Teleradiology comes into focus

16.05.2012

PUBLISHED: 15 May 2012 PRINT EDITION: 15 May 2012

 Dr Charles Lott examines a patient’s X-rays and reports – often for hospitals thousands of kilometres away as telemedicine gains popularity. Photo: Tamara Voninski

 Emma Connors

 It’s Monday morning in an office block in Sydney’s financial district and Charles Lott is studying an X-ray of an ankle. The X-ray was taken in the Royal Melbourne Hospital emergency department on the weekend and staff doctors reviewed it. Dr Charles Lott, a radiologist and medical director at radiology services supplier Imaging Partners Online, is doing a detailed follow-up report.

 A few doors down in another office at IPO, an English trained and accredited radiologist is examining images sent by a London hospital, working through the English night.

Welcome to the world of teleradiology. Doctors have long studied medical images many kilometres from where they were taken. This practice is expanding, both in volume and reach, and as a third-party provider, IPO is clocking up rapid growth.

 Unlike other forms of telemedicine, teleradiology is well established, driven by necessity from rural and regional areas. It is a heavily regulated market where international demand and supply is tempered by licensing and accreditation rules, said Jacinda de Witts, a partner at Minter Ellison, who has advised referring practitioners.

 “The only people that can read scans in Australia for British patients, for example, are radiologists who qualified in Britain, are registered in Britain and living in Australia, Ms de Witts said. “And the only ones who can read scans in the UK for Australians live in the UK but are accredited and licensed in Australia.

 “But in countries where the costs of healthcare are so high, and particularly when it is not governments but health insurers who pay, you have to wonder how long it will be before there is real pressure to explore this model further,” Ms de Witts said.

 Sydney-based IPO began overnight reporting five years ago, initially for Australian patients only, said co-founder Bob Sheraton.

“There is a shortage of radiologists and one thing they hate is reporting after hours,” Mr Sheraton said. “Traditionally they are rung at home and hauled out of bed to do a report. The cost of that is enormous,” he said.

There are now 90 hospitals that outsource some radiology work to IPO. These include some of Australia’s largest such as Royal Melbourne and Sydney’s St Vincents, who complement their own radiology department by diverting either routine work or after-hours images. A referring doctor can discuss the results with an IPO radiologist within the hour.

Last year the company began a joint venture with the NHS trust that runs University College London Hospitals. IPO hopes to expand the joint venture in the UK and is also looking to Asia for future business.

 This year marked a turning point, Mr Sheraton said.

 “It’s as if a light has switched on. To begin with our customers were mainly from rural and regional areas. Now the big teaching hospitals are interested. All public hospitals need to find ways to be more efficient.”

 For many though it is a big leap to engage radiologists to study reports offsite. Dr Lott understands this reticence. He said he was sceptical of the benefits before he got to know the model where the latest technology is complemented by radiologists who haven’t had just a few hours sleep after a long shift. Now he is convinced outsourcing has a role, as long as quality assurance is a priority.

In addition to IPO’s own auditing, many hospitals impose an extra level of quality assurance on top of this. Royal Melbourne for example, did a six-month trial. In the UK, all of the joint venture’s work was audited for six months.

Dr Lott said everyone involved puts quality first. “Outsourcing for cost only won’t work.”

The Australian Financial Review
 

Reviews needed on mountain of backlogged X-rays, says professor

16.05.2012

Anna Patty

May 16, 2012

Premier s Delivery Unit. L to R...Professor Brian McCaughan and Dr John Stuckey who are apart of the Premier s special advisory team. Friday November 16, 2007. SHD POLITICS Pic by Fiona-Lee Quimby

"I think that every X-ray performed should have the benefit of a specialist radiologist's opinion" ... cardiothoracic surgeon and professor, Brian McCaughan. Photo: Fiona-Lee Quimby

A PROFESSOR of medicine tasked with looking into why some of Sydney's biggest hospitals have an unacceptably high backlog of X-rays not examined by qualified radiologists, says every X-ray taken should have a radiologist's report.

