Remote Reading Offers a Final Solution However It's Not Needed

As remote reading gains in popularity and adoption increases, what began as a way to provide nighttime coverage to busy hospitals and facilities, extra help while radiologists vacationed or as a temporary staffing solution, has now evolved to include weekend coverage, daytime interpretations, preliminary and final as well as subspecialty interpretations for small and large healthcare organizations.

Final Reads

Using remote reading for final interpretations is a way of streamlining workflow, even on individual, case-by-case situations. Facilities can choose remote reading for final reads when necessary, for a more cost-effective solution.

Joseph Tienstra, MD, president of Florida Radiology Consultants (FRC) in Fort Myers, Fla., knows first-hand the economical benefit of using a teleradiology vendor for final reads. The main advantage to having a teleradiology service do preliminary reads is cost, he says. Prelims are about $50 compared to the cost of final reads, which is about $70 per read.

However, preliminary reads leave a lot of repeat work for a radiologist to do the next day. “We decided it was more cost-effective in a busy practice such as ours to pay the extra money for final reads, which leaves the radiologists able to start the next day’s work right away, instead of wasting time over reading in the morning,” he says.

In the last five years, Tienstra says the group has seen CT use in the ER grow significantly. “We have seen an explosion in CT [studies] in our group, and it quickly became apparent that we were staying up all night looking at images on the eRAD PACS,” he says. The download time took too long from home computers to combat the sheer volume of studies to be read.

Also, if a radiologist was up all night reading CT scans, he or she had to be taken off the rotation for the next day. “We were looking at taking up at least a 1.3 FTE [full time equivalent] requirement of staffing as well as determining who was going to be up all night every other week,” Tienstra adds.

FRC looked to Virtual Radiologic Corporation (VRC) for preliminary night reads and then for final reads on Friday and Saturday nights to cover staff shortages. Tienstra says they quickly realized the cost and time savings possible by having VRC do all final interpretations. VRC has been doing final reads at night for the last nine months.

The move has allowed for more productivity during the most demanding part of the day.  “It is totally a different situation now—a start fresh from the get-go,” Tienstra says. “When the radiologists show up at the hospital, they can immediately start to take care of that day’s work in the morning.”

Late night

In contrast, McCready Health Services Foundation in Crisfield, Md., uses remote reading to provide night coverage for the sole radiologist on staff at this small community hospital.

“If during the night, a study is not a STAT read, we save it for our radiologist to do the next day to keep costs down,” says Imaging Department Director Lesli Beckett, RT(R), ARRT. Since 2004, the foundation has been using Templeton Reading for final STAT reads at night.

Beckett says the radiologist onsite was retiring and McCready needed full-time coverage while a replacement was found. Now, Templeton provides final-read remote coverage each weekday after 2 p.m. until 8 a.m., 24-hour coverage on weekends and holidays and week-long virtual locums coverage when the onsite radiologist is scheduled away, or for any unexpected fill-in needs. For McCready, the benefit of using remote reading for final reads does not translate into cost savings, except during the week-long virtual locums coverage.

The benefits of final remote-reads go beyond cost savings or the ability to have quick report turn-around. They go a long way toward distinguishing radiology services within a community. Amir Glogaus, president and CEO of Advanced Diagnostic Group Imaging Centers in Tampa, Fla., is utilizing Franklin & Seidelmann Subspecialty Radiology for final remote-reads to “become the leading provider of MRI and CT as well as all other imaging services throughout Florida” by offering final interpretations to his referring physicians in any area of expertise.

“One of the key things from our perspective is to offer our referring physician a radiologist of his or her choice,” he says. “We have no internal interest in who reads for whom and why. For the most part, our referring physicians would rather have a radiologist who can offer a final interpretation that can address their specific needs or concerns and provide a report that meets their diagnostic needs.”

Glogaus says it does not really matter if the radiologists are next door or in a different state. In his opinion, using subspecialty expertise for final reads cannot be matched by having a general radiologist on site. “On the one hand is the demand and the awareness of the referring physicians, and on the other is the ability of imaging centers to provide that [high] level of expertise. That is driving more adoption of remote reading,” he says.

Building upon the notion of the relationship between a facility and its referring physicians, Chris Bright, national sales director of RAMIC Medical Imaging in Montville, N.J., says that it is the dynamics of the relationship that drove RAMIC to ProScan Imaging for final remote reads.

“Using remote reading for a prelim is only beneficial if you need a report STAT or in an after-hours situation,” he says. Local radiologists sometimes have limited hours of operation and it can sometimes mean waiting for the next business day to get a report done. Virtual radiologists seem to understand the need to provide a service that can get a physician a prelim report for physicians that may need them quickly or outside of regular business hours, he adds.

“When I look at what they do, it is really more about how much they understand the relationship between the rad and the physician. The referring physicians really need to trust you to take care of their patients. Understanding that dynamic is imperative to surviving,” Bright says.

RAMIC’s community was not getting the service they needed, whether it was quick turn-around same day or 24 hours for reports. “We needed to be able to provide that turn-around time to stay competitive,” he says. ProScan primarily performs final reads but can do prelims if the referring physician cannot wait for dictation to take place, he adds.

While there was some initial pushback from the referring physicians for using remote radiologists, Bright says that disappeared quickly. “When you have patients that, in the past have had to wait two or three days to find out if they have a brain tumor, can now find out within an hour if necessary, physicians quickly realize the overall benefits of using a rad outside of the community,” he says.

Bright says they needed a radiologist, not who would come in, read and go home, but one that would get the message out to the community that RAMIC provides the best of the best because from a physician’s point of view, it is “always better to have a fellow physician give you credibility.”

What the future holds

No matter what type of coverage is needed—nighttime, daytime, subspecialty—many facilities are realizing that using remote reading for preliminary reads does not always translate into cost-savings, depending on size and imaging volume.

There are two things to consider in the future for radiologists, says Tienstra. The first is the radiologist shortage. “It is a little difficult to recruit rads right now and those programs that offer nighthawk remote reading and remote reading are obviously going to be much more attractive to potential employees,” he says.

The second issue centers on the paranoia among some radiologists that remote reads could actually take over hospitals and hospitals would no longer need them onsite, Tienstra adds. “No matter how small your hospital is, there are always procedures that need to be done onsite, and so while a remote reading group could take care of 90 to 95 percent of the reads, there is still 5 percent or 10 percent of onsite work to be done that would kill off an entire remote reading deal.”

The general consensus seems to be that while remote reading provides many benefits to facilities small and large, it is still a service that is used in conjunction with hospitals, not to replace the onsite radiologist, but perhaps as well, to transform the role of the virtual radiologist.

The job of a virtual radiologist has become a valuable supplement to local radiology staff while working outside the confines of the traditional radiology and teleradiology group.

Steve Pawar, MD, a virtual radiologist for Lewiston Hospital in Lewiston, Penn. said they can work 30 percent faster and more efficiently at home. He adds that when he is onsite, about 15 percent of his time is taken up with functions not directly related to interpreting or exams like fluoroscopy or biopsies, for which he may or may not receive reimbursement for performing.

Another advantage of working in this fashion, Pawar says, is the close, continuous, working relationship with medical staff technological personnel.

“In the future, remote reading is either going to be where radiologists work from home or for teleradiology groups,” he says. Pawar feels that many radiology departments will be staffing with less onsite radiologists and outsourcing the remaining work to teleradiologists. “There are enough technological means and enough demand for remote reading to really ignore it,” he adds.