Technology overcomes shortfall in radiologists

Research suggests that healthcare organisations are experiencing plain film reporting backlogs of over 40% of their total radiology reporting workload.1 Last year, the British Medical Association (BMA) estimated that an extra 1,300 consultant radiologists are required in the coming years. A shortage of consultant radiologists, increasing demand for diagnostic imaging and screening, combined with new legislation on working hours, will further exacerbate the problem. The NHS breast screening programme, for example, has expanded considerably over the past ten years with the extension of the upper age for screening invitation from 65 to 70, the use of two view mammography at all screens and routine double reading of mammograms.2 The NHS Cancer Reform Strategy also announced that the bowel screening programme will be extended from 2010 to all men and women aged 70 to 75. Dr Gill Markham, vice-president of the Royal College of Radiologists and dean of the Faculty for Clinical Radiology, commented: “Demand for scans and complex imaging is rising year on year and is set to increase even further in light of recent developments with extra patients being referred from the Government’s planned extension of its breast and colonic screening programmes. We need a steady and sustained expansion in consultant numbers if we are to deliver this level of service to patients safely and to the high standards that patients deserve.” Medica Group chief executive, Simon Rasalingham, believes teleradiology services could provide the answer. “Radiology services are already under considerable pressure from the National Stroke Strategy, the NICE head injury guidelines and A&E waiting times,” he commented. “In June, the referral-to-treatment target drops to two weeks for imaging departments and the European Working Time Directive (EWTD) is due to come into force just two months later. We need to stand behind our NHS Trusts because the pressure to provide out of hours imaging and reporting is becoming unsustainable.” The company already partners over 50 NHS Trusts and is now in talks with many more, as healthcare organisations are seeking a low-risk, cost-effective solution to the problem.

 UK expertise
When Simon Rasalingham and chief operating officer Bob Harper first established the business around five years ago, they initially encountered a common perception that outsourced teleradiology reporting means the use of “off-shore” expertise. However, Medica Group made a strategic decision not to adopt this model and the provision of UK-based expertise has been the key to gaining the confidence of Trusts. “There is a large pool of consultant radiologists in the UK – they are simply in the wrong place, at the wrong time,” he commented. “Technology can overcome this problem – providing a UK solution for a UK marketplace, which is important to users. “While consultants overseas may have extensive radiology knowledge, they do not have the experience of working within NHS hospitals and there can be distinct differences in their training. From a Trust’s perspective this is an important consideration as they are producing reports for physicians, surgeons and GPs based in the UK.” The company has a UK-wide network of over 75 consultant radiologists, with sophisticated teleradiology equipment in their own homes. Clinical directors and managers are given the freedom to choose when to use the service helping them to optimise resource allocation in their departments. Using this network, the company is able to spread the load of out-of-hours reporting more effectively than a Trust can locally. By the end of the year, the company expects to have 125-150 consultants providing expertise. The Nighthawk service provides 24-hour emergency CT and MRI reporting – which includes the provision of a fully authorised, date-stamped, electronic report, compiled by a consultant radiologist, as well as a verbal report to the referring clinician within one hour. In fact, analysis presented to a scientific meeting at the British Institute of Radiology has shown that the median turnaround is 23 minutes. “In the past, an opinion would be given over the phone. However, the team would have to wait until the morning for the report to be fully authorised before they could discharge a patient. The Nighthawk service speeds up clinical decision-making and helps avoid bottlenecks in A&E,” Simon Rasalingham explained. The national stroke guidelines and 18-week targets have also increased demand for cover during the day. The MRI/CT Dayhawk service with a sub 30-minute turnaround is designed to help Trusts deliver against the new stroke guidelines. Rapid turnaround is crucial in cases where a clinician needs to administer thrombolysis, for example. Both of these services are delivered securely, exceeding the NHSIA security compliance requirements. The reporting service is fully integrated with hospitals’ IT systems, so it can review the patient’s previous history, obtain previous imaging if relevant, as well as the latest scans, and provide a report based on all of the available information. 

Recruitment
Simon Rasalingham pointed out that enabling consultant radiologists to operate from home has been a significant factor in establishing an extensive network and attracting the right type of individual. “We found that working from a centrally located, teleradiology centre does not work as a business model – consultants do not want to have to face congestion in London after a full day’s work, for example. The fact that they do not have to travel to a central location has encouraged a greater number of consultants to provide their services to Medica Group, as working from home is a much more attractive proposition. “Remote reporting technology means that geographical barriers are removed – allowing Trusts to access the knowledge of radiology consultants located across the whole of the UK,” he commented. By accessing a larger, more diverse pool of expertise, the company also found that the quality of reporting increased. It is now able to offer highly specialised knowledge in the fields of paediatrics and gynaecology, for example. “Employing the services of the type of people that Trusts themselves would employ has been a key factor,” commented Simon Rasalingham. “Users are able to view the CVs of the consultant radiologists who provide the service to ensure they are confident in the quality of the reporting. If a Trust does not wish to use the services of a particular consultant they have the option of selecting a preferred individual.” Simon Rasalingham pointed out that delivering radiology services seven days a week, including out of hours, with only five or six consultants in local hospitals, is often difficult. However, in some areas, Trusts also experience difficulties in recruiting consultants. “We can ‘plug the gap’ in these instances. Furthermore, Trusts do not have to employ extra staff to cover seasonal peaks in demand,” he commented. This proved to be the case at a Trust based in Wales. While three radiology consultants were employed on a permanent basis, they found they were “swamped” with patients during the holiday season as the local area was a popular tourist destination. The Trust decided to use teleradiology reporting to provide flexible capacity during times of high demand. “As the Trust only pays for the service when they use it, this was considered to be a more cost-effective approach,” Simon Rasalingham continued.