In February 2020, we had the pleasure of hosting a teleradiology webinar with Gautam Agrawal, M.D, CIO and co-founder of Vision Radiology. The group has 53 FTE radiologists serving over 140 hospitals. Vision’s core practice focuses on Emergency Teleradiology with a growing focus on non-emergent sub-specialty interpretations. As a leader in radiology and an advocate for improving patient outcomes, Dr. Agrawal spoke with Dicom Systems’ Executive Vice President Florent Saint-Clair about the changes, challenges, and trends in teleradiology in 2020 and beyond.
To set the context for the webinar and take-aways, we began by reviewing some of the numbers. The global teleradiology market is forecasted to reach $11.5 Billion. There will be 75 million Americans over age 65 by 2030. With aging, the population is projected to experience more chronic disease, and therefore, need more imaging and extended health data in the next decade. The sheer volume of imaging data acquired, stored, and transferred presents challenges as well as incredible opportunities.
- Consolidation Across Radiology Groups
Smaller radiology groups are being acquired and/or are merging with others. Until recently, consolidation in radiology has been limited, when compared to other specialties such as emergency medicine, anesthesia, and dermatology. Private equity firms, private equity-backed group practices, and publicly traded multi-specialty groups have recently turned their attention to radiology. Dr. Agrawal shared a key reason for this teleradiology trend: economies of scale. The complexity of medicine is ever-expanding. The difficulty in the regulatory and legal environments is also ever-expanding. To that end, economies of scale can be very valuable for radiology practices. Insurance reimbursement and MIPS/MACRA is another reason behind the consolidation trend. As groups get larger and larger, they can command reimbursement from insurance companies. With larger team backing radiology groups, they are able to leverage technology and artificial intelligence on a greater scale.
- Teleradiology Allows Greater Collaboration
Having specialists or being able to access specialists 24/7 is incredibly valuable. With teleradiology or remote radiology, specialists can be located across time zones, making the time difference an advantage. Dr. Agrawal shared an example of a specialist who lives in Hawaii and can collaborate with teams on the East Coast. “They can do things that are very valuable for the group and you can use time shifting to allow them to bring expertise to bear and to help ultimately improve patient care and patient outcomes.” This is one of the ways that Vision Radiology maintains impressive SLAs and turnaround times. Turnaround time pressure is particularly amplified in the emergency medicine setting.
There are two different strategies for how radiologists handle the incoming queue. One of them is to keep reading until the queue is empty: the “first in, first out” approach. The other, more systematic approach, involves the presentation of studies to different physicians based on their preferences and sub-specialization: neuro-radiology, musculoskeletal radiology and other levels of specialization. Intelligent routing, or a rules-based routing system, enables cases to be assigned to the appropriate specialist. Dr. Gautam shared that Vision Radiology employs a hybrid approach, true to its mission of doing what is in the best interest of the patient. This is where workflow optimization comes in.
- Throughput Improvements: Delivering Studies at 10X
With the increase in volume of imaging studies due to the aging population and increase in chronic conditions discussed on the webinar, radiology groups have a higher volume of studies to process. An analogy we can use is highways handling more cars on the road. One of the ways teleradiology providers can stay ahead of the curve, and deliver results with shorter turnaround times, is leveraging technology to increase throughput. Parallel threading has a similar effect to opening up more lanes on the highway: the capacity for flow of studies increases dramatically when parallel “threads” or “channels” become available.
Dr. Agrawal shared the tenfold increase in throughput achieved by Vision Radiology with the help of the Dicom Unifier.
Another strategy that allows radiology groups to shorten turnaround time is by pre-fetching relevant priors. Prefetch from Dicom Systems enables radiologists to have both current studies and relevant priors routed to their workstations at the same time. Once a new order is assigned to a radiologist, that doctor’s ‘Priors’ preferences’ are used to create a Query/Retrieve message. Prefetch also features the ability to combine persons from multiple facilities under one Enterprise Patient ID. Physicians are able to see all prior image sets/reports, regardless of how the number of sites at which the patient has been imaged. Utilizing DICOM 3.0 standard TLS encryption & DCMSYS’ router compression algorithms significantly improves delivery time.
We appreciate the collaboration with Dr. Agarwal and his observations from the “frontlines” of teleradiology. Dicom Systems is honored to support the work done by Vision Radiology. We look forward to being part of continued innovation in teleradiology.
To view the complete webinar on demand, view the recording on Zoom >