Hospital medical staffs are increasingly expecting more from radiology—and small, traditional groups are struggling to keep up with those demands. That was the situation faced by Charles Rhoades, assistant administrator of clinical ancillary services at El Centro Regional Medical Center (ECRMC) in California. “In September 2010, our previous radiology group approached us to voice its concerns about being able to handle increased demands for subspecialty interpretations and interventional procedures,” he recalls. “They were asking for help, so the hospital started looking for solutions.” In familiarizing themselves with the marketplace, Rhoades and the members of his team rapidly found themselves considering another option for radiology services. “We compared the pros and cons of the traditional group (supplemented with outside teleradiology services) versus working with one radiology group that provided round-the-clock coverage using a mixture of on-site and off-site radiologists,” he says. “Being in a rural community, having continual access to subspecialty radiologists really intrigued us. Subspecialty radiology was something our former group wasn’t always able to provide.” In June 2011, ECRMC went live with Radisphere (Beachwood, Ohio), a provider of accessible and accountable subspecialty radiology services to community hospitals, following a 2.5-month implementation process. “The availability of final reports 24/7 has been huge for us,” Rhoades says. “It’s gone over very well with our referring physicians.” Time and Timeliness Scott Seidelmann, president and CEO of Radisphere, observes that hospital medical staffs have an extremely diverse set of needs, when it comes to imaging services. “The real customer is the medical staff, and the reality is that even in a small community hospital, you’re talking about 200 physicians across 20 specialties, all consuming radiology in fundamentally different ways,” he says. “The actual product of radiology is giving information and diagnoses, and you have to understand how the medical staff at a specific hospital will consume that information.” Rhoades notes that in the case of ECRMC, timeliness of report delivery was a key factor in the decision to work with Radisphere. “Before the new implementation, we provided on-site radiologists during the day, and at night, we went over to a service that would do a preliminary interpretation for certain procedures,” he says. “Now, it goes straight to the final interpretation. It’s timely, and Radisphere put fees at risk based on its ability to meet these turnaround times.” In addition, the process for handling critical-results delivery has improved—a factor of increasing importance to hospitals, Seidelmann notes. “One of the biggest complaints we hear is about critical findings,” he says. “Radiologists don’t always call them in, which is a big issue, since it’s one of the leading causes of malpractice suits.” Rhoades notes that these failures in communication often result from the difficulty of the process. “It’s very manually intensive—the radiologist tries to contact the referring physician to deliver the results, but there’s no automated way to keep track of it or to monitor compliance,” he says. For that reason, Radisphere employs administrative staff dedicated to handling and documenting critical-results delivery. “The radiologist can go on reading while someone else is making sure to get that physician on the phone and connect him or her with the radiologist,” Seidelmann says. “It’s all tracked and documented, and we audit the reports by doing a systemwide lookup of all studies and identifying those that may have a critical value to send for peer review. Today, about 14% of our volume has a critical-finding call, and 98% of the time, it’s delivered at the time of diagnosis—the physicians speak an average of 90 minutes after the initial call is made.” As a result, at ECRMC, “The chance of something important falling through the cracks is minimized,” Rhoades says. “It’s completely transparent.” Specialization and Consultation Another growing need observed by Seidelmann and his team is that for consultation with the radiologist. “Radiology is only getting more complex as time goes on, and clinicians are using imaging in new ways,” he says. “For a radiologist to convey all that information in the report is not always the best way. The whole point is to be accessible to answer a clinical question, and it’s hard to do that when you don’t know what the question is, or when the question has changed.” The task of answering the clinical question is aided by Radisphere’s adherence to structured reporting, Rhoades says. “There’s no variation between the different radiologists, and it provides for the systematic inspection of images and anatomic structures,” he says. “It lessens the likelihood that some obvious pathology will distract them from a subtle or unexpected finding, and ensures that the reports coming out of the imaging department are consistently formatted, which helps the referring physicians.” When further discussion is needed, Radisphere allows physicians to connect electronically with its radiologists for a remote consultation, Seidelmann says. “It’s all about access—you can use a little bit of technology to make better access possible,” he notes. “When any clinician calls, the first thing he or she is asked is whether he or she wants to speak with the radiologist. If so, we schedule that discussion with the radiologist, wherever her or she is—in the hospital or working from another state.” Leveraging this capability enables ECRMC’s clinicians to “consult with the radiologists easily through the software,” Rhoades says. “The referring physicians can get online and view images in real time, with the radiologist, to review the case.” As a result, he says, “There’s always a specialist in any specific domain available to talk with the referring physician.” Rhoades concludes that the switch to Radisphere has provided his medical-staff members with the subspecialty imaging they need, in the accelerated timeframe they require to offer the best care. “The challenge now is on our side—the radiology group is turning around the studies so rapidly that the emphasis now is on improving our processes to get the studies to the radiologists as quickly as possible,” he says. “The radiology part is working very well.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.