Why teleradiology threatens healthcare quality

While teleradiology has secured its place in today's healthcare environment, it continues to evoke strong reactions--both pro and con--from within the specialty itself.

The American College of Radiology's Task Force on Teleradiology Practice recently weighed in on the debate when it issued a white paper on the subject. In describing the positives and negatives of teleradiology, the task force neatly summarized the ongoing argument--teleradiology does a great job of helping small hospitals with overnight and subspecialty coverage, for example, but an exclusive focus by some companies on "report delivery" devalues the specialty and leads to its commoditization.

FierceMedicalImaging recently spoke with David Levin, M.D. (pictured), professor and chairman emeritus of the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia, and a long-time critic of teleradiology, to get his take on issues with the practice.

FierceMedicalImaging: It's widely know that you have a problem with teleradiology. Have you changed your opinion at all?

Levin: No, I still think it's a very bad thing for radiology, particularly for medium- and large-sized groups.

What has happened, of course, is that these companies when they first started out years ago, were there to help small practices cover at night and maybe provide a little bit of subspecialty expertise.

That's the way it used to be. As time went on, some of these companies went public, so now you're dealing with investors who are looking for profit growth, and so these guys had to continue to grow; the only way they could grow was by becoming day hawks and to try to push incumbent radiology groups out of their hospital contracts and take those contracts over.

FMI: Would you agree that teleradiology is necessary in certain cases?

Levin: The original concept was not all that bad--they were providing a service to small radiology groups like three-, four- or five-person radiology groups that didn't want to be constantly on call, and maybe didn't have subspecialty expertise in areas like neuroradiology or musculoskeletal radiology.

But it has been subverted over the years. Now you have radiology groups of 50, 60 or 70 people who could easily rotate night call. Each radiologist would have to work one or two weeks a year at night, but even that seems to be too much--these groups will still outsource to nighthawks. That sends a terrible message.

FMI: What kind of message?

Levin: I think it just sends a very bad message about the dedication and convenience of radiologists. 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. They want to come in at eight in the morning, stay until 5 p.m., and sort of abrogate the night and weekend call responsibility to someone else and let these other people worry about it. It says they are more interested in their own personal convenience than about the patients in their hospitals.

FMI: What are the quality issues associated with teleradiology?

Levin: If you look at the model the teleradiology companies use, the way in which they can make a profit is to read very fast. They have to read lickety-split, and the faster they read, the more likely it is they will overlook something.

Another issue is that radiologists that work with these companies have very little contact with referring physicians, and certainly no contact with patients. As a specialty, we're putting more and more emphasis nowadays on communicating with patients. But [teleradiologists] can't do that because they can be a thousand miles away.

And very often, if you're a radiologist reading a case and you come up with a difficult finding, you can grab hold of a colleague and get a second opinion right on the spot. But when you're at home, by yourself, reading studies, it might be hard to get a consult from a colleague.

Then, teleradiologists may have very little access or no access to patients' charts, or lab reports, or surgical reports or path reports. And sometimes they may have no access to imaging studies done on the same patient, in different modalities. And they get very little clinical follow up on their clinical interpretations.

Obviously, there are some teleradiology operations that may be providing decent quality. But I think a lot of them aren't.

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