Brian McCaughan, a cardiothoracic surgeon based at Royal Prince Alfred Hospital and professor at the University of Sydney, is part of a taskforce the government recently appointed to look into why some hospitals including Liverpool, Westmead and on the central coast, have a backlog of tens of thousands of X-rays not reviewed by a radiologist.

''I think that every X-ray performed should have the benefit of a specialist radiologist's opinion,'' Professor McCaughan said.

The new taskforce, headed by Professor Cliff Hughes, the chief executive of the Health Department's Clinical Excellence Commission, has been asked to look into whether the backlog has adversely affected patients.

The Health Minister, Jillian Skinner, asked whether hospitals are ''over-ordering X-rays and whether or not each and every X-ray needs to be re-checked by a radiologist, when it has already been read by a treating doctor''.

Senior specialists have told the Herald they have overlooked health problems on X-rays that were later picked up in a radiologist's report.

The opposition's spokesman for health, Andrew McDonald, said more specialist radiologists were needed to clear the backlog of unreported X-rays.

''To say that one of the biggest hospitals in the state is ordering too many X-rays as a cause for lack of reporting just shows how out of touch the health minister is,'' Dr McDonald said.

''Every clinician has missed abnormalities on an X-ray that have been picked up by a radiologist - but with the minister refusing to make these reports a priority, there is no guarantee the problem will ever be fixed.''

NSW Health has confirmed an estimated 79,000 standard X-rays were awaiting review by a radiologist at Liverpool Hospital and 4000 at Westmead. The X-rays, which include those of chests and broken bones, date back to January 2010.

The Australian Medical Association NSW said it was important that radiologists reported on X-rays to prevent serious problems being missed.

X-ray backlog 'endangering patient health'

16.05.2012

Anna Patty
May 15, 2012

TENS of thousands of X-rays are not being looked at by qualified specialists at some of the state's biggest hospitals, raising concerns that serious health problems are being overlooked.

A spokeswoman for NSW Health confirmed an estimated 79,000 standard X-rays were awaiting review by a radiologist at Liverpool Hospital and 4000 at Westmead. The X-rays, which include those of chests and broken bones, date back to January 2010.

 The vice-president of the Australian Medical Association NSW, Michael Gliksman, said it was important that radiologists reported on X-rays to prevent serious problems being missed.
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''Reading X-rays accurately is a specialisation that takes many years to acquire,'' he said. ''Many experienced doctors are OK at reading X-rays in their own field, but they can't be expected to pick up more general problems.

''There is a real risk that something important will be missed or its interpretation delayed.''

Dr Gliksman said it was especially important qualified radiologists report on X-rays in emergency departments. Specialists had reported the backlog of X-rays ran into thousands in Sydney hospitals, he said.

A national shortage of radiologists has contributed to the problem. Radiologists also cite a lack of state and federal funding for extra training positions.

A senior doctor in south-west Sydney told the Herald a Health Department memo was sent recently to direct hospitals to clear significant backlogs, particularly on the central coast.

The opposition spokesman on health, Andrew McDonald, who is a doctor, said a prompt radiologist's report was vital to patient care. ''Every clinician has missed abnormalities on an X-ray that have been picked up by a radiologist,'' he said. ''It is quite common for fractures and cancers to be missed and only discovered on the X-ray report.''

In opposition, the Health Minister, Jillian Skinner, said the backlog was putting patients in danger. ''A backlog means patients aren't getting treated and therefore their lives are potentially at risk,'' she said then.

Last night, Mrs Skinner said a review of more than 6000 X-rays had found no cause for alarm. ''I have asked the ministry to examine whether there's an overuse of X-rays, and whether, in each case, there's a need for a radiologist to re-check and report on an X-ray that has already been read by the treating doctor,'' she said.

The president of the Royal Australian and New Zealand College of Radiologists, Dinesh Varma, said most hospitals required all X-rays to be reported on by a radiologist. It was appropriate for some senior trainees to provide provisional reports to help cope with demand, he said. But Medicare required reports to be completed by fully trained consultants.

''Hospitals would not survive if they didn't have trainees doing reports,'' Associate Professor Varma said. ''Most public hospitals are under pressure to get consultants to provide a final report.

''Consultant radiologists are very busy because they also have to do training, teaching, attend clinical meetings, academic work and research.''

