Remote Reading Services: Answering the Call for Better Quality & Lower Cost

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Eagle Imaging Partners in Oklahoma has opted for a subscription agreement to pay for teleradiology software, and infrastructure from Virtual Radiologic that includes, preliminary and final reads during overnight and weekend hours, according to Eagle CEO Eric S. Slimmer.

As the economy has soured and facilities investigate new ways to cut costs, many have turned to outsourcing their radiology needs via remote reading services. Able to provide expert remote reads and reports, teleradiology can cut the costs linked to staffing in-house radiologists during overnight, weekend or off-hours when patient volume is often slim. Yet, cost efficiency should never trump quality of patient care, and newer services do not require that trade-off. 

On the nightshift

Rather 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 record

For 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