November 1, 2011

We are continuing our discussion from last time, reviewing the risks and benefits of an increasingly popular practice: teleradiology. By outsourcing the interpretation of X-rays, CAT scans and other imaging tests, a small-town hospital miles away from Portland can receive test results quickly without the expense of a staff radiologist.

As we said in our last post, the lack of direct communication between the radiologist and the treating physician can have dire results for the patient. According to a study in Radiology magazine, almost 10 percent of radiology errors resulted in injury to the patient.

The system seems ripe for miscommunication, and at least one study, in the Annals of Family Medicine, found that errors in communication precipitated 2 out of 3 medical mistakes. Again, health care professionals have to ask themselves if outsourcing is benefitting the patient more than it’s benefitting the bottom line.

In a strictly electronic exchange of information, something is bound to get lost — especially when there is little opportunity for back-and-forth between the professionals. It’s hard not to imagine that some crucial fact could be omitted or just lost. A system glitch could delay delivery of the report, so it’s not received until after the patient has been discharged. And, without discussion, there may be no context, no point of reference for the radiologist.

Sadly, these examples aren’t entirely conjecture. In one case, a patient went in with chest pains. His doctors ordered a CAT scan that, in turn, was read by a teleradiologist. The patient had told his doctors that the pains started after eating, but the doctors did not pass the information on to the teleradiologist. Based on the information he had, he looked at the chest, missing the small tear in the esophagus caused by the food. The patient died because of that missed diagnosis.

Critics of teleradiology ask another question: Who’s reading the tests, really?

We’ll continue this in our next post.

Source: MSNBC, “Is a doctor reading your X-rays? Maybe not,” Katherine Eban, Oct. 26, 2011


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