A board director of the Australian Institute of Radiography, Christopher Whennan, said training was being considered to allow radiographers to provide interim reports to assist junior doctors in emergency departments.

A spokeswoman for NSW Health said the central coast and south-western Sydney health districts were working to reduce the number of standard X-rays awaiting secondary review and reporting by radiologists. About 80 per cent of all plain film X-rays at Liverpool Hospital had a secondary review within 48 hours.
 

The World Class in Radiology Services

10.05.2012

www.imagingpartners.com.au/files/pdf/Resource_Centre.pdf

Patient scans from top hospitals sent to Australia to beat problem of calling radiologists out of hours

23.04.2012

Patients at some of the country's top NHS hospitals are having their scans sent to Australia to be examined.

The NHS trust that runs University College London Hospitals has set up a company called Radiology Reporting Online to run the scheme.

The venture means patients being treated out-of-hours in Britain are having their conditions diagnosed by clinicians 10,000 miles away.
 
Results of NHS scans carried out by University College London Hospitals are being sent to Australia

There are concerns this could lead to problems if scans are misdiagnosed.

But the trust says it is a positive change and replaces a system where a trainee radiologist would receive a phone call at home out of hours.

Radiology Reporting Online is a joint venture with Australian organisation Imaging Partners Online (IPO).

Tony Nicholson, a former Dean of the Royal College of Radiologists, said: 'A lot of overseas radiologists are very impressive indeed.

'But at the end of the day they can only report on what is put in front of them and have no idea about the clinical position of the patient.'

UCLH chief executive Sir Robert Naylor said there were three reasons why the project was launched.

He said: 'First of all it was to improve productivity, secondly to speed up reporting to enable clinicians to make early diagnostic decisions, and thirdly to save money.'

IPO could not be reached for comment.
 

Teleradiology promises real benefits for radiologists

02.04.2012

21 December 2009
Diagnostic Imaging Europe. Vol. 25 No. 8

BY GEORGE MCINNES, FRCR

DR. MCINNES is a consultant radiologist for Poole Hospital NHS Foundation Trust in the U.K., and Telemedicine Clinic in Barcelona, Spain

Teleradiology is evolving at different rates across Europe. There are some countries, like in parts of Spain, where a group that owns several radiology clinics can benefit in many ways by contracting all reporting to a single teleradiology firm. In other countries, where healthcare organization is different, autonomous institutions may choose to outsource only out-of-hours work.

In Scandinavia, the teleradiology market is reasonably mature. In the U.K. the situation is much more volatile. Many U.K. National Health Service hospitals used teleradiology services over the past five years as part of a government initiative to reduce reporting times. This scheme has now ended and hospitals with strict targets may choose to contract individually with teleradiology firms or may find themselves having to alter their working practices.

Some teleradiology companies are firmly established within a particular country. Others, like Telemedicine Clinic, are pan-European. However, all companies need to operate some sort of economy of scale to be viable. There is a fine line between profitability and survival. As Europe begins to move out of recession, some consolidation is inevitable as smaller companies merge or are acquired by the bigger players.

I know radiologists who are concerned that they may lose their jobs to teleradiology firms, which can provide a reporting service more cheaply. However, when the cost of applying appropriate safeguards to ensure the quality of outsourced work is factored in, teleradiology providers might not be so competitive, representing less of a threat on purely financial grounds.

Teleradiology companies use strict quality control processes not achievable in most conventional hospital radiology departments.

In fact several teleradiology firms have implemented double-reading as standard. In Telemedicine Clinic, the RIS was designed so that if the second reader disagrees with the first reader, the first reader is alerted. If consensus is not then reached, a third expert intervenes. A system like that would be difficult to implement in a hospital environment. Radiologists at Telemedicine Clinic also have access to voice over internet protocol (VOiP) communication tools so that when necessary, they can easily discuss examinations with colleagues or referring institutions. And they do so on an hourly basis.

With videoconferencing tools, teleradiologists can participate in multidisciplinary team (MDT) meetings, just as if they were sitting in the same room. However, when you start building in time for this type of activity, the economics can become quite challenging. If you employ radiologists who can report 10 or 15 MRI studies per hour, but they spend that time involved in MDT meetings, it inevitably impacts on service costs.

