Teleradiology today is far more complex than providing overnight reads. The evolution of the industry has created a foundation for the future.

Success as a radiologist or imaging facility requires much more than expertise and drive in today’s environment. Survival in a complicated atmosphere of expanding tools, growing diagnoses, and contracting profits is a delicate balancing act that is prone to peril. The advent of teleradiology has offered salvation through more efficient operations, but the demands on radiology continue to grow. As a result, the field of teleradiology is evolving beyond mere outsourcing to offer radiologists the extra hands, brains, and backbone sorely needed.

As physicians and patients increasingly rely on diagnostic imaging as a central part of care, radiologists are in high demand. But at the same time, this increased need for imaging means the day-to-day work environment is one of pressure and time shortage, inappropriate support, and less-than-ideal reimbursements.

With the significant demands placed on radiologists today, it’s no wonder that companies are developing services to ease the delivery of radiology imaging. Radiologists want to provide more efficient, better care at a higher return, both for the patient’s benefit and their own. But to do this is a difficult endeavor. So radiologists are searching for resources that will enable them to deliver.

“I am constantly looking for efficiency and improvement in patient care,” said David Katz, founder of Next Generation Radiology, a practice made of four medical imaging office sites in the New York region. “Any services that can help me do this, help me provide higher-quality care in a more efficient manner, is absolutely integral to our success. Whether we like it or not, we’re in an era of declining reimbursements. We must scan at a very high and productive level if we’re going to survive.”

Teleradiology has emerged in recent years as one of these important solutions. Initial teleradiology systems were built upon a central idea: radiologists are increasingly required to be everywhere at once in order to deliver superior patient care and financial solvency. To enable radiologists to do this, teleradiology firms offered outsourcing of key tasks, providing preliminary and overnight imaging reads from local and external radiologist sources. Radiologists gained some breathing room in hospitals and private practice groups.

This original setup was a major boon to many in the field. But demand continues to grow for imaging, squeezing radiologists and health care providers tighter in terms of time and money. Hospitals and physicians need to turn around reports faster in order to stay profitable, and increasingly, those reports are reliant upon specialized modalities and anatomy.

Traditional teleradiology services add another layer of complexity to an already complicated operation. Much work is still needed by the local technician to pull patient data and pair it with images before external reads are possible, involving manual collating, phone calls, and other tasks that are work and labor intensive. This opens up room for error and threatens efficiency and workflow. In a small practice, it’s a burden; in a national chain or hospital network, it’s a disaster.

Recognizing these evolved needs, the teleradiology market has progressed to help providers keep pace with demand.

Subspecialty Focus

One route of evolution has been offering expertise to which some radiology practitioners may not have access.

Franklin & Seidelmann Subspecialty Radiology formed in 2001 as a teleradiology firm offering final and subspecialty reports. For imaging centers, physician practices, radiology groups, and hospitals, F&S offers clinical specific and detailed reports 24/7, as well as consultation services. The company, comprised of more than 100 United States-based and trained radiologists, all of whom are licensed and board-certified in their areas, have expertise in the areas of musculoskeletal, body, cardiac, oncologic, neurology, and breast subspecialties, as well as training in advanced modalities, including 3.0T/1.5T MRI, MDCT, and PET/CT. In addition to teleradiology, the company also extends providers services in RT, IT, licensing and credentialing, account management, marketing, finance, operations, and billing.

The specialty focus is how F&S differentiates itself from other teleradiology providers, and offers significant benefits to radiology practices across the industry and locations. The network of remote subspecialty radiologists gives detailed interpretations to meet the demands of specialized clinicians. Plus, they don’t stop there—the team takes a collaborative approach, remaining highly accessible for physician consultation, utilizing a standard lexicon, and adhering to a quality-control and peer-review process.

The company also relies on an advanced technology infrastructure that connects clients and radiologists across the country, an essential component of evolved teleradiology services. Its AccuRad platform distributes information, images, and reports, combining remote installation services (RIS), PACS, and dictation workflow with standardized processes to route image data sets and enhance communication. Clients receive their radiology reports via fax, online access, or encrypted e-mail.

Taken together, this new direction for teleradiology is a promising addition to radiology practice.

“A very exciting aspect of telemedicine is the ability to aggregate this high-end radiological expertise everywhere it’s needed,” said Scott Seidelmann, CEO of Franklin & Seidelmann Subspecialty Radiology. “We’re the largest final-read teleradiology provider, delivering this expertise through high-quality, reliable, fast, and consistent service. We also offer the ability to integrate systems and reports and provide value-added support services to meet the specialized needs of radiology providers.”

To present this vast network of specialized radiologists to clinicians at any location would seem a major challenge. To ensure they have top talent, the company requires extensive experience in the specialty and uses a rigorous selection process, testing applicants with 20 to 30 imaging cases in that specialized area. Because of the company’s national network and growing reputation, it receives a high volume of subspecialty cases, which allow its radiology team a substantial amount of interpretations each year and the ability to build and maintain expertise.

