The current moment represents a time of rapid change in many medical specialties, including radiology. Changes in regulations, payment, business arrangements, clinical practice, and information and medical technology are all contributing to this being a particularly unsettled period for practicing radiologists in the United States.
With the volume of diagnostic imaging procedures increasing at the same time as shortages of radiologist availability afflict many hospitals and multispecialty medical groups, a confluence of policy, business, and technological forces is continuing to build the teleradiology market. Just a decade-and-a-half ago, teleradiology was still viewed in many quarters in U.S. healthcare as a somewhat marginal phenomenon, one involving gaps in radiologist coverage during late-night and weekend periods, and initially filled by small groups of radiologists working mostly in India—where the time difference, and a surfeit of U.S.-trained radiologists who had returned to India to live, helped boost the initial teleradiology phenomenon.
Much has happened since then. Among other things, younger radiologists working in hospitals and medical groups are, like their counterparts in other medical specialties, demanding a better work-life balance. Meanwhile, technology has made teleradiology far easier to implement and optimize, and the engagement of teleradiology firms, staffed by radiologists from all over the world, has boomed.
One of the organizations that has made use of external teleradiology services is William W. Backus Hospital, a 213-bed community hospital in Norwich, Connecticut. Phillip Kohanski, M.D., chief of radiology at the hospital, has been practicing there for 17 years, the past five of them as head of radiology. The use of teleradiology at Backus has evolved over time. Three years ago, Kohanski led his colleagues to select the New Haven, Conn.-based Teleradiology Solutions, as their teleradiology services partner.
Recently, Dr. Kohanski spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about the organization’s journey around the use of teleradiology services. Below are excerpts from that interview.
Can you share with us the background story leading up to your hospital’s use of teleradiology services?
When I first started here 17 years ago, we did our own overnight call. We did what was in effect teleradiology, ourselves; we simply read cases at home. Over time, the ER sort of exploded, and there were just more and more cases. About ten years ago or so, it just became too much, and we made the shift to using external services. Once, the volume of radiological cases [that we manage through external teleradiology] was five or six cases a night, but now it’s all night. It supports us [as attending radiologists]. We use the reads overnight and then do an over-read in the morning.
Phillip Kohanski, M.D.
We started with a small company that was OK, though their interpretations were somewhat spotty. Then, over time, we moved to a bigger company that was physician-owned, and the quality and turnaround time were somewhat better. But after that company was sold to non-physicians, our experience of their work was that the level of service had gone down, while the price had gone up. So we came across Teleradiology Solutions about three years ago now, and have been pleased with them.
In selecting a teleradiology firm, you were looking for good service, accurate reads, and reasonable pricing, correct?
Yes, that’s right. The first two things go hand in hand. Any external company really does have to provide both a quick turnaround time and accurate reads. The teleradiology service represents us during night hours when we’re not taking call. And if they take too long, the ER doctors are eager to tell me about it. And there have been some hiccups along the way. But the Teleradiology Solutions people are very responsive, and take care of everything right away. When I meet someone who represents the company, I deal with that person; he’s the point person, and he takes cares of things.
There used to be some hesitation among referring physicians, and among radiologists, about using external services, correct? But that hesitation has dissipated now?
Not entirely, actually. As soon as ordering physicians see a new name on a report, they’re skeptical, and it takes a while, maybe four or five or six months, for people to get comfortable [with the use of teleradiology-based colleagues’ services]. We’ve had three external services now, and yes, that happens. Also, we were slow to go onto teleradiology external services, for fear of losing our work; but over time, we’ve learned to rely on it.
Do you ever get to try anybody out, in the sense of a trial run, with teleradiology companies?
Well, vetting a company is not easy. The first time, the physician who connected with that first external company, met them at RSNA. And they started out OK. It was a small company, and there were only four or five guys, and over time, their turnaround time got worse; and they hired a new guy, and his interpretations weren’t so good. So then we switched to a new physician-owned company, and that worked out well until they were sold to investors. And now we’re on our third; and most of the Teleradiology Solutions guys trained at Yale, and that helped a lot. And of course, we have our own informal network, and we ask them.
What would your advice be, around vetting teleradiology firms?
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