A responsible firm that puts a premium on training and CME may find it is less competitive than its rivals. The answer must be to insist that this type of activity is part of any reporting contract. Teleradiology companies must also support their claims to have a high degree of radiological competence and expertise by auditing and publishing their own results.

Legislators and accrediting bodies should be facilitating the growth of teleradiology in Europe in a responsible way. We need to think imaginatively and allow reporting to be outsourced across international borders, particularly with regard to on-call cases. A secure digital environment should allow on-call cases from European hospitals to be reported by radiologists in Australia during their daytime and vice versa. Would you rather your 3 a.m. emergency CT head scan was reported by an alert radiologist in Australia or a sleepdeprived radiologist in the U.K. who has to work the next day?

Although advances in IT have brought teleradiology to its current level, there remain challenges. When reporting a chest x-ray, for example, all previous chest x-rays and reports need to be easily accessible. It can be difficult if not impossible to quickly and securely extract the information from the old RIS in many hospitals.

We may all be doing very different jobs in 20 or 30 years’ time, from diverse locations. For the radiologist, teleradiology can provide an exciting opportunity to work in a flexible environment in another country. It would be unfortunate if something that could be done well, safely, and cost-effectively—and which might bring benefits to both patients and radiologists—was not facilitated in a responsible way.

Teleradiology day reads shake up the specialty

02.04.2012

6 October 2009

Diagnostic Imaging. Vol. 31 No. 10

BY H.A. ABELLA

Mr. Abella is associate editor of Diagnostic Imaging magazine. Senior editor James Brice contributed reporting.

In fact, you may not need to genuflect before their hospital administrators anytime soon. But a growing trend of teleradiology-minded folks going after the day-read business is eroding perhaps the most powerful bargaining chip for contract negotiation radiologists ever had. The perceived commoditization of imaging interpretations is thus leaving hospital radiologists with few choices: enhance the quality of their services, be nice to hospital CEOs, or get ready to be replaced by day hawks.

Back in June, the Mercy healthcare system in Toledo, OH, shocked the radiology community when it replaced the local radiology group that staffed its three hospitals with an out-of-town practice-management firm that used teleradiology for primary daytime interpretations. According to the Toledo Blade, St. Vincent Mercy Medical Center had been unable to reach a contract agreement with Consulting Radiologists and decided to hire Imaging Advantage, based in Santa Monica, CA.

The relationship between the 19-member radiology group and Mercy hospitals that had endured for over half a century broke up nastily last May. Contract negotiations had been stalled for about a year when Consulting Radiologists got—almost literally—its two-weeks' notice. The radiologists were on the faculty at the University of Toledo, which retaliated by pulling all of its radiology residents from the Mercy hospitals. Radiologists from the former group were offered jobs under Imaging Advantage's supervision, but none stayed. The resulting shortage disrupted mammography, interventional radiology, and other imaging-related services. What was meant to be a seamless transition turned, by some accounts, into an administrative nightmare that left in its wake grieving technologists, disgruntled referring physicians, and widespread turmoil.

Circumstances surrounding the case have been tinged with hearsay and misinformation. In early August, an e-mail attributed to teleradiology company NightHawk Radiology advocating the death of the middlemen, hospital-based radiology groups, incited uproar among radiologists. The note, allegedly in a quarterly report, stated that the best strategy to address recent revenue losses and the need for long-term growth would be “bypassing the radiology groups and working directly with the hospitals.” A stream of comments propagated through the Internet also pointed the finger at the Coeur d'Alene, ID, firm for supposedly having a hand in displacing the Toledo radiology group.

In an Aug. 10 letter addressed to its customers, NightHawk Radiology's president and CEO Dave Engert said all the allegations were false. Engert said the remarks were actually excerpts from a report by an independent analyst and erroneously attributed to NightHawk, which had disowned such a strategy.

“We absolutely do not do that. We don't have any group within our company that does that. We are focused on a business level to provide services to our radiology partners. And we don't compete with our own radiology customers or any radiology group for contracts,” Engert told Diagnostic Imaging.

