Optimal Readings was formed about a year ago and is now up to full speed providing radiologists the ability to read images at times and places where an on-site radiologist isn't available.
The concept is simple, really: Build a staff of radiologists who can fill in, long-distance, when a hospital otherwise would not have a radiologist on staff.
Parker gives the example of an outlying hospital that is covered by a Birmingham radiology practice during the day. But at night, that hospital now turns to Optimal Readings to handle the occasional auto accident or other needs in the emergency room.
"We have a network of readers who are already working all night long, so we can move a nighttime image from that hospital to a centralized reader here in Birmingham," Parker says. "That allows the local radiologists to get a good night's rest so they can start fresh the next morning, and it allows the ER physician to have a trained radiologist at his beck and call for consultations or emergency situations that arise."
Optimal Readings works with each hospital to set up a system that is appropriate and affordable for their needs. The company installs hardware and software that are used to "push" the digital image from the hospital to Optimal Readings' data center, where a complex set of prequalifications and routing rules is used to send that study to the correct one of Optimal's 40-plus radiologists. (The radiologist must be licensed in the same state where the image was done, has to have credentials at the hospital, and if it's a subspecialty read, must have that specialty certification.) The image will appear in the radiologist's worklist; he or she will interpret the scan and provide either a preliminary or final diagnostic, depending on what's called for. Then the report is sent back to the requesting facility.
Many teleradiology companies have traditionally focused on overnight services — so much, in fact, that the term "nighthawk" has come to be used for this area. In a study presented last month during the American Roentgen Ray Society's annual meeting, hospitals were surveyed about their use of nighthawk services. Of the hospitals that participated in the study, 51 percent of practices said they obtain between 1 percent and 5 percent of their reads from a nighthawk service.
"Radiologists in America have tended to group together in metropolitan areas, frequently around large research institutions," he explains. "So in a place like Birmingham, there's an ample supply of radiologists.
"But move outside of Birmingham and go to a place like Thomasville or Greenville, and more likely than not you'll find there's no full-time radiologist who lives in the community. There may be a radiologist who covers the small town hospitals one day a week, or he'll ride a circuit and be there three days every two weeks. When the radiologist is not there, those community hospitals are really at a disadvantage in terms of providing care to local residents. We've leveraged technology to help elevate the standard of care in those underserved communities."
The problem is only projected to get worse, Parker says, as the use of medical imaging grows.
"The Radiological Society of North America predicts that imaging volume will grow three times faster than the available pool of radiologists over the next five to 10 years," he says. "You couple that with the increasing movement toward specialization, and the supply is even more limited. The new modalities make it increasingly difficult for radiologists to stay expert in all the modalities."
Teleradiology not only offers benefits to hospitals and patients, Parker says, but also to radiologists. Those working for Optimal Readings often enjoy flexible hours; in some cases the ability to work in their homes; and the chance to concentrate on a preferred type of read, such as on mammography or musculoskeletal or pediatric scans, he says.
Parker notes that in some cases, smaller radiology practices in non-urban areas might use the service to supplement their expertise. "They may not want to read a really complicated ankle, but send that to someone in Birmingham who knows ankles like the back of his hands," he says.
Teleradiology is not without controversy. In a 2005 article in Imaging Economics, critics express concern that teleradiology could "commoditize" radiology, especially as some teleradiology is being outsourced to readers overseas. "The ultimate commoditization nightmare," writes George Wiley, "is one in which images would flow in to some offshore radiological sweatshop where radiologists' pay would be a fraction of what U.S. doctors charge."
Parker acknowledges that great care must be taken not to eliminate the personal interaction between hospital staff and radiologists.
"That personal interaction is important to the continuity and overall quality of patient care," he says. "When a radiologist is in a remote location, you have to take extra steps to help them become familiar with and comfortable with each other. So we assign a limited number of radiologists to any one customer site, so they get to know their assigned radiologists and build a high level of comfort with them in a very short order."
Parker says Optimal Readings has been well received in the Southeast, where the company is currently concentrating its efforts. "The response has been overwhelmingly positive," he says. "We've grown faster than our internal expectations. People are thrilled with a new tool to help deliver improved patient care."
June 2007
