Teleradiology providers emphasize quality, trust

“Trust us; it's not in our interest to offer a substandard service.” That was the message from teleradiology providers at this year's U.K. Radiological Congress. The role of outsourced reporting in Europe remains a hotly contested topic. The standard and cost-effectiveness of teleradiology providers has been questioned, as has the impact of outsourcing on hospital radiologists' jobs.

Many European hospitals and clinics are, nonetheless, turning to teleradiology firms to help clear reporting backlogs or provide out-of-hours service. Those that do should be able to trust the system, according to Dr. George McInnes, consultant radiologist at Poole Hospital NHS Trust in the U.K., and Telemedicine Clinic in Barcelona, Spain.

“Ensuring quality is paramount,” McInnes told delegates at the UKRC meeting in June. “There have been legitimate concerns expressed about commoditization. Practicing responsible teleradiology should take away a lot of these fears.”

Telemedicine Clinic is one of several companies now offering outsourced reporting from a European base. The company's main reporting hub is in Barcelona, though it also uses radiologists based in Iceland, Sweden, Finland, Denmark, Germany, Hungary, Estonia, France, Italy, and the U.K. Reporting services are currently provided for clients in Scandinavia, Spain, and the U.K.

Unilabs Teleradiology (formerly Eurad Consult) likewise offers outsourced reporting to hospitals and clinics across Europe. Radiologists at the company's main reading center, near Brussels, together generate around 40,000 reports each year.

All teleradiology businesses need to make a profit to survive, but efforts to keep costs low should not compromise service standards, McInnes said. Equally, although prompt turnaround times are important, it may sometimes be better to delay a nonurgent report by one or two days so that the images can be viewed by a radiologist with relevant subspecialist expertise.

Remote reporting does not need to mean no communication with referrers. Teleradiologists can use video-conferencing technology to participate in multidisciplinary team meetings and can telephone clinicians if accompanying notes are unclear, McInnes said.

Double reading may be used as an internal check on the accuracy of reports delivered, and this is often specified in contracts. The RIS used by the Telemedicine Clinic allows a second reader to highlight any areas of disagreement. Consensus must be reached on major discrepancies before the report is signed off and issued.

“Double-reading has been a very good way of monitoring radiology quality,” McInnes said. “It is also a very good educational tool. You can learn a tremendous amount from having other people look at your reports and change them.”

Some companies are downplaying the “remote” aspect of their business in a bid to win clients' trust. Medica and Four Ways Healthcare, both exhibiting at UKRC, were keen to stress that images received from U.K. clients would be reported only by U.K.-based radiologists.

The value of outsourcing from an end-user's point of view was discussed at UKRC by Dr. Jenny Maniyar, resident radiologist at Stepping Hill Hospital in Manchester, U.K. Out-ofhours CT head and/or neck reporting at Stepping Hill was contracted out to Medica in March 2008. An audit of outsourced reports over the next five months (51 cases) revealed no significant discrepancies.

Had in-house consultant radiologists done this overnight reporting, the hospital would have had to fund locum cover for elective radiology services the next day at a cost of over £17,000 (€19,300), Maniyar said. Teleradiology reporting costs for the same period were less than £8000 (€9100).