Engert acknowledged there are situations where NightHawk's radiology customers happen to be competing with one another for a specific hospital contract. This includes radiology groups as well as practice management organizations employing radiologists.

“We have had some situations that may have come across looking like there is a change in our mission and direction, and that's absolutely not true. We are true to our mission,” he said.

The damage was already done, however. Online discussion boards, such as a general radiology forum maintained by online radiology news publication Aunt Minnie, was swarmed with postings from angry radiologists, some of whom advocated boycotting the firm.

Despite the unproven claims, the Toledo case was an eye-opener for radiologists. Traditional teleradiology companies and some of their less conventional brethren may not intend to openly compete with local radiologists, but the indisputable fact is that many in the teleradiology business have been quietly claiming a stake in the day reads market for a long time.

Teleradiology firm Franklin & Seidelmann, based in Cleveland, has had a presence on the remote daytime interpretations market since its founding in 2001. On July 1, Central Michigan Community Hospital became the latest addition to Franklin & Seidelmann's portfolio of customers with full-service radiology coverage. The deal includes around-the-clock preliminary and final interpretations performed remotely by emergency department and other subspecialty radiologists, aided by onsite radiology physician assistants and other medical personnel.

Just a few days later, Virtual Radiologic, a teleradiology company headquartered in Minneapolis, announced a similar arrangement with the National Rural Health Association. That nonprofit organization has nearly 20,000 members and provides services for about 60 million people living in rural communities across the country.

Teleradiology groups sometimes must deal directly with hospitals, some of which are located in remote areas with no access to imaging interpretation services. And even when these hospitals do have some radiologists on staff, the scope of the services they can provide might be limited.

“Our mission is to augment and assist local radiologists and local radiology practices. We don't plan to replace or compete with them,” said Virtual Radiologic CEO Rob Kill.

But it takes two to tango. Hospital administrators have an important role in this trend and it may actually be less subtle than it seems. Administrators may not be actively seeking to replace their radiologists. But that does not mean they aren't looking at the prospects.

“We've been approached by several hospitals that weren't happy with their local radiology practices,” Kill said. “We passed on those opportunities because they were at odds with our mission and we don't believe being used as a wedge in negotiations is beneficial to any party.”

Teleradiology booms

According to Clay Larsen, senior vice president of marketing at Franklin & Seidelmann, multiple factors have led teleradiology firms to pursue the day read business, but competition for its own sake is not one of them. The trend is only a response to a logical, though unintended, effect bouncing off much deeper issues brewing within the hospitals themselves.

“This is about identifying a specific need that we feel qualified to address. If you look at what the needs are out there, clearly hospital medical staff are usually pretty disappointed with the service they get from their radiology groups,” Larsen said.

But teleradiology's vigorous push into the daytime interpretation market has led others to suspect there is little, if anything, casual about it. One factor that has encouraged or even forced teleradiology firms to move in this direction has been the need for growth and expansion of their business, said Joe Moock, CEO of StatRad, a San Diego-based teleradiology provider.

“The preliminary nighttime read market is heavily saturated,” Moock said. “Because some [teleradiology companies] are publicly traded, they are forced to show increasing profits and growth. That naturally leads them to look toward the full hospital contracts in order to grow their businesses.”

Individual investors and analysts now keep a close eye on these companies' performance; And they want to see continued growth and expansion. Although large, the teleradiology market does have a roof. If these companies want to continue selling stock, eventually they are going to look toward competing with their client base, Moock said.

10Q reports for the second quarter of 2009 from both NightHawk Radiology and Virtual Radiologic show a drop in the average price per read. This could be a result, as NightHawk's report suggests, of increased competition in the off-hours market.

Teleradiology is helping drive the corporate growth that Dr. Robert Epstein, president of University Radiology Group, considers essential to combating the factors that challenge a successful radiology practice.

The 80-member University Radiology Group is the professional radiology group practice at the Robert Wood Johnson Medical School in New Brunswick, NJ, but it is not a cozy academic practice. URG has been challenged by the rate cuts from the 2005 Deficit Reduction Act and a New Jersey state ambulatory care tax that grabs 3.5% of its gross revenues.

