth was rather seamless because the company provided the entire infrastructure needed—a small software server. Poon notes that patient images and reports are sent directly from the imaging modality to Imaging
On Call’s RIS/PACS to be interpreted by a teleradiologist.
If the technological infrastructure is already in place, some workflow management and communication processes should be developed for a seamless integration, McElroy says.
Turnaround times, track recordFor Eagle Imaging Partners, which covers the radiology needs of rural and metro hospitals in Tulsa and Oklahoma City, Okla., choosing a teleradiology provider centered on enhancing the communications and infrastructure at its facilities.
In early 2009, the eight-radiologist physician group partnered with Virtual Radiologic to outsource its afterhours and weekend radiology needs, says Eric S. Slimmer, Eagle’s CEO.
According to Slimmer, prior to the venture, Eagle and its 23 hospitals and imaging centers had no infrastructure in place. “A vital component when choosing our after-hour coverage was the fact that Virtual Radiologic had an infrastructure to offer,” he says.
Under its subscription agreement, Eagle pays the provider for its service and software solutions—the Enterprise Connect 2.0 RIS. As part of the deal, the provider was able to put workstations in all of its facilities, permitting them to work off of the same centralized worklist as the teleradiology provider.
“Ultimately,” says Slimmer, “we are able to collectively—with our group and the on-site daytime radiology group—provide a seamless workflow with 24-hour coverage.” Eagle uses the company’s software and systems, in addition to its after-hour and weekend remote reading services.
The service provides Eagle and its facilities with 1,000 preliminary and final reads or more per month. At the larger facilities like Duncan Regional and Servant Medical Imaging, comprising seven imaging centers, teleradiologists provide final reads in addition to preliminary reads.
During these overnight and weekend shifts, emergency and acute patient cases take precedence. These cases are moved to the top of the teleradiologists’ worklists, interpreted and reported immediately via phone to the referring physician, regardless of the hour. “We are reporting critical findings directly to the referring physician in a 30-minute turnaround so that they can then treat the patient,” says Slimmer.
For Eagle, track record and turnaround times are a key facet to making these services work. According to Slimmer, between its in-house radiologists and its teleradiologists, referring physicians can expect a 24-hour turnaround for non-urgent cases and a 30-minute turnaround for acute and urgent cases. In fact, at Duncan Regional Hospital, a 148-bed facility, non-urgent cases average a four-hour turnaround time 24/7/365, says Slimmer.
Prior to the partnership, this now “seamless” process was muddled. In the past, facilities worked off two different workflow systems depending on the time of day. Reports were rotated from one system to another beginning at 5 p.m. Since adding teleradiology, the system is completely uniform. “All the images go to the same place and all the reports come back in the same manner whether it’s the middle of the night or the middle of the day,” Slimmer explains.
When weighing the pros and cons of using teleradiology, costs were on the back burner for Slimmer and his group. “Obviously cost is a factor in making a decision like this but quality and infrastructure were No. 1, cost was No. 2.”
While Slimmer reports a slight cost savings, he says the ability to provide care 24/7/365 is something that has tremendously helped to increase quality and has led to “outstanding” patient care.
As facilities strive to provide the best possible care for their patients while at the same time shaving away costs, teleradiology use during off-hour and weekend shifts is becoming more and more common. While some believe that teleradiology enhances patient care, others believe these services to be its Achilles heel due to inadequate turnaround times and deficient quality assurance measures. While outsourcing radiology needs, facilities must delve deeper than simply focusing on costs and commit themselves to providing paramount care 24/7/365.