By: Seth Hays for Medtech1Late at night in hospitals across the U.S., doctors in India, Switzerland, Israel and Australia are interpreting medical images from American patients via the Internet in a healthcare outsourcing movement resulting from a nationwide shortage of radiologists. This trend, said Dr. Robert M. Wachter in a February article for the New England Journal of Medicine, has profound implications for the future of healthcare policy and practice.
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Facts about Medical Outsourcing
Several hundred U.S. hospitals use “nighthawking” services or nighttime international teleradiology services.
The FDA through its Center for Devices and Radiological Health (CDRH) regulates the safety and effectiveness of telemedicine devices.
20,000 Californians have healthcare plans that cost 40-50 percent less because medical care is outsourced to Mexico.
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For hospitals that struggle with a lack of radiologists, companies like Teleradiology Solutions, NightHawk Radiology Services and Virtual Radiologic offer the expertise of licensed healthcare professionals overseas around the clock. Frequently these services are rendered at night, while American radiologists are sleeping and their counterparts in other areas of the world are awake. But as healthcare costs keep rising, the market for these cheaper and often more flexible services increases, sparking concern about quality and the protection of healthcare jobs in the U.S.
Chief Radiologist at the Virginia Hospital Center, Russell McWey, whose hospital uses one of the teleradiology services, said there have been no major inaccuracies. "We'll find little things here and there, the same way we find little discrepancies amongst our own radiologists."
But fears still remain, especially concerning a practice called "ghosting," when a qualified professional approves the interpretations made by a potentially unqualified individual without adequate review and scrutiny. In 2003, an Indian technology firm, Wipro, used Indian radiologists who were not certified in the U.S., but subsequently halted the practice.
Today, however, all current teleradiology services say they adhere to the American College of Radiology’s recommendation that all radiologists performing distance reading of medical images be board-certified and carry licenses and malpractice coverage in the state where the image was obtained, as well as have appropriate credentials at the source facility.
Dr. Wachter believes outsourcing has great potential to improve the quality of healthcare providing patients access to specialized care they wouldn’t normally have available to them locally. This competition might also provide an incentive for local physicians to increase their quality of care.
But with the potential for low-wage foreign radiologists to take work away from domestic ones, Dr. Wachter predicts that the people and institutions harmed by outsourcing will not take it sitting down and use legislation, licensure and reimbursement regulations to protect their industries.
Radiology is not the only area to experience outsourcing. In response to labor shortages as well, intensive care units are beginning to see off-site intensivists monitoring patients by closed-circuit television and streams of physiological data, sometimes entering orders directly into the hospital’s computer system.
Healthcare outsourcing takes on many forms, from medical tourism - a practice where patients fly to other countries under tourist visas for medical treatment - to the practice some southern California HMOs have requiring members to seek cheaper services in Mexico.
Outsourcing will continue to grow and Dr. Wachter predicts a flurry of initiatives to protect the status quo. In the meantime he suggests that this growth will require the rapid development of thoughtful legal and quality standards.