University Teleradiology was formed to capitalize on URG's size and its ability to provide around-the-clock coverage and expert subspecialty consultation. Its objective is to diversify the group's service portfolio while expanding its geographic influence. To date, its work mainly involves after-hours dictation for trauma services that lack the resources to provide around-the-clock coverage themselves.

“We are working cooperatively with other radiology groups to augment their coverage,” Epstein said. “We have tried not to be predatory.”

Epstein anticipates that University Teleradiology will expand in its reach to states outside of New Jersey and in its placement or employment of board-certified radiologists in other U.S. states or foreign countries.

“There will be winners and losers,” he said. “Teleradiology will help big, powerful groups like ours that can offer subspecialization. It will hurt small groups, the mom-and-pop operations.”

Game changer

The current reimbursement model might have pushed radiologists to focus almost exclusively on image interpretation simply because this is the aspect of their job that comes with a paycheck. And teleradiology, the use of PACS, and other state-of-the-art information technologies have contributed to making highly skilled physicians such as radiologists less accessible and, paradoxically, less valuable to their clinical peers and hospital staff, said Dr. Eliot Siegel, chief of radiology and nuclear medicine at the VA Maryland Health Care System.

“Teleradiology has contributed to commoditization, but it has been able to do that because we radiologists in the community have enabled it,” Siegel said. “It's very difficult to commoditize high-quality patient care, but it is very easy to commoditize just the image interpretation.”

This factor alone might have forever diminished radiologists' bargaining power with their hospitals. When radiologists do not communicate properly with their referring physicians, shy away from training technologists or lecturing peers, or avoid in any way the responsibilities or issues associated with being part of the hospital community and focus instead only on reading images, they are setting themselves up to be ratcheted down, Siegel said.

One result of this is a reduction in their perceived value and power.

“Hospital administrators see themselves in the driver's seat more now than in the past,” said Fred Gaschen, executive vice president of Radiological Associates of Sacramento, CA.

Teleradiology made the opening that allowed this change, but it represents only an interim solution, Gaschen said. In the past, radiologists had more leverage when negotiating for better pay or subsidies from the hospitals. They could always threaten to walk out if they did not get their way and hospitals usually blinked. Now, teleradiology gives administrators the leverage and they know they can use it as a last resort to make up for lost services while they recruit new physicians, Gaschen said.

Until a few years ago, administrators could deal only with the people who lived in their communities. The shortage of radiologists, on the other hand, made it nearly impossible to bring in as many as were needed at any given point. Hospitals had virtually no bargaining power. Technology changed all that, said Imaging Advantage chairman and CEO M. Naseer-Uddin Hashim.

“In the world today, if you are a hospital, you can actually go and talk to companies like ours and see if there are other solutions,” Hashim said.

According to Hashim, although technology and the complexity of patient care have changed exponentially in the last decade, the radiology world remained static. A line was drawn between radiologists who read at night and those who do the job during the day to ensure they never competed, he said. Traditional workflow management strategies required hiring more people to handle the backlogs that occurred only at specific hours of the day. The model was inherently inefficient because it required hiring someone full time to read about a fifth of what a typical full-time–equivalent radiologist would read.

Thanks to technology advances, now anybody who meets licensing and credentialing rules can be in the teleradiology business, Hashim said. Such disruptive technology has infiltrated hospitals, it has made the practice of radiology more flexible and ubiquitous, and it cannot be stopped. Radiologists thus have only two choices: They can despise it or they can embrace it, he said.

“I'm not on the side of the hospitals. I am simply trying to create a better use of the technology and the dynamic situation that exists in the marketplace today,” he said.

Protecting practice

No hospital would actively seek to replace its radiologists unless it was truly unhappy with them. During a bad economy, administrators have to look for ways to reduce costs and, besides leverage, teleradiology now gives them another way to pinch pennies. Although replacing an entire radiology group could prove a daunting task, the possibility of their work being outsourced is hanging in the air and now more than ever radiologists need to know what makes them vulnerable.

“Usually, hospitals are unhappy with their radiologists because of service issues,” said Dr. Lawrence R. Muroff, president and CEO of Imaging Consultants.

