Teleradiology services, though not new, are becoming increasingly important to hospitals. Innovation in software and service delivery continues to drive down interpretation fees and turnaround times, and many organizations have replaced their radiology department with a teleradiology vendor.
What is Teleradiology?
Teleradiology can be defined in two ways: the ability to send radiographic images (X-rays, MRIs, CT scans, etc.) from one location to another, or the actual service of a radiologist that reads and interprets radiographic images taken elsewhere. According to Dr. James H. Thrall, in a June 2007 Radiology article on the history of teleradiology, teleradiology is “the ability to obtain images in one location, transmit them over a distance, and view them remotely for diagnostic or consultative purposes.” Think of it like telemedicine, but just for medical imaging, and with physicians as the end user.
History of Teleradiology
The earliest research and development of teleradiology systems “was performed in the 1960s and into the 1970s,” according to Thrall. These systems were designed and implemented to reduce the need for patients or radiologists to travel to one another. Early innovators included Boston’s Massachusetts General Hospital, which used microwave transmissions to beam a television image from Boston’s Logan Airport to the hospital in order to provide care to travelers. Also, Walter Reed General Hospital in Washington, D.C. used a closed-circuit television system to transmit images between the radiology department and the emergency room, “sometime in the mid-1960s,” according to Thrall, who remembered using the system when he interned there in 1968. Issues with resolution and contrast — and the exorbitant cost — “relegated [these] systems to novelty status, and ensured they were “never used seriously for patient care,” according to Thrall.
It wasn’t until the 1980s that teleradiology systems first became commercially viable, but they still bore little resemblance to the vendors of today. Early teleradiology systems were most often used after hours, so radiologists could read and interpret emergent imaging study results from their home, rather than keeping a radiologist on-call at the hospital overnight. The first modern teleradiology vendors — organizations that solely exist to provide teleradiology services to hospitals and physician groups — didn’t start to appear until the 1990s.
One of the first large teleradiology vendors in the U.S. was Teleradiology Diagnostic Service (TDS), founded in 1997 by Dr. Wilson Wong to serve the Southern California market. In an article from Radiology Business, Wong recalled how the radiologist shortage at the time left he and his colleagues exhausted from constantly being on-call. “Imagine working all night, and then you have to work the next day — another full-time job,” Wong said. He realized that much of the after hours on call time was wasted, “with the interruptions and the ups and downs there were a lot of dead periods.” So he founded TDS and within a short time, he and a few other radiologists were doing preliminary reads after hours for 80 hospitals on the West Coast. According to Wong, in the beginning “there was no competition; everybody was clamoring to be a customer of ours.” Competition came quickly, however. Today, hundreds of organizations, large and small, offer teleradiology services to hospitals and physician groups.
Teleradiology or Radiology Services?
According to Radiology Business, “many of the largest providers of remote radiology interpretations are working to reformulate themselves as full-time providers of professional radiology services.” This change in terminology is due to increasing competition between providers of remote radiology services (teleradiology) and traditional radiology practices. Teleradiology companies are now vying for the same hospital contracts as traditional radiology practices — they’re no longer only after hours service providers. Even with strict and expensive regulatory requirements — radiologists at teleradiology companies must be licensed separately in each state they serve to qualify for full reimbursement from Medicare/Medicaid — teleradiology companies usually still can provide faster and less expensive services than many traditional radiology practices, simply due to economies of scale. Further complicating the matter is the fact that many radiology practices use teleradiology companies for after hours reads or sub-specialties with which they’re unfamiliar.
The Future of Teleradiology
In an interview for an article in Physician’s Practice, Dr. Larry Muroff, CEO and president of Imaging Consultants in Tampa, Florida, a traditional radiology group, said “you can argue that [teleradiology] is for the good or the bad, [but] if you don’t think that it’s a disruptive force, then your head is in the sand.” This disruption is causing the lines between traditional radiology and teleradiology to blur, meaning the future of such services is likely one of increased cooperation — perhaps even to the point of consolidation.
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