By Dr. John Feole, AuntMinnie.com contributing writer

February 18, 2014 -- The ability to transmit digital radiologic examinations has radically changed how radiologists practice medicine over the past two decades. The ability to move exams quickly, securely, and inexpensively has made this a practical solution for hospitals and radiology practices.

Many of us trained before digital imaging was an option. All analog film was read in-house, and many hours were spent processing films. Some new radiology graduates have never read a nondigital film, and they've never had to drive back to the hospital to read a CT performed after hours. These exams can now be quickly processed and transferred to any location where an expert can review the study.

We have come a long, long way, and it's very easy to forget what the world of radiology was like only 20 years ago.

Dr. John Feole
Dr. John Feole of Strategic Imaging Consultants.

As a radiologist, I truly believe the majority of us will always want to do what is best for the patient, regardless of monetary gain. That is the way we were trained, and that is how it should be. "How would you treat a family member?" The answer to that question is how you should treat your patients.

In 2014, the economy is strained, healthcare costs are high, and more patients than ever need care. This is why we need to create a "win-win-win" environment. A successful relationship is based on that foundation: a win for the patient, the provider, and the radiologist. They must coexist.

Enhancing local practices

I believe working with a good teleradiology practice is an opportunity for a local group to enhance and support its practice. Being on call every other night and working the next day is very difficult. Allowing someone you trust to care for your patients during the off-hours may make the local radiologist's practice sustainable. This, in turn, will lead to better clinician and patient interactions.

When interacting with any teleradiology firm or partner, a noncompete should be signed so there is no threat of being displaced. Likewise, teleradiology rates must be competitive to be sustainable. A local group and/or hospital cannot lose money buying coverage. The teleradiology services should be transparent.

Another potential benefit of teleradiology is access to subspecialty reading that may not be offered onsite. Perhaps the local radiologist would like certain exams to be read by a specialist. This improves patient care and reflects well on the hospital and the radiology practice.

A teleradiology service can also improve your report turnaround time by reading the backlog after hours or by working in conjunction with the day staff to improve efficiency. Similar to an onsite radiologist, a remote radiologist can protocol exams, speak with patients and technologists, and assist with accreditation and marketing services. Email and instant messaging make communication instantaneous.

Misconceptions about teleradiology

There are a number of misconceptions about teleradiology that I would like to explore.

"Teleradiologists read too quickly."

Radiologists all read at different speeds. A fast reader will do so regardless of his or her reading environment. A teleradiologist may have a long worklist and some stat cases to call, but it really is a relatively calm environment overall to work in.

For in-house radiologists, it's not uncommon to multitask from the minute they walk in the door through late in the day, often working through lunch. Having a growing worklist of cases, a technologist at the door with a question, a referring doctor on the phone, and a patient waiting for you in fluoro simultaneously is commonplace.

I respect the radiologists who do this, and they should be paid handsomely for it. It's not easy, but a good radiologist can juggle these demands. A teleradiologist may be of great assistance to someone working solo in this situation.

"It is unclear whether teleradiologists practice high-quality radiology."

Teleradiologists should be subject to the same rigorous screening and hiring process that any medical practice would utilize. Board-certified physicians with appropriate training and state licensing should be screened and background checks should be run for verification.

Performance, peer review, and American College of Radiology compliance are necessary for monitoring the health of your services. In addition, radiologists choosing this career path are often very well-trained, as obtaining these positions can be competitive. This combination of activities should result in the same quality of care received in any other radiology practice.

"A teleradiology company's primary goal is profit."

This generalization could be said of any hospital, radiology practice, university, or business. Practicing quality medicine should be our primary goal. Making a good living and/or profit is not the primary objective. It may, however, be the byproduct of honest hard work performed at a fair price. Most hospitals and radiology practices strive to improve and expand their services. If these new services are offered at fair market value, physicians, hospitals, and patients will all benefit, and as a result, a profit may result.

Conclusion and impressions

Like any radiologist, I will end with a conclusion or impression. Teleradiology services should exist to transparently support local radiologists and hospitals, not to displace them. The advantages of working together with a teleradiology group are many and include workflow efficiency, improved turnaround time, added specialization, and -- last but not least -- call coverage.

This combination of services, previously unavailable, should not be fought but welcomed as a winning formula for hospitals, radiologists, and patients. It is this formula that will allow you to treat those patients like family.

Dr. Feole is the founder and CEO of Strategic Imaging Consultants, a national provider of teleradiology and PACS services in Chapel Hill, NC. He is a board-certified, fellowship-trained radiologist with 15 years of private-practice experience. He has 10 years of experience in hospital-based radiology and established Strategic Imaging Consultants in 2006. He has also served as the medical director of three outpatient imaging centers owned by MedQuest Associates and supervised radiology services for thousands of patients and many radiologists at these facilities.


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