How Teleradiology Helped Develop Telehealth

Teleradiology is one of the oldest tools under the telehealth framework, dating back to the transmission of radiologic images via phone lines in the 1940s. One article described this early process as:

Primitive by modern standards, the equipment consisted of a glass drum with a clamp on top to attach the film while the drum rotated at a uniform speed of 180 rpm. A beam of light illuminated tiny elemental areas of the film and picked up by a photo cell inside the cylinder and connected with a preamplifier to produce the full picture. The image was passed through an output amplifier before connecting it to a telephone line or radio transmitter.

Today, technology has enabled the reliability of fast capture, storage, and transmission of big data imagery files on secure cloud and on-premise networks, allowing for greater collaboration and communication between physicians and their patients. Teleradiology has come a long way – but we’re not done yet.

This article will look at teleradiology as a service line. How is this form of remote medicine being used to improve the lives of the patients we serve?

To state the obvious, teleradiology is the electronic transmission of radiological images between healthcare providers. Typically, the images flow from a primary care or specialty provider to an off-site radiologist, who analyzes and diagnoses based on the images. Most applications of teleradiology use store-and-forward telehealth tools that take digital imagery from today’s modern radiology equipment, compress the image, and then quickly transmit it as data.

The science is being used today with all of the standard imagery tools, including MRIs, PET/CT, ultrasound, and of course, X-rays. These images are most typically transmitted today via the Internet in a secure, HIPAA-compliant connection.

Teleradiology can be applied to cross-sectional imaging, abdominal imaging, mammography, nuclear medicine, thoracic imaging, and many more medical applications to improve the quality of care.

There are hundreds of teleradiology providers around the U.S. today that provide these services as an outsourced resource for clinical facilities.

The practice of teleradiology can be leveraged across a spectrum of healthcare settings, including:

• Hospitals can outsource additional help from teleradiologists if their existing radiology department is backed up. Or, if it is a small community facility, the care center can seek the cost savings from outsourcing imaging and diagnosis.
• Urgent care settings often see patients with joint, bone, or mobility injuries. A teleradiologist is a perfect supplement to these facilities.
• For any facility that lacks an in-house radiologist, teleradiology is an excellent way to still provide service to patients.
• For consults and second opinions, teleradiology is a viable service with great value.

There is real value in teleradiology in a variety of settings, which is exactly why the practice as a service line is capturing a growing market segment within the field of telehealth.

The primary impetus behind teleradiology is the same as in telemedicine: it cuts overhead. It’s expensive to keep a full-radiologist on-site, especially for small practices, clinics, and hospitals. Having an on-call teleradiologist off-site allows the consult to occur when you need the service instead of having a high-value resource on-site just waiting for the next case.

While that’s one of the primary benefits of teleradiology, we should note the other benefits of the service, including:

• The quality of patient care is improved by allowing access to subspecialties such as pediatric radiologists, MRI radiologists, musculoskeletal radiologists, or other categories of providers that might not normally be as assessable.
• In rural areas, particularly for small practices, requesting a teleradiology consult improves access to care in ways these rural caregivers simply couldn’t otherwise afford.
• Orthopedic trauma images and patient history can be sent from an ER to an orthopedic surgeon to evaluate. Patient management can then be communicated back to the referring ER doctor.
• Teleradiology can provide after-hours or weekend care that is less costly than having an on-site provider.
• Faster response and turnaround allows teleradiology vendors to improve the speed of treatment and quality of care.
• For emergency treatment, teleradiology can improve the amount of time spent under costly ER care. While teleradiology cuts costs for hospitals, it should be noted that it also cuts costs for patients and payers.

These benefits have been proven to be widespread. Considering that widespread provider shortages are predicted over the next few years, teleradiology is a way to bridge the gap between supply and demand around the world.

The implications of providing care to third-world countries are life-changing. The World Health Organization (WHO) published a study recommending teleradiology to improve HIV-related tuberculosis screening and case management in remote regions of Malawi. They found that 70.9% of the teleradiology findings mirrored the diagnosis of clinical staff. Their final recommendation was to expand the use of teleradiology in these settings to provide additional care to remote, poor, and third world countries.

“Many hospitals are already looking to decentralize their niche offerings, especially Teleradiology with the help of community extension services or by partnering with emergency care centers.”
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The market for teleradiology is expected to surpass $21 million by 2026, according to Transparency Market Research. However, there are still reimbursement and licensure hurdles that need to be overcome. For example:

• The interpreting radiologist must be licensed in the state transmitting the image.
• This means that some teleradiologists have 50 medical licenses!
• Licensure across state lines is a complex and evolving process.

The American College of Radiology (ACR) has their own guidelines for the practice of teleradiology. They suggest:

• That the person performing the interpretation be available for consultation.
• That the radiologist also be credentialed as a member of the medical staff at the institution requesting the imaging consult.

While most teleradiology companies are in the United States, the ACR counsels caution when using overseas consults, saying, “Jurisdiction is more problematic.” Holding a clinician accountable to provide quality care in these instances is more difficult. However, they also say “there is no inherent technological difference between domestically generated teleradiology interpretations and reports and those generated outside the United States.”

Finally, the future of teleradiology is sure to be affected by the extensive merger and acquisition activity among radiology groups around the country. These factors are all changing the level of competition both for teleradiology companies and for practices that still remain independent.

While teleradiology remains an important part of telehealth, the future of the service, like the technology it uses, is almost certain to evolve.