Teleradiology stokes fears in Europe of loss of clinical community

Outsourcing of some percentage of services may be inevitable, but the radiology community must take care to ensure that the benefits of teleradiology outweigh the risks, according to a recent European editorial.

"Teleradiology may lead to fragmentation of well-established comprehensive services, which in turn may hinder research, training, clinical governance, and quality assurance," said Dr. Adrian K. Dixon, of the radiology department at the University of Cambridge in the U.K.

One of Dixon's concerns about teleradiology and outsourcing, from a European perspective, is that a definitive report is usually generated from a European radiologist registered with the host country (J Am Coll Radiol 2008 Jan;5[1]:12-18).

"This leads to confusion about style of reporting and the clinical separation of the reporting process from the clinical service being provided," he said.

Until recently, the U.S., where final reports are almost always issued by local radiologists, was immune from this danger. That may change as more U.S. teleradiology firms begin offering final reads.

The fear is that teleradiology may erode the sense of clinical community necessary to quality healthcare.

Radiology is essentially a clinical partnership with the referring physician. Discussion of complex cases is best handled at clinical meetings where all parties attend, Dixon said.

"This is not possible with teleradiology," he said.

Another fear is that teleradiology could deplete local radiology services, particularly under the U.K.'s National Health Service.

"Outsourcing could result in there being few local radiologists left to support imaging needs of the community," Dixon said.

The danger Dixon sees is that local imaging units would be left vulnerable if it becomes no longer financially viable to keep these units open, leading to reduction in services to a community.

Dixon also fears teleradiology may diminish the central role radiology departments play at most NHS institutions, where clinicians enthusiastically attend clinicoradiologic meetings to glean further diagnostic nuances about their patients.

"If a large proportion of reporting is outsourced to a remote stable, however, the local team may become so denuded that such dialogue becomes impossible," he said.

Another danger Dixon sees is that outsourcing could diminish the skills of local radiologists.

"Simple referrals - knee MR, headache - 'stolen' by outsourced providers, can lead to problems, not just in training residents but also in deskilling established radiologists," he said. "The recognition of unexpected or subtle abnormalities depends on seeing large numbers of normal cases and a wide range of normal variations."