Teleradiology’s Technological Advancement

Merge Healthcare presents another interesting example of a company evolving for today’s teleradiology marketplace. A medical imaging innovator known for its Fusion RIS, PACS, and RIS/PACS systems, and the DICOM viewing software (eFilm Workstation)—the widely used diagnostic desktop software—the company has partnered with many radiology practices over the past 21 years, developing the first iterations of teleradiology. Next Generation Radiology, for example, formed as a pioneer in the use of outside connections, linking through Merge systems to outside subspecialty experts for reads, and creating greater operational efficiency and return.

In 2007, Merge launched preread teleradiology services. The Consult PreRead consulting service relied on radiologists based in India to help US providers prepare final diagnostic reports. The Consult PreRead was tightly wound with the TeleRead software application, integrating images into RIS/PACS workflow and streamlining information distribution. But with the changing, crowded marketplace and a recent corporate shift, Merge is rethinking its teleradiology offerings and looking to deliver an even more distinct evolution of service. Rather than being a provider of teleradiology reading services, Merge is now changing focus, looking to create value in the marketplace by extending technology that helps other teleradiology providers to better deliver their analyses.

“Our strategy is to leave the business of practicing medicine to those who do it the best,” said Anthony Grise, vice president, business development, Merge Healthcare. “We want to provide a solution set that integrates the teleradiology process more efficiently and comprehensively. We believe our strength is in providing superior technology to those who are in the business of turning reads around, helping them do it better and more cost-effectively.”

The new Merge-managed services will involve the existing software packages and imaging solutions, as well as off-site archives and other infrastructure capabilities. Merge will tackle the time-intensive manual tasks associated with traditional teleradiology and automate them, as well as improve communication between internal and external partners. By empowering teleradiology providers with a better way to collect current images, relevant priors, demographic and clinical information, and all other pertinent data in a seamless, secure manner, those companies can better provide their clients complete diagnostic reports.

It’s a new path with high potential, and with a successful track record and loyal clients the move could pay off for Merge.

“Merge has been very good to us,” Katz said. “We’ve been partners for 10 years, at a time when this was brand-new and difficult to do. They’ve helped make our practice possible, and we’ve helped them in the design of their PACS systems. As they evolve and continue to provide services that help productivity and efficiency, we’ll continue our partnership.”

The Benefits of New Teleradiology

Ultimately, the evolution of teleradiology services, whether it’s final subspecialty reads or a technical system that allows access to everything in one secure spot, means more benefits for imaging centers, hospitals, and other practices utilizing radiology services.

Through more comprehensive teleradiology services, practices can increase patient load, scanning at the levels necessary to secure survival and profits. With more radiologists and tools available for the full spectrum of analysis, the practice workload isn’t limited by on-site radiologists and staff. At the same time, the high quality of patient care provided to the clinicians is maintained or even boosted, with expert resources to rely upon for accurate and reliable diagnostic reads.

Teleradiology’s external resources also eliminate inefficiency, reducing waste and saving costs. Part of this is eliminating human error. Rather than tying up FTEs to manually collate patient history and prior reads, resulting in cumbersome processes prone to human error, more sophisticated processes and technology automate essential processes. Image readers have a more comprehensive error-free spectrum of data to pull from, and employees are freed for other tasks.

Enhanced teleradiology services also mean more satisfaction all around.

“With accurate, clinically specific reports, in reliable, consistent formats, internal satisfaction can grow enormously,” Seidelmann said. “That’s the goal of hospital administrators, CEOs, and practice owners. The ability to produce quality radiology work means an ability to treat patients quickly and more effectively, leading to increased patient satisfaction. It also leads to improved job satisfaction for physicians and staff. Taken together, referring physicians will be more likely to send patients to that imaging facility as well.”

From another perspective, the advent of advanced teleradiology also offers benefits for the career prospects of radiologists. For new graduates or for radiologists looking to focus on their careers, teleradiology offers an appealing method of practice. By working with a subspecialty teleradiology provider, for example, radiologists can exclusively read images in their chosen specialty. The work is collaborative, flexible, and increasingly insulated from some of the challenges of traditional group practice.

The evolution of the teleradiology market as it responds to radiologists’ pressures is dramatic, but not finished. As radiology continues to change, and patient demand spikes, so will teleradiology and other solutions.

“The practice of radiology is changing, and we’re going to see less and less of the generalists reading studies,” Grise said. “A radiologist recently told me that reading studies is like flying: a pilot who flies a 747 will be at a loss when piloting a fighter jet. Imaging has now become so complicated that general radiologists reading all types of studies are at a disadvantage. Providers will increasingly need to give consumers the subspecialty expertise that they demand.”

Amy Lillard is a contributing writer for Medical Imaging. For more information, contact .