Day for Night, East for West

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Teleradiology permeates the specialty as practices cross state, regional, and global boundaries to purchase and practice radiology

How did a 2000 lecture tour in China spawn a teleradiology revolution? For William G. Bradley, MD, PhD, FACR, the idea for an international business evolved from a reading that he did nine years ago in the Far East. Thanks to PACS and the Web, Bradley, who is now chair of the radiology department at the University of California, San Diego (UCSD) Medical Center, interpreted an MRI of the brain in China and then called the neurosurgeon in the United States.

“It was the middle of the night back in Long Beach, Calif, and the middle of the afternoon in China,” Bradley recalls. “At that point, it occurred to me that with PACS and the Internet, you don’t have to be up at night anymore—which is the worst thing about being a radiologist.” That, he adds, was the genesis of the first after-hours teleradiology coverage provider.

After returning from Asia, Bradley mentioned the idea to friend and colleague Paul Berger, MD. With PACS, increased Internet bandwidth, and lossless images fueling the digital transformation, the idea took hold. Berger nurtured the concept, eventually starting a company with a name that became generic in the industry and synonymous with nocturnal radiology.

“What we started was simple,” Bradley says. “You moved to Sydney. You moved to Zurich—and you worked during the day.” At present, he reports, 26% of US hospitals are covered by the original company, and 55% of hospitals are covered by one of its 40 competitors.

Over time, and through the adoption of PACS, many traditional radiology practices have embraced teleradiology, not just as customers, but as providers of daytime coverage for contracted hospitals and long-distance and after-hours coverage for rural hospitals and small radiology practices.

Today, for example, UCSD is not only a client of the original after-hours coverage provider, but is also a purveyor of subspecialty teleradiology services. Each day, UCSD radiologists perform 50 to more than 100 teleradiology interpretations; Bradley expects this service line to generate revenues of $1.5 million in 2009.

When taking on a new hospital client, many radiology groups, such as Radiology Consultants of Iowa (RCI) in Cedar Rapids, keep a close eye on the windshield factor, preferring to contract only with hospitals no farther away than a two-hour drive. Kathryn Epley, RCI’s chief administrative officer, presides over the 27-radiologist RCI group and takes pride in the company’s ability to offer both distance readings and on-site services with a personal touch.

With the continuing rise of subspecialization, high-end MRI, and interventional procedures, Epley points out, it is tough for small, rural hospitals to retain enough radiologists with all the necessary credentials and skills. The highly dispersed population centers of Iowa mean that RCI primarily deals with critical-access hospitals (of 25 or fewer beds) outside its urban home base.

When Epley arrived four years ago, most of those hospitals still had film-based radiology services, and turnaround for routine studies could take days. To make matters worse, radiologists had to spend time traveling to those hospitals to provide on-site coverage, even for studies that could have been interpreted via PACS (if it had been available).

With the help of an IT committee of four radiologists and a new CIO, Joe Moore, RCI selected a PACS in 2005 and began visiting outreach hospitals. “The most precious resource we have is the doctors’ time,” Epley says. “For them to be driving to outreach sites is a poor use of their time if they can do that same work in a remote reading room.”

Realizing the dream of providing networked, real-time radiology service for all of the contracted outreach hospitals was not easy, but Epley and her staff made steady progress. “Our vision required that those hospitals develop a stronger relationship with us, in terms of trusting us to purchase their PACS through us, which was a real leap of faith,” Epley says. “Since that time in 2005, every one of our 10 outreach hospitals has come onto what we call RCI Net. We provide a completely turnkey digital system because most of these hospitals don’t have the IT infrastructure necessary for PACS. We also provide 24/7 reading within our group because we have radiologists working all three shifts.”

With those pieces in place, multislice CT, MRI, digital