Teleradiology: A Utility for Telemedicine?

Radiology has been blessed with more than a half century of true innovation. Historically, the annual Radiologic Society of North America (RSNA) meeting has been the place to go to get an early look at these advances.

The meeting seemed different this year. The convention hall was quieter, taxi lines were manageable and investment analysts’ reviews were down.  Innovation seemed incremental rather than transformative. The meeting—and radiology in general—needs to reboot and incorporate some adjacent opportunities.

Radiologists tend to think their job ends with a dictated report, yet ACR’s Imaging 3.0 recommends that radiologists take a more active role in discussing findings with referents and patients. While I support this change, Imaging 3.0 seems more about improving the buying experience (acquiring and reporting images) for the patient than fundamentally changing the user experience—i.e., impacting the patient’s outcome. That latter change would, after all, require us to participate in the care continuum.

Such a role for radiology has lingered on the horizon for nearly 20 years. Beginning in the late 1990s, radiologists began developing teleradiology as an opportunity to provide care for anyone, by anyone, at a distance. These solutions required both IT and administrative innovation. Images had to be moved from place to place, but (just as importantly) business relationships had to be established, including licensure, credentialing and reimbursement.

Teleradiology is a mature market today with well-established business alliances. It has not, however, expanded beyond the silo of imaging. While early on, teleradiology was featured at telemedicine meetings, today meetings and practitioners from the two communities rarely overlap. Why?

Though imaging is thought of as a required telemedicine feature, those practicing teleradiology tend to think strictly in terms of business opportunities related to imaging. They fail to see the larger picture: Teleradiology is telemedicine.

What if teleradiology could be used for more than x-rays? What if the highway built to carry images also could facilitate care opportunities for telemedicine? The specialty has the same functional requirements as telemedicine, both in terms of technology and business relationships.

Throughout the country, radiology practices are well positioned to offer an upsell in the form of additional services on providers’ networks. After all, hospitals in need of remote radiologists are likely in need of other specialists as well.

For example, neurologists, psychiatrists and neonatologists all would benefit by partnering with the existing imaging networks. Given the diminishing number of practitioners, load balancing will grow as a problem for many other specialties. Our bandwidth, integration into electronic medical records and business relationships lend themselves to other forms of care.

Why us?

Through its experience with PACS, radiology has a 20-year head start as domain experts in telemedicine.  We commonly think about PACS strictly in terms of IT, but results delivery required a change in how imaging services partnered with the medical community.

Radiology is one of just three clinical departments that provide critical results to all other departments, requiring active enrollment and identification of individual physician preferences.  This enrollment process—how to find people by name (Dr. Smith) or role (the doctor covering Dr. Smith on call)—is at the center of a virtual practice. In short, radiology is well positioned to act as a hub to enable care through the continuum.

Yes, there would be issues related to workflow and video. Radiology tends to use store-and-forward technology, while clinical care requires face-to-face, real-time encounters. These challenges, however, are not insurmountable.

Progressive radiology groups have taken ownership of IT, and some have become IT subcontractors for their hospital, resulting in significant additional revenue. Yet these IT superhighways still carry only one form of freight—images.

Ask your referents if they have interest in remote coverage of some of your existing partners.  If there is interest, can’t a piece of the highway be “leased” for delivery of orthopedics, neurology, behavioral services and more?

Radiology’s primary role always will be as domain experts for imaging, but CT, ultrasound and MR haven’t changed much in the last 30 years. By leveraging decades of experience in managed services, practitioners of teleradiology—all of us, really—can add value to many other forms of care. If radiology gets out of its own way and thinks more broadly about related opportunities, the specialty could assume a new role as orchestrator of care continuum.

Alan Pitt, MD, is professor of neuroradiology, Barrow Neurological Institute. He recently was named CMO of a global telemedicine company.