The State of Teleradiology in 2018

It’s a branch of radiology that’s been around for nearly 30 years, and it’s come a long way, significantly impacting the industry on its journey.  

Teleradiology has surpassed the nighthawk service it once was. Today, it’s an option for radiologists looking for more flexibility in the work-life balance, a way for smaller hospitals to access sub-specialty expertise, and a fill-in service when providers in smaller practices go on vacation.

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Over the years, skepticism of teleradiology has waned as more referring physicians, radiologists, and facilities have gained confidence that teleradiologists can provide quality interpretations, industry leaders say. In fact, it’s growing in popularity and has helped more healthcare facilities offer patients high-level radiology services.

“Outsourced teleradiology is an issue that has basically stabilized and matured,” says Lawrence Muroff, MD, FACR, chief executive officer and president of Imaging Consultants, Inc.

Presence

According to a recent Research and Markets report, the global teleradiology market is on the upswing and is forecasted to reach $8.2 billion by 2024. As of 2015, the North American market accounted for roughly 40 percent of that overall value.

Muroff agrees teleradiology has become pervasive, penetrating nearly 50 percent of private practices. In addition, smaller hospitals are demanding round-the-clock radiology coverage for both routine and acute, emergency cases. So, access to prompt interpretations has become the expectation and the norm.

“If you don’t have 24/7/365 coverage of some sort, whether it’s in-house or outsourced, you’re not providing patients with the coverage or the expertise they need or deserve,” he says.

In fact, says Elizabeth Krupinski, PhD, professor and vice chair for research in the department of radiology and imaging sciences at the Emory University School of Medicine, teleradiology implementation is happening across the board from both underserved rural and urban hospitals to academic medical centers. And, providing sub-specialty services access is one of the key benefits.

“Many facilities might have a general radiologist, but if you have someone come in from a car crash with a potential brain injury, you want a neuroradiologist looking at the images,” she says. “Having the ability to transmit images to a sub-specialist and get a timely response is one of the advantages.”

The future

Despite becoming more widespread and profitable, Muroff says, the teleradiology market is actually likely to shrink over the next 3-to-5 years. As larger teleradiology groups acquire smaller ones and bigger practices bring these services back in-house, there will be fewer teleradiology organizations.

Teleradiology is also likely to follow the larger radiology industry, incorporating AI technologies, Krupinski says.

“If images look like an accident victim with brain trauma, AI tools will assign it highest priority,” she says. “I can see teleradiology changing as a byproduct of the overall industry shift, offering the same benefits to remote sites.”

The impact

In recent years, teleradiology services have fundamentally changed, says Samir Shah, MD, a member of the American College of Radiology (ACR) Task Force on Teleradiology. It’s become a far more detailed service.

“Teleradiology over the last decade has shifted from being only preliminary reports that might be provided by board-certified providers located outside the country, to final reporting performed by U.S. radiologists,” says Shah, who is also vice president of clinical operations at Radiology Partners. “Now, they’re fully fleshed-out reports based on comparisons to prior images that have separate impressions and conclusions, as well as ICD-10 compliant billable histories.”

Hospital personnel-administration, surgeons, and emergency physicians-have largely driven this change, he says, to improve patient safety and transparency. They need comprehensive interpretations to ensure they provide the highest quality services in the timeliest manner.

Additionally, it’s largely eliminated the long interpretation wait times that once existed in remote facilities, Krupinski says. Instead of waiting for a traveling radiologist to circle through every few weeks to complete batch reads, teleradiology makes it possible for referring physicians to frequently give patients results during the same appointment.

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Consequently, Muroff says, the response to teleradiology among most providers has been positive.

“Generally, there’s great satisfaction with teleradiology,” he says. “Day-in and day-out, they focus mainly on reading a sub-specialty of images, and they do a great job.”

Challenges

Although teleradiology offers many benefits, some challenges still exist, Krupinski says. For example, the state-of-the-art equipment needed can carry heavy price tags, stretching some facilities’ budgets thin.

“Some environments don’t have the funds to make these purchases so their images may not be high enough quality for a teleradiologist to read them easily,” she says. “It’s a disadvantage.”

Training technologists to meet teleradiologists’ preferences can also be difficult because individual providers will likely have specific ways they would like to have images acquired. Discussing this at the beginning of a partnership can help side-step miscommunications, she adds.

Patient response

As with radiology overall, teleradiology faces the plight of anonymity. Outside of mammography or interventional radiology, rare is the provider who meets patients face-to-face. Consequently, in most cases, patients either assume the radiologist interpreting their studies is down the hall - or they don’t think about it at all.

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“Just like patients don’t usually interact with a radiologist in the hospital, they don’t really realize there’s a radiologist working somewhere else to do a quality interpretation of images,” Krupinski says. “So, from the patient perspective, even if they’re getting their images read faster, there’s often no perceived difference than if the radiologist were in the same hospital.”

However, Shah said, as use and awareness of teleradiology continues to spread, patients are picking up on it. Although there haven’t been any large-scale studies on how patients view teleradiology, there is anecdotal evidence they consider it to be a beneficial service.

“I’ve had individuals tell me a radiologist diagnosed them as having X or Y condition during the night,” he says. “There’s an awareness in the community among laypersons that these radiologists are in the trenches with emergency doctors, reading films.”

Getting involved

According to Shah, teleradiology isn’t only a career choice for young radiologists interested in doing preliminary interpretations from remote locations. Its attractiveness has expanded.

“Radiology residents and fellows don’t think about the dichotomous choices between private practice and academia anymore. Teleradiology is a third choice to actively consider,” he says. “And, it’s not just drawing radiologists in their early years. Now, we’re seeing people joining teleradiology groups in the middle and even later stages of their careers.”

But, before jumping into teleradiology, there are things to consider, he says. In 2013, the ACR published a white paper, giving providers a roadmap for what they need to think about when choosing teleradiology. Following the suggestions can help radiologists be successful.

The ACR echoes the state mandates that providers be licensed to interpret studies not only in their states of residency, but also the states for which they will read studies. It also recommends teleradiologists hold medical staff privileges at all transmitting hospitals, as well as maintain board certification, complete continuing medical education, and participate in peer review to ensure quality and patient safety.

Additionally, the ACR promotes discussing image acquisition preferences with technologists, being available to consult with referring physicians, and always participating in conveying findings, particularly critical ones.  

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Ultimately, Muroff says, teleradiology has established itself as integral radiology tool that shows no signs of disappearing.

“All patients deserve prompt and qualified interpretations,” he says.