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Hybrid Model of On-Site and Remote Radiology for Enhanced Patient Workflow

Posted Mar 23 2013 12:00am

Because teleradiology is so well established and digital pathology (i.e., telepathology) still in its infancy, we need to look carefully at how teleradiology is evolving to order to plan our own future in pathology. I have always held the opinion that digital pathology will not replace pathologists in smaller hospitals but rather support and supplement their work. Currently, pathologists in smaller hospitals select their most challenging surgical pathology cases and send the glass slides, via expedited delivery, to their favorite consultants for an additional opinion. The time interval for the return of the consultant reports will be variable but will usually will be measured in days.

Under a digital pathology model, the same hospital pathologists will instead send the whole slide image (WSI) file for a case to the consultants and ideally receive the reports back in 24-48 hours. National pathology networks are also now evolving that can provide such services (see: PathCentral Debuts Agnostic Global Pathology Network ). This model should result in enhanced quality and little disruption to patient throughput and lab workflow. Below is an excerpt from an article discussing a hybrid teleradiology model that has been adopted in a 370-bed California hospital (see:  Partnering for Progress: Imaging and the Rapidly Growing Hospital ):

Mercy San Juan Medical Center is a 370-bed acute-care hospital in Carmichael, California, that is part of the not-for-profit Dignity Health System. It has experienced significant growth since it opened its doors in 1967....Most patients are affected by imaging, so timeliness, access, and partnership in care of the patient are critical. As the patient load seen by the facility has increased, so have the service lines offered to those patients, according to [the] COO of the hospital. “The case complexity of the patients we are seeing continues to increase over time,” she says. “In addition to being a level II trauma center, we feature neurosciences as a key service line....When patient volume is a key consideration, nothing is more critical than throughput, and the need to get patients through the hospital quickly and appropriately has made imaging a linchpin of care....Without radiologists partnering with us and aligning toward that effort, we will not survive.” Toward that end, Dignity Health System has taken a hybrid approach to its radiology coverage, using a radiology group that is part of the Dignity Health Medical Foundation for daytime and on-site work, in addition to using subspecialty teleradiologists from Virtual Radiologic (vRad) .....“This model allows them to access radiology seamlessly. Even at the busiest of times, vRad can help us load balance so that we meet the turnaround times the referring physicians ...need.”....“We have an extensive specialist group of neurologists, neurosurgeons, and interventional neuroradiologists,”...“We’re quickly becoming the center of choice for ambulance and transfer patients from other hospitals for diagnosis and treatment of any type of neurology-related condition.”Without both subspecialty radiologists working remotely and on-site interventional neuroradiologists, this offering would not be possible....

The reason that I like the model described above so much is that improved patient workflow is the most important rationale for deploying teleradiology support in the hospital rather than cost-savings. Mercy San Juan Medical Center has created a hybrid radiology staffing model comprised of its own radiology group for daytime and on-site work and Virtual Radiologic (vRad) for load-balancing and off-hours work. 

Obviously, the key to deploying such a hybrid model is the allocation of work assignments between the two collaborating radiology groups. However, I suspect that this could be a relatively simple matter using computer algorithms based on the orders for various radiology procedures, the complexity of the cases, the degree of urgency of each case, and the available resources at the time from the two professional pools, local radiology and on-line vRad. Obviously, in some hospital settings, such a hybrid model can be controversial in the sense that it takes work away from the local radiology group. Here's a very detailed look from a legal perspective at Alternative Hospital-Radiology Practice Models that was posted on the American College of Radiology web site. 

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