Teleradiology experience gained by reading images for many hospitals is not on par with experience gained by repeatedly reading images for just a few hospitals, according to a study published online on December 20, 2012, in Organization Science.

To determine whether learning and performance improvement are customer specific, Jonathan Clark, PhD, assistant professor of health policy and administration at Pennsylvania State University in University Park, and colleagues examined the experience and productivity of 97 teleradiologists reading more than 2.7 million images from 1,431 hospitals, focusing on image review time as a key variable.

"By estimating learning curves, we were able to determine the extent to which a radiologist's productivity reading an image for hospital A was a function of his or her prior experience reading for hospital A, versus his or her prior experience reading the same image for other hospitals," Clark said in a press release.

The team found that the radiologist's prior experience with an ordering customer has a greater effect on performance than his or her overall experience reading the same type of image for other customers. Repeated reading for a particular customer builds familiarity with the provider’s standard operating procedures and may improve communication and trust, according to Clark et al.

"Somebody might look at that finding and say either what we should have is outsourcing radiologists who read for only a few customers or we shouldn't have outsourcing at all," Clark said, "because if you're going to focus a radiologist on one or two customers, then you might as well make the argument that you should have him or her work as an employee for that customer."

However, the researchers also found that the customer-specific knowledge gained by individual radiologists is aided by the variety of customers with whom a radiologist has experience. In other words, both specialization and variety are important. The optimal situation balances both. Reading for a variety of providers may allow teleradiologists to identify and transfer best practices.

The study authors also reported that the customer specificity of learning diminished as the teleradiology provider gained more experience with a particular customer.

"Overall, this finding suggests that while there is customer specificity to learning for outsourcing radiologists, the implication is not that we shouldn't outsource. Rather, our findings provide guidance to outsourcers in terms of how they might think about designing the work of their radiologists to maximize productivity. For new customers, an outsourcing firm may wish to keep individual providers relatively more focused on serving a specific customer. As organizational experience accrues with a specific customer, however, such dedication becomes less critical," Clark said in the release.