By Dr. Alan Pitt
In the mid 1990’s beepers started to be replaced by cell phones for most Americans. At the same time, radiologists, experts in medical imaging began exploring new approaches to delivering services – teleradiology. Given the critical role imaging plays in modern healthcare there was a need for 24/7 round the clock coverage for hospitals. This was taxing the existing supply of physicians available at night. Enter teleradiology. Leveraging some of the same technologies used for digital cameras emerging companies built infrastructure where clinical exams were moved from a patient’s location, to another for interpretation. By having the right radiologist read the right case, outcomes improve while the cost of care was reduced. This transfer allowed load balancing and subspecialty interpretation within a broader pool of radiologists.
Today teleradiology is a mature market. However, other specialties have been much slower to adopt this approach to care. If a hospital needs nighttime coverage or daytime specialty access the infrastructure (bandwidth for the video component as well as software for integration into the EMR and clinical workflows) is typically built from scratch. This poses a significant barrier to entry. This begs the question – why not reuse the technology highway already built for imaging for other clinical services?
Teleradiology: a Hub Enabling Care Through the Continuum
Hospitals in need of remote radiologists are also likely in need of other specialists. The requirements for telemedicine and teleradiology have significant overlap, both in terms of technology and business relationships. Radiology practices are well positioned to offer an up-sell in the form of additional services on the networks.
As an example, neurologists, psychiatrists, neonatologists would all benefit by partnering with the existing imaging networks. The fact is that specialty expertise and load balancing are not problems specific to radiology. So why not capitalize on these rich networks to treat more patients and to include more specialty areas? There are many hospitals in need of specialists, but a good number are unable to pay for and staff multiple doctors at their location. A patient may or may not need to access those specialty services on any given day, but in the event they do, their hospital should be ready to treat those patients. So how do you get specialists to meet your patient needs without having to worry about losing money and overstaffing? This is where teleradiology business model used in comes into play. Holding time on a doctor’s schedule with no patients to treat is an issue, but so is not having a specialist for a patient in your network. In that case, the patient goes out of network not only losing your hospital business, but potentially costing the patient more money. In reality, the opportunity here even extends beyond remote care. As one of only three clinical departments (the other two being lab and pharmacy) providing critical results, radiology is well positioned to act as a hub enabling communication and collaboration throughout the care continuum.
Yes, there are still issues related to workflow and video. Radiology tends to use store-and-forward technology (interpretation is delayed for a brief period of time) while clinical care requires face-to-face real time encounters. However, these challenges are not insurmountable, and I believe the benefits outweigh any potential costs.
Imaging at the Center of the Value Chain
A Radiologist’s primary role will always be as domain experts for imaging. However, CT, ultrasound, and MR haven’t changed much in the last 30 years. As a result radiology should look to explore other opportunities. By leveraging decades of experience in managed services, teleradiology can add value to many other forms of care. If radiology can get out of its own way, think more broadly about related opportunities, the specialty could play an important role as the orchestrator of the care continuum.
By Dr. Alan Pitt is Chief Medical Officer at Avizia and Attending Physician and Professor of Neuroradiology at the Barrow Neurological Institute
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