What’s Standing in Teleradiology’s Way?

When teleradiology first came onto the industry’s stage, it was controversial. Would it siphon work away from facility- or office-based providers or would it pave the way for even greater productivity? As its use has grown, the benefits have come into clear view, but, according to some industry leaders, teleradiology still has more to offer.

In particular, the lingering COVID-19 pandemic has shown a bright spotlight on how integral teleradiology has become – and will stay – in the specialty. It has allowed providers nationwide to continue processing images while practicing social distancing, said a group for researchers from Emory University School of Medicine.

“Teleradiology has evolved from an occasional tool for convenience and, at times, a perceived marketplace disruption and threat into an increasingly systems-focused healthcare partner in improving access to imaging care across the nation,” said lead study author Tarek N. Hanna, M.D., an emergency and trauma radiologist in Emory’s radiology and imaging sciences department. “Technologic limitations and regulatory hurdles still hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.”

Hanna’s group outlined four challenges that face teleradiology in the Oct. 14 American Journal of Roentgenology.

Licensing & Credentialing: This process can be difficult for teleradiologists. Each state is individualized, and teleradiologists must be knowledgeable of the requirements at both the sending and receiving sites. Consequently, because teleradiologists work with several facilities across state lines, this can be a stumbling block.

“These barriers result in practice inefficiencies and restricted access to emergent and subspecialty care, especially in rural markets,” the team said.

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In 2014, the Interstate Medical Licensure Compact smoothed the path somewhat, making it easier for providers practicing in multiple states, but not every state participates. Larger states, including Texas, California, New York and Florida, are not included, making the more difficult for providers to practice.

Regulations: In many instances, individual states have put rules in place that control certain aspects of workflow that can make daily activities harder for teleradiologists, the team said.

For example, they said, New York conducts quality control testing every two weeks on diagnostic monitors for remote reading. They also conduct quarterly evaluations, as well as annual testing by a licensed medical physicist. Complying with the regulations can be expensive and complicated for teleradiologists who live in rural areas, they said. Given that, some states with more rural populations, such as Minnesota and Wisconsin, have more relaxed mandates.

“Radiologists must stay engaged and use their (individual or collective voices to influence regulatory legislation,” the team said. “ We support evidence-based regulation; standardization of regulation across geography; and regulation that does not result in disparities in the quality of, or access to, imaging care.”

Systems Integration & Communication

It can also be harder for teleradiologists to collect all relevant clinical information since they interpret studies from a variety of facilities that use different PACS and electronic medical record systems. Because of this, there is a need for augmented efforts to break down data-sharing barriers without weakening security and safety measures, such as statewide teleradiology networks.

In addition, interpreting radiologists are responsible for overseeing clinicians who complete the imaging exams. Consequently, because they are working remotely, there is a larger onus on these physicians to ensure streamlined communicate between themselves, the technologists, and the ordering provider. One strategy that has proven effective, the team said, is the virtual consult with instant messaging.

After-Hours Staffing Models and Reimbursement Implications

One of the biggest factors behind teleradiology’s growth is its ability to provide night and emergency coverage. But, just like with other facility-based radiologists, this schedule, as well as working rotating shifts, can lead to decreased job satisfaction, higher safety risks, and make it more difficult to recruit providers to work these hours. These schedules are also less attractive because there is not a CPT code that provides for adequate reimbursement.

“Radiologists should work with specialty societies to address such care discrepancies, understanding that this may involve more rigorous staffing (of both physicians and technologists) after-hours,” the team said, “and that such change may require both culture shifts and support from new reimbursement models.”

Despite these challenges, there are still several opportunities around the growing use of teleradiology, the team said. Alongside continuing to expand sub-specialty coverage to more rural locations and bolster care during public emergencies, such as the pandemic, teleradiology also stands to benefit from the continued growth of artificial intelligence. There is room for smart work lists that can rapidly triage urgent cases and more effectively match the studies with the best-trained teleradiologist who is available for interpretation, the team said.

Overall, the team said, even though challenges remain, teleradiology has proven itself to be a beneficial component to diagnostic imaging.

“In recent years, teleradiology has evolved from an occasional tool for convenience and, at times, a perceived marketplace disruption and threat into an increasingly systems-focused health care partner in improving access to imaging care across the nation,” they said.