- Eric Nyberg, C. Lanzieri. 2007. American Diagnostic Radiology Moves Offshore: Surfing the Internet Wave to Worldwide Access and Quality Perspectives: American Diagnostic Radiology Moves Offshore: Where Is the Internet Wave Taking This Field. Abstract: I. INTRODUCTION II. MEDICAL CARE VIA THE INTERNET III. REGULATION FOR QUALITY IV. HEALTH CARE COST CONTAINMENT V. IMPORTANCE OF ON-SITE RADIOLOGY VI. OFFSHORING AND OPTIMIZATION VII. CONCLUSION I. INTRODUCTION International reading of medical imaging studies, or offshore teleradiology, has been a successful, though limited, practice benefiting patients and physicians for over a decade. Domestic and international market forces will continue to expand the demand for teleradiology as an important complement to United States based diagnostic radiology, though a full exodus of diagnostic reading to offshore sites is unlikely and inappropriate. Considerable obstacles remain to taking the teleradiology market to scale; however, barriers related to licensure, liability, quality assurance, and reimbursement will likely yield to market forces to be resolved in recognition of the significant benefits teleradiology offers to consumers and providers. II. MEDICAL CARE VIA THE INTERNET As in other aspects of the economy, the world of medicine is becoming flat as the necessity of physical proximity is becoming less essential in the doctor-patient relationship. Telemedieine, which is the use of electronic information and communication technologies to diagnose and manage medical care from a distance, is realistic, successful, and even preferred in several instances. (1) Telemedicine has existed for decades with telephone and fax, but with the Internet and the ability to view large amounts of audio and visual data at increasingly faster and cheaper rates, the practice of telemedicine is rapidly expanding. Radiology is not the only specialty affected by telemedicine and, by extension, the possibility of being offshored. Intensive care unit telemedicine is growing, and studies have shown it to achieve profoundly improved clinical and economic outcomes for both pediatric and adult populations. (2) Telepathology, which is the remote interpretation of cytological specimens, has been active for two decades and continues to grow more sophisticated as virtual laboratories are being created. (3) And tele-home care, which is the use of telemedicine in home-based settings, has shown to be successful in enabling community living older adults to maintain independence by providing monitoring of such vitals as blood sugar, blood pressure, heart rate, and mental status. (4) Even the practice of telemedicine in psychiatry has grown with one major study finding that there was no significant difference on patient satisfaction between telepsychiatric care and other specialty care via telemedicine. (5) Some patients, particularly those who were abused or suffered trauma, even show a strong preference for it. (6) Teleradiology specifically has considerable advantages for both providers and patients. One such benefit is using differences in time zones to alleviate the local burden of overnight calls and the loss of quality that comes with sleep deprivation. This service is generically known as "nighthawking" after the pioneering company NightHawk Radiology Services whose founder coined the term after nighthawk helicopter pilots on night flights in Vietnam. (7) When it is midnight on the east coast, a well-rested radiologist can be reading studies at 2 p.m. in Sydney, Australia. Teleradiology provides economic benefit to many smaller private radiology practices who would need to allocate one of their partners to staff an overnight shift which may only generate a few studies per hour while losing that staff member during the subsequent "post-call," more productive day time shift. In this case, the teleradiology service can keep its partners productive by servicing enough domestic radiology practices to keep them operating at capacity. Teleradiology also provides critical access to imaging services and timely interpretations for rural areas that cannot attract or afford on-site radiology interpretation, or alternatively in cities where the workload is too great. …