According to Muroff, specific service issues include an unwillingness to accommodate service requests from referring physicians, or failure to meet patients' needs or respond to legitimate requests from the administration.

In many cases, it involves cost-cutting strategies sought by hospital administrators, such as avoiding transcriptionists and asking radiologists to edit their reports themselves. Unfortunately, the issue remains contentious because such measures always bear economic implications for somebody.

Turnaround speed also can affect the decision. Teleradiology poses a particular threat to groups that cannot perform basic imaging tasks, such as cross-sectional imaging, in real-time, said Dr. J. Raymond Geis, a radiologist at Advanced Medical Imaging Consultants of Fort Collins, CO.

“That's basic. If you aren't doing that 24/7, then you really are vulnerable to the teleradiology groups being able to offer better service,” Geis said.

Teleradiology companies are not the only threat. Sometimes, hospitals administrators need go no farther than their own counties to get the services they need. In June, the board of trustees for the Natchez Regional Medical Center in Natchez, MS, decided to end a 50-year relationship with Radiology Associates, the oldest radiology group in the historic town. The medical center decided to contract out with Comprehensive Radiology Services, a 17-member radiology group in Hattiesburg, 125 miles southeast of Natchez. The trustees were assured that by contracting with CRS, turnaround would be cut to two hours.

Subspecialty reads also come into the equation. Radiology groups working for hospitals that have orthopedists or neurosurgeons or pediatricians have to be able to meet this subspecialty reading need, Geis said.

“That's tough to deal with if you're only a four- or five-person group—or even a 10-person group—to have somebody around all the time who's a specialist. So that's an issue.”

There are those who see this, however, as a true opportunity for radiologists. According to Dr. Paul Chang, vice chair of radiology informatics and medical director of enterprise imaging at the University of Chicago and a pioneer in PACS, many radiology groups will end up being outsourced. There are many more, however, that will realize they can be truly collaborative value providers. These groups will adopt electronic tools to leverage services to their hospitals and will, in the end, be able to offer these services to outside customers, just like teleradiology firms do, he said.

“They will have to embrace exactly the same technology as the teleradiology groups do and be able to provide services to other groups,” Chang said. “The whole overall quality of radiology will improve and the question of whether it is provided remotely or locally will become less important than the quality of the service.”

Fill-in radiologist stood down after errors

08.02.2012

Recruitment processes at Southland Hospital are under review after a locum radiologist was stood down because of his error rate three weeks after he began work on December 1.

The hospital was under contract to continue paying the locum until March 1, the chief medical officer for Southland said yesterday.

The American radiologist was recruited by the Southern District Health Board through Whanganui recruitment centre Medlink but was interviewed by chief medical officer David Tulloch on December 19 after complaints were made about the quality of the radiologist's reports. Mr Tulloch said the locum was experienced and had excellent references.

But an audit found 37 of the 218 CT, MRI and ultrasound scan reports made by the locum had errors. Mr Tulloch said the doctor was stood down on full pay which Mr Tulloch could not disclose.

A district health board spokesman said the average salary for a locum radiologist at Southland Hospital was $275,000-$325,000 per annum.

The locum has returned to the United States pending the outcome of a review of processes, Mr Tulloch said, while Medlink and medical councils both here and in the US had been informed of the audit and the review.

Patients had not been adversely affected, Mr Tulloch said.

While the hospital was confident no-one had been harmed because of the errors, they were not acceptable and the hospital would be looking at its processes closely, he said.

An 0800 number had been set up for anyone concerned about their reports at Southland Hospital from December 1 to19.

Medlink executive director Kathleen Haskell said this was the first time an incident like this had happened for the recruitment company and it put Medlink in an uncomfortable position.

"We have absolutely no idea what happened. He came with good references, which were backed up verbally both in the US and in New Zealand, and had worked under supervision as all new doctors to New Zealand do."

Efforts had been made to find the radiologist since his return to the US, to look into the incident, with no success so far, she said.

The radiologist was a senior doctor, she said. "All we can do is speculate at this time."

The Southern District Health Board had reacted "perfectly" to the situation, she said.

"They did what needed to be done and acted quickly to look after their patients."