The case for teleradiology: A community hospital perspective

In an interview published earlier this month with FierceMedicalImaging, David Levin, M.D., a professor and chairman emeritus of the department of radiology at Thomas Jefferson University Hospital in Philadelphia, discussed some of his reservations with the practice of teleradiology. According to Levin, while the original concept of teleradiology--providing supplemental services to smaller radiology practices that struggled to be constantly on call--wasn't a bad one, in recent years it has devolved into an excuse for radiologists to work less.

"That sends a terrible message," Levin said. "It basically tells the rest of the medical world--other physicians, hospital administrators, policy makers, etc.--that radiologists aren't interested in being real, consulting physicians."

However, for Carlos Vasquez (pictured)--division director of radiology services for two of Franciscan St. Elizabeth Health's three hospitals in Lafayette, Ind.--teleradiology has been the difference between the ability to provide coverage for most of the day and round-the-clock coverage.

In an exclusive interview with FierceMedicalImaging, Vasquez, who also serves as president of the Association for Medical Imaging Management, talks about his hospitals' experience with teleradiology services and how he views teleradiology's place in industry, overall.

FierceMedicalImaging: What was your rationale for using a teleradiology service?

Carlos Vasquez: I manage two community hospitals and our group of radiologists is the size of about 8.5 full time employees to cover two hospitals. That is enough to cover during the day, but not enough to cover 24 hours a day, seven days a week. So the telerads cover nights, giving our radiologists a chance to sleep. We only have teleradiology services from 11 p.m. to 7 a.m.--so we still have radiologists on site for 16 hours a day.

FMI: What were you looking for when you contracted with a service?

Vasquez: We wanted to make sure they were a good fit for our system. For example, they go through the same credentialing process as any of the physicians on site, which is painful because you may have to go through the process of credentialing 15 or 20 radiologists to cover one shift. But that's what we did.

FMI: How would you assess the role teleradiology has played in your hospitals?

Vasquez: Speaking as an administrator, I have some mixed feelings. When it comes to practicing radiology, it all comes down to relationships because it's really about trust in the relationship between two physicians; that's true for teleradiology, as well.

The emergency department physicians here have been able to develop relationships with some of the doctors with the teleradiology company, and they've told me they would like to see a regular teleradiologist be [on-call] all the time. But that's just not possible--there's a different radiologist reading every night.

We've also had a few experiences where it's taken a little bit of an effort to arrange for a consult between a radiologist and ER doctors, so I would absolutely like to make that process more efficient.

FMI: What kind of role do you think teleradiology should play on a wider scale for hospitals?

Vasquez: There is certainly a value in teleradiology, especially in community hospitals like mine. There are three hospitals in my region and they all use the same telerad provider, reading from 11 p.m. to 7 a.m. If my doctors don't have teleradiology, there would be no way they could provide the level of service that our medical staff requires. So there is obviously a place for teleradiology.

What is interesting is if the medical staff of a hospital has a say, they want radiologists on site, right now, even though you hardly ever see ER doctors--who are the doctors we provide most of the after hours services to--go into a radiologist's office for a consult. Everything usually happens over the phone.

In 2009 we put out a request for proposal for a radiology group, and many of the responses we received were driven by teleradiology. For example, they would have one radiologist on site, and have maybe 80 percent of the work done by teleradiologists. So it appeared that most of the groups were leaning toward providing remote reading.

When I provided my findings to the medical staff in my system, though--the surgeons and the ER docs--they were totally against that idea. And when we got out of that meeting, my corporate medical officer told me there was no choice but to stay with what we had and only telerad those eight hours a night.

I think now with the bigger systems and bigger practices--any group with over 40 doctors--it looks like they are starting to develop their own 24-7 coverage so that there aren't any of those gaps that teleradiology needs to fill. They may be dedicating one of their own radiologists to work at night, either on-site or from their house, so in a way they might be doing teleradiology on their own without the outsourcing.

Editor's note: This interview has been edited for length and clarity.

Suggested Articles

Children’s National Health System announced a formal partnership with Virginia Tech, including the construction of a biomedical research facility.

Medicare Advantage insurers are eyeing loneliness as a crucial social determinant of health to target.

Welcome to this week's Chutes & Ladders, our roundup of hirings, firings and retirings throughout the industry.