6 keys to selecting a world-class teleradiology provider.
Subject: Radiologists (Technology application)
Radiologists (Practice)
Radiology (Technology application)
Radiology, Medical (Technology application)
Author: Palacio, Mark
Pub Date: 12/01/2009
Publication: Name: Applied Radiology Publisher: Anderson Publishing Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Anderson Publishing Ltd. ISSN: 0160-9963
Issue: Date: Dec, 2009 Source Volume: 38 Source Issue: 12
Topic: Event Code: 200 Management dynamics Computer Subject: Technology application
Geographic: Geographic Scope: India Geographic Code: 9INDI India
Accession Number: 231313778
Full Text: The worst-case scenario in personal computing technical support is having your call routed to some far-off call center in Calcutta, or maybe Bombay, and having all of your queries met with scripted responses and guarantees that "power cycling" your device (a fancy term for shutting it off and turning it on) will solve your problem. Situations like this leave the caller wishing she could just get someone on the phone who she could communicate with instantly. Fact is, many radiology groups are letting this type of activity transpire with their referring physicians while they are off counting sheep.

Estimates today place the number of radiology groups using some form of third-party teleradiology service at about 70%. Clearly, U.S. radiologists place a high value on lifestyle and the quality of that lifestyle. These days, a nighttime-reading solution is close to a business necessity in order to recruit radiologists. With more than 100 companies offering such services, how do you ensure that your referrings don't come to expect a lower-quality read just because a scan was sent at 11:13 p.m.?

A teleradiology service must be considered carefully and not just evaluated on a cost-per-procedure scale. The service should be viewed as a seamless extension of the practice. Referring physicians should be able to pick up the phone and contact the radiologist who read the study at 2 a.m. the same way they can at 2 p.m.

This article will review 6 main criteria that should be evaluated when negotiating a service level agreement (SLA) for new or replacement teleradiology services. An online version of this article will cover these topics in greater detail and can be found at www.appliedradiology.com. The primary selection criteria for any teleradiology provider should be:

* Workflow (e.g., who reads the images and who answers the phone?).

* Error rate and internal quality assurance.

* JCAHO accreditation.

* Value-added services (e.g., final reads, subspecialty reads and billing).

* Contract terms and blackout dates.

* Measures of satisfaction.

By carefully evaluating the services that other teleradiology providers bring to the table, you may realize it's time to power cycle your old provider. An additional online-only sidebar to this article reviews 2 innovative technology companies that power the delivery of images and information in teleradiology settings.

Differentiating providers

Part of the challenge to selecting a teleradiology vendor is looking past the concept of these services as mere commodities. It is true that in many cases a practice can come to the negotiating table with price as the foremost concern but simply choosing the lowest-cost provider could be sacrificing numerous value-added features.

"With so many players in this space, there is significant pricing pressure," said Rob Kill, Chairman and CEO of Virtual Radiologic Corporation, Eden Prairie, MN. "While many providers can compete on price, not all of them have established reputations when it comes to quality of care and service excellence. Undoubtedly we are living in a cost-focused environment, but ultimately we are talking about patient care and you can't make decisions on patient care based only on price."

QA, subspecialty and final reads

Another point to consider is how the teleradiology provider handles discrepancies. In this regard, it helps to understand the provider's quality assurance (QA) processes. Some vendors have dedicated QA committees while others will provide more ad hoc QA reviews. Additionally, some vendors will overread a certain percentage of studies in an effort to continually control quality.

When looking to extend your practice's service offering, a teleradiology company can often times provide subspecialty reads, although generally the larger groups are the ones who offer this level of service. Typically, smaller groups with <10 radiologists are not capable of providing true subspecialty service.

Increasingly, the market is demanding final reads instead of preliminary reads. As scrutiny of healthcare expenditure, especially the cost of medical imaging, continues to escalate, administrative agencies like the Centers for Medicare & Medicaid Services (CMS) are beginning to consider preliminary reading as an inherently inefficient process. In fact, CMS will currently not reimburse for studies that are read in foreign countries, because billing is done for the radiologist's location and not the patient's location. So it is also important to ensure that the teleradiology provider has a CMS-compliant billing process in place.

Finally, it is important that the provider can deliver on the technical integration of teleradiology. Specifically, the provider must have a way to get the report back into the hospital's radiology information system (RIS) or hospital information system (HIS).

Workflow and turnaround time

An additional factor to consider is how quickly the provider turns around images and how they route images to their radiologists. Some providers can guarantee a consistent turnaround time <30 minutes. However, longer turnaround times for nonemergent cases could help a facility better tailor an SLA to its particular budgetary needs.

"When competing for business it almost always comes down to a combination of price, turnaround time, availability and a certain QA level," said Howard Reis, Director of Business Development at Imaging on Call, Poughkeepsie, NY. "We see that a 30-minute turnaround time has been fairly standard but the turnaround number can change as you go from preliminary reads to finals. However, nonemergent cases can be read at a slower turnaround time, perhaps 2 hours, and these specifics could be built into the SLA."

It is also important to discern how images are routed to radiologists. Some providers have elaborate routing schemes and employ radiologists who read in centralized locations vs. radiologists who read from home offices. The benefits here are that workflow coordinators can route calls so that the radiologist who interpreted the study, or another qualified radiologist, is always available to discuss results with referring physicians. In some business models these workflow coordinators also do initial review of the studies to ensure that they are complete and that the study finds its way to the proper physician.


The teleradiology market is becoming a practice necessity across the country. With radiologists, in general, at a premium, the old contention that teleradiology services help foster a better quality of life, and thus happier and more productive radiologists, cannot be overlooked. Selecting the right teleradiology services provider can ensure that referring physicians, and ultimately patients, receive a similarly high quality of care no matter what time they present to a hospital.

For expanded coverage of this topic, visit www.appliedradiology.com.

Mark Palacio is Executive Editor of Applied Radiology.
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.

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