Teleradiology
Encyclopedia
Teleradiology is the transmission of radiological patient images, such as x-ray
s, CT
s, and MRIs, from one location to another for the purposes of sharing studies with other radiologists and physicians. Teleradiology is a growth technology given that imaging procedures are growing approximately 15% annually against an increase of only 2% in the Radiologist population.
Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient. This is particularly important when a sub-specialist such as a MRI Radiologist, Neuroradiologist, Pediatric Radiologist, or Musculoskeletal Radiologist is needed, since these professionals are generally only located in large metropolitan areas working during day time hours. Teleradiology allows for trained specialists to be available 24/7.
Teleradiology utilizes standard network technologies such as the internet
, telephone
lines, wide area network
, local area network
(LAN) and the latest high tech being computer clouds. Specialized software is used to transmit the images and enable the Radiologist to effectively analyze what can be hundreds of images for a given study. Technologies such as advanced graphics processing, voice recognition, and image compression are often used in Teleradiology. Through Teleradiology, images can be sent to another part of the hospital, or to other locations around the world.
Preliminary Reports include all pertinent findings and a phone call for any critical findings. For some Teleradiology services, the turnaround time is extremely rapid with a 30 minute standard turnaround and expedited for critical and stroke studies.
Teleradiology Final Reports can be provided for emergent and non-emergent studies. Final reports include all findings and require access to prior studies and all relevant patient information for a complete diagnosis. Phone calls with any critical findings are signs of quality services.
Teleradiology Preliminary or Final Reports can be provided for all doctors and hospitals overflow studies. Teleradiology can be available for intermittent coverage as an extension of practices and will provide patients with the highest quality care.
In addition, advanced teleradiology systems must also be HIPAA compliant, which helps to ensure patients’ privacy. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a uniform, federal floor of privacy protections for consumers. It limits the ways that entities can use patients’ personal information and protects the privacy of all medical information no matter what form it is in. Quality teleradiology must abide by important HIPAA rules to ensure patients’ privacy is protected.
Also State laws governing the licensing requirements and medical malpractice insurance coverage required for physicians vary from state to state. Ensuring compliance with these laws is a significant overhead expense for larger multi-state teleradiology groups.
Teleradiology expanded rapidly as the growth of the internet and broad band combined with new CT scanner technology to become an essential tool in trauma cases in emergency rooms throughout the country. The occasional 2-3 x ray studies a week soon became 3-10 CT scans, or more, a night. Because ER physicians are not trained to read CT scans or MRI's, radiologists went from working 8–10 hours a day, five and half days a week to a schedule of 24 hours a day, 7 days a week coverage. This became a particularly acute challenge in smaller rural facilities that only had one solo radiologist with no other to share call.
These circumstances spawned a post dot.com boom of firms and groups that provided outsourced, off-site teleradiology on-call services to hospitals and Radiology Groups around the country. As an example, a teleradiology firm might cover trauma at a hospital in Indiana with doctors based in Texas. Some firms even used overseas doctors in locations like Australia and India. Nighthawk, founded by Dr. Paul Berger, was the first to station U.S. licensed radiologists overseas (initially Australia and later Switzerland) to maximize the time zone difference to provide nightcall in U.S. hospitals.
The early innovators in this field like Teleradiology Solutions, Nighthawk Radiology, The Radlinx Group, and Virtual Radiology Consultants (VRC or VRN most recently), became multi million dollar companies today. Nighthawk (symbol: NHWK) and VRC (symbol: VRAD) ultimately went public and established almost a billion dollars in market capitalization.
However, on May 17, 2010, Providence Equity Partners
acquired and took private Virtual Radiologic. Moreover, on September, 27, 2010, Virtual Radiologic and NightHawk Radiology Announced their Merger. Finally, on December 23, 2010, Virtual Radiologic (vRad) and NightHawk Radiology announced the completion of their previously announced merger, with NightHawk continuing as a wholly owned subsidiary of vRad.
The Radlinx Group, founded by Greg Lowenstein and Mark Bakken, pioneered the expansion of teleradiology services beyond just night coverage to also provide coverage to hundreds of small rural hospitals and clinics, throughout the U.S., who otherwise had no on-site access to full-time radiologists.
Currently teleradiology firms are facing pricing pressures. Industry consolidation is likely as there are more than 500 of these firms, large and small, throughout the United States.
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s, CT
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
s, and MRIs, from one location to another for the purposes of sharing studies with other radiologists and physicians. Teleradiology is a growth technology given that imaging procedures are growing approximately 15% annually against an increase of only 2% in the Radiologist population.
Teleradiology improves patient care by allowing Radiologists to provide services without actually having to be at the location of the patient. This is particularly important when a sub-specialist such as a MRI Radiologist, Neuroradiologist, Pediatric Radiologist, or Musculoskeletal Radiologist is needed, since these professionals are generally only located in large metropolitan areas working during day time hours. Teleradiology allows for trained specialists to be available 24/7.
Teleradiology utilizes standard network technologies such as the internet
Internet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...
, telephone
Telephone
The telephone , colloquially referred to as a phone, is a telecommunications device that transmits and receives sounds, usually the human voice. Telephones are a point-to-point communication system whose most basic function is to allow two people separated by large distances to talk to each other...
lines, wide area network
Wide area network
A wide area network is a telecommunication network that covers a broad area . Business and government entities utilize WANs to relay data among employees, clients, buyers, and suppliers from various geographical locations...
, local area network
Local area network
A local area network is a computer network that interconnects computers in a limited area such as a home, school, computer laboratory, or office building...
(LAN) and the latest high tech being computer clouds. Specialized software is used to transmit the images and enable the Radiologist to effectively analyze what can be hundreds of images for a given study. Technologies such as advanced graphics processing, voice recognition, and image compression are often used in Teleradiology. Through Teleradiology, images can be sent to another part of the hospital, or to other locations around the world.
Reports
Teleradiologists can provide a Preliminary Read for emergency room cases and other emergent cases or a Final Read for the official patient record and for use in billing.Preliminary Reports include all pertinent findings and a phone call for any critical findings. For some Teleradiology services, the turnaround time is extremely rapid with a 30 minute standard turnaround and expedited for critical and stroke studies.
Teleradiology Final Reports can be provided for emergent and non-emergent studies. Final reports include all findings and require access to prior studies and all relevant patient information for a complete diagnosis. Phone calls with any critical findings are signs of quality services.
Teleradiology Preliminary or Final Reports can be provided for all doctors and hospitals overflow studies. Teleradiology can be available for intermittent coverage as an extension of practices and will provide patients with the highest quality care.
Subspecialties
Some teleradiologists are fellowship trained and have a wide variety of subspecialty expertise including such difficult-to-find areas as Neuroradiology, Pediatric Neuroradiology, Musculo-skeletal MRI, Mammography, Nuclear Cardiology.Regulations
In the United States, Medicare and Medicaid laws require the Teleradiologist to be on U.S. soil in order to qualify for reimbursement of the Final Read.In addition, advanced teleradiology systems must also be HIPAA compliant, which helps to ensure patients’ privacy. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a uniform, federal floor of privacy protections for consumers. It limits the ways that entities can use patients’ personal information and protects the privacy of all medical information no matter what form it is in. Quality teleradiology must abide by important HIPAA rules to ensure patients’ privacy is protected.
Also State laws governing the licensing requirements and medical malpractice insurance coverage required for physicians vary from state to state. Ensuring compliance with these laws is a significant overhead expense for larger multi-state teleradiology groups.
Industry growth
Until the late 1990s teleradiology was primarily used by individual radiologists to interpret occasional emergency studies from offsite locations, often in the radiologists home. The connections were made through standard analog phone lines.Teleradiology expanded rapidly as the growth of the internet and broad band combined with new CT scanner technology to become an essential tool in trauma cases in emergency rooms throughout the country. The occasional 2-3 x ray studies a week soon became 3-10 CT scans, or more, a night. Because ER physicians are not trained to read CT scans or MRI's, radiologists went from working 8–10 hours a day, five and half days a week to a schedule of 24 hours a day, 7 days a week coverage. This became a particularly acute challenge in smaller rural facilities that only had one solo radiologist with no other to share call.
These circumstances spawned a post dot.com boom of firms and groups that provided outsourced, off-site teleradiology on-call services to hospitals and Radiology Groups around the country. As an example, a teleradiology firm might cover trauma at a hospital in Indiana with doctors based in Texas. Some firms even used overseas doctors in locations like Australia and India. Nighthawk, founded by Dr. Paul Berger, was the first to station U.S. licensed radiologists overseas (initially Australia and later Switzerland) to maximize the time zone difference to provide nightcall in U.S. hospitals.
The early innovators in this field like Teleradiology Solutions, Nighthawk Radiology, The Radlinx Group, and Virtual Radiology Consultants (VRC or VRN most recently), became multi million dollar companies today. Nighthawk (symbol: NHWK) and VRC (symbol: VRAD) ultimately went public and established almost a billion dollars in market capitalization.
However, on May 17, 2010, Providence Equity Partners
Providence Equity Partners
Providence Equity Partners is a global private equity investment firm focused on media, entertainment, communications and information investments...
acquired and took private Virtual Radiologic. Moreover, on September, 27, 2010, Virtual Radiologic and NightHawk Radiology Announced their Merger. Finally, on December 23, 2010, Virtual Radiologic (vRad) and NightHawk Radiology announced the completion of their previously announced merger, with NightHawk continuing as a wholly owned subsidiary of vRad.
The Radlinx Group, founded by Greg Lowenstein and Mark Bakken, pioneered the expansion of teleradiology services beyond just night coverage to also provide coverage to hundreds of small rural hospitals and clinics, throughout the U.S., who otherwise had no on-site access to full-time radiologists.
Currently teleradiology firms are facing pricing pressures. Industry consolidation is likely as there are more than 500 of these firms, large and small, throughout the United States.
See also
- TelemedicineTelemedicineTelemedicine is the use of telecommunication and information technologies in order to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities...
- PACSPicture archiving and communication systemA picture archiving and communication system is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities . Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or...
- DICOMDigital Imaging and Communications in MedicineDICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. The communication protocol is an application protocol that uses TCP/IP to communicate between systems...