In the teleradiology services I am associated with we are getting a large number of calls from veterinarians that are upset with their current teleradiology provider*. This is great for our business but distressing to me as veterinarians who are unhappy with any radiologist does not help my profession.
The following are the 10 primary reasons why people call and tell us that they are unhappy with their teleradiology provider. Some of these reasons are because of unreal veterinarian expectations and some are because of the teleradiology service. When possible, I offer ideas about what you can do to prevent this from happening and ways to work with your radiologist find a solution rather than jumping from provider to provider.
1. Know who is reading your films: Teleradiology is a service. It is not a widget. The quality of the service depends on the clinician interpreting the radiographs. Experience counts. Know who is reading your films. Some services allow residents, non-boarded radiologists, and other “specialists” interpret radiographs. With all things, you get what you pay for. Personally knowing your radiologist is helpful as it adds to personalized attention (i.e. when you call for additional information about a request).
2. Shop wisely: Choosing your teleradiology provider “because I met them at a show” or “they came with my digital equipment” appears not to be the best selection method. Teleradiology services are different and depending on your expectations you might find that one service is better than another for your situation. Some services are very personalized but cost a little more; while others crank out reports on the cheap. You did your research for your digital machine. Do the same for your teleradiology provider.
3. Speed Kills: A fast turnaround time is important but is