The Makeup of a Successful Subspecialist Teleradiology 24/7 Strategy
 
Authors:
Rasu B. Shrestha, MD, MBA, University of Pittsburg Medical Center; Brian Kolowitz, MBA; Christopher Neff, MBA; Gonzalo R. Lauro, MBA; Harry Black, MBA
 
Background:
UPMC’s organization consists of 20 separate hospitals, each with their own combination of HIS, RIS, and PACS systems. In an effort to cut costs, provide increased coverage, improve patient care, and eliminate redundancy, UPMC has developed a unique yet comprehensive strategy for providing specialist coverage of Radiological procedures around the clock. Reimbursements are going down, the numbers of clinical procedures are going up, and patients are becoming more aware of the care they are getting. Meanwhile hospitals and imaging departments are left footing the bill. While many hospitals are transitioning to outsourced Radiological services, UPMC is moving toward an in-house solution - opting to stop some existing outsourcing practices and fully in-source the service to within the UPMC health system.
 
Evaluation:
The combination of a myriad of HIS, RIS, and PACS systems across UPMC’s many hospitals provides unique challenges for a hospital system in this era of distributed diagnostic imaging amidst an economic downturn. These challenges are on par with those faced by organizations trying to form RHIO’s or those found by countries nationalizing health care.

The Teleradiology 24/7 solution that we developed focuses on the patient at hand, rather than the information system involved. It allows any Radiologist at any location within UPMC to view and read a patient’s images, regardless of the site or information system. The Teleradiology 24/7 application works within the constraints of the existing information systems in a way that the existing systems are agnostic to Teleradiology 24/7’s existence. This paper discusses the uniqueness of this solution, as well as the applicability of those approaches to broader challenges faced by many imaging departments and hospitals.

UPMC has chosen to recall their outsourced services and provide an in-house alternative. This paper also discusses the impact of such a comprehensive teleradiology solution on (1) patient care, (2) business of radiology, and (3) the physician. The organization feels that it can provide a unique advantage over competitors by guaranteeing subspecialist coverage of all procedures around the clock – providing higher quality services at a lower cost within a smaller window.

With the 24/7 Teleradiology application as the foundation, we have developed a grouping structure that organizes the hospitals into zones during the evening hours. Each zone has a home base where the subspecialist radiologists are located. All hospitals are covered by the central zone during the overnight shift. This zone coverage model allows UPMC the ability to maximize utilization by distributing their specialists within the zones.

Figure 1
 
Discussion:
In this paper, we attempt to discuss important and relevant questions such as:
  • What are the technological constraints of having multiple HIS and RIS systems?
  • How can 24/7 coverage be provided across hospitals in an un-federated organization?
  • What specific features are required by Radiologists, Residents, Technologists, and the Administration?
  • How can key parameters such as turnaround times, volumes and wRVUs be improved and tracked across the system?
  • Will the quality of procedures dramatically improve over outsourced services?
  • What benefits will the patient receive because the physician is on site?
  • What impact will UPMC’s decision have on retaining or attracting talent?
  • Will UPMC be able to staff their facilities 24/7?
  • What will be the cost of these decisions, now and in the future?
  • Can UPMC provide these services at a higher quality and lower cost than outsourced services?
  • Can UPMC use this program as a marketing tool against their competitors?
Conclusion:
UPMC is in the process of rolling out version 1.2 of their Teleradiology 24/7 application. Currently 7 of the 20 hospitals are included, and the application has been an overwhelming success. The Teleradiology 24/7 system has met the Radiologists needs for providing top-tier coverage, the Residents needs for enhanced training, and the Administrations goals for optimal report turnaround, cost reduction, and improved patient care.