Remote Reading: Practice Extender, Not Practice Extinction

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Virtual Radiologic’s remote reading workstation

Ten years ago, the American College of Radiology surveyed nearly 1,000 practices as to their utilization of teleradiology. They found that 71 percent of multi-radiologist practices had teleradiology systems in place, while 30 percent of solo practices had deployed remote reading systems.

“Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations,” wrote the authors of the survey (Am J Roentgenol 2005; 185:24-35). “Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.”

Fast-forward a decade and remote reading is part of the day-to-day routine of the majority of practicing radiologists. Most groups manage diagnostic image interpretation for multiple sites; including hospitals, clinics, free-standing imaging centers and other specialty practices.

Technology—the proliferation of high-speed data lines, the widespread availability of low-cost high-performance workstations and a boom in digital imaging and PACS adoption—has both propelled and enabled the expansion of teleradiology. In addition, referring clinicians are ordering diagnostic imaging in ever-increasing volumes, further fueling the growth of remote reading.

Uncertainty and doubt

However, this distance between the interpreting radiologist, the patient and the referrer has led some to question the role of teleradiology.

“The clinical interaction may be lost when outsourcing work,” says Steve Field, MD, chairman of the Royal College of General Practitioners in an article in the August 2008 issue of the British Medical Journal. Field’s worry is that outsourcing this relationship can jeopardize effective communication between specialists.

“Prior to teleradiology, radiologists were protected in their practice sinecures by a variety of barriers to competition and had wide latitude to look at life according to their own viewpoints and self-interests,” wrote James H. Thrall, MD (Radiology 2007; 244:325-328). “It is likely that major consolidation in the practice of radiology will be fostered by means of teleradiology to achieve benefits of scale, provide more timely service, provide access to subspecialist clinical expertise, and better match supply with demand.”

A legitimate concern among some radiologists is that the explosion of remote reading will lead to a commoditization of their skill set.

“The trend toward commoditization is accelerating because of globalization, increased information exchange, and technological developments, all of which are currently applicable to medical imaging,” wrote Eliot L. Siegel, MD, and Bruce I. Reiner, MD (J Am Coll Radiol 2009; 6[3]:167-170). With the widespread adoption of teleradiology, universal information technology standards (such as Health Level 7, Integrating the Healthcare Enterprise, and DICOM) and PACS, medical imaging has all of the prerequisites to fulfill this commoditization trend.”

Thrall sees remote reading as offering a double-edged sword to radiology.

“If the practice of radiology is defined narrowly as the interpretation of imaging examinations, the specialty indeed risks becoming commoditized to the degree that outsourced teleradiology services have taken over a growing fraction of radiology work,” he wrote (J Am Coll Radiol 2009; 6[2]:73-75). “However, if the practice of radiology is defined more broadly and comprehensively, it is clear that radiology is not a commodity, and that teleradiology, rather than being the instrument of commoditization, can be an important tool for the enhancement and optimization of providing imaging services to patients.”

Delivering quality care, everywhere

The overarching benefit of widespread internet access, PACS and the development of remote-reading only radiology practices is that the capability exists to provide a quality diagnostic image interpretation anywhere, at any time.

“These powerful tools are already giving small and rural radiology practices access to subspecialty interpretations that they might not have had access to previously,” observed William G. Bradley, Jr. MD, PhD (Radiology 2008; 248:337-341). “Small radiology groups without fellowship-trained subspecialists can now contract out for subspecialty interpretations to provide the higher level of service increasingly being demanded by subspecialty clinicians.”

Virtual Radiologic, a Minneapolis-based remote reading firm has