Teleradiology in India : hype vs. reality

Teleradiology,i.e radiology services provided from a remote location has been doing the rounds in the media for quite a while. This post is an attempt at a reality check on the mass media hype.
The fact remains that the demand for radiology services in the US market is growing while the supply of radiologists is not growing enough to match the requirements. However we need to take a step back and examine this from a different perspective which some times is missing, when every other person wants to be running a healthcare BPO business these days. My intent is not to discourage the gold seekers, but to play the devil’s advocate.

Can India be a teleradiology hotspot?

Some of the teleradiology centers in Australia and Lebanon have several US board certified radiologists working from those locations. I guess we have a handful of US certified radiologists of Indian origin working from Bangalore, which is perfectly within the confines of US rules and regulations. However when a large Indian IT organization wanted to relocate more radiologists of Indian origin to Bangalore, there were no takers. Is there the right incentive for a radiologist in US to relocate to India today, for professional reasons?


US radiologist vs Indian Radiologist debate

Healthcare in US is built on stringent regulations, because healthcare is a politically sensitive issue in the country. The fact is that, though there is a shortage of healthcare professionals in the US, the country would NOT want to have less qualified professionals providing healthcare services. The reality is that though you and I are aware of the excellent clinical knowledge of Indian radiologists, the perception in US different. The common man is the US is really concerned about a radiologist in India whose credential are suspect by many of the folks here. To the average John Doe, despite all the hype that is created about outsourcing, India is still a developing country. My tax consultant is worried that US supermarkets are importing prescription drugs from India, which he feels may not be meeting FDA standards. Credibility being a key issue, the answer to successful teleradiology operation is to have one/several US board certified radiologists who can sign off on the radiology reports.

Medical Transcription vs Teleradiology

The layered review approach used in Medical transcription may not work very well in Teleradiology. The teleradiology equivalent of this (having some medical students run through the initial report and then reviewed by a senior radiologist and then finally by the US radiologist) kind of model may not work very well. Analyzing an image coming up with a report is a highly individualistic clinical centric affair and cannot be broken down into phases. At the bottom of the heart no US Board Certified radiologist (at least the ones I have talked to including one of the veteran US radiologists) is really confident of signing off on a report with his name, without actually having infinite confidence in the offshore radiologist, who comes up with the report.

Training & Scalability:

My understanding is that just about 50-100 radiologists graduate every year from the medical colleges in India. Many of them are very quickly absorbed into the labor pool. How many would want to moonlight after their regular work at hospitals/radiology centers? As the teleradiology facilities scale up one could expect shortage of radiologists in India accompanied by and attrition and wage inflation. So scaling up the operation to large numbers may be a concern. To create a reasonable supply of radiologists there needs to be collaborative policy decisions from the Indian Medical Council and the Government such as more medical seats and training facilities in the country.

Legal and Regulatory Aspects:

Apart from HIPAA there are other regulatory and political challenges as well. The American College of Radiology has come up with a stance that only US Board certified radiologist with malpractice insurance should be involved in teleradiology. A recent discussion in the radiology circles in the US centered around a limit on the number of radiology reports a radiologist could sign per day. So if a radiologist signs too many reports per day than humanly possible it might be considered that the radiologist did not actually review the records. Though tracking reports of each radiologist on a daily basis and building a legal case may be not practical, it also reflects the extreme reactions in the healthcare community to clinical process outsourcing.

Looking ahead..

I would think that more than the operational and business side of teleradiology, the real issue that slows adoption of offshore teleradiology services is to do with the regulatory framework surrounding the same in the US. We are seeing political initiatives to reign in healthcare costs that may limit medical malpractice lawsuits, rampant in the country today. Would there be a tipping point when the cost of radiology services becomes so expensive that the healthcare payer community would lobby to rationalize the cost of radiology services in the US? Would offshore teleradiology then be the norm for US hospitals? Would other countries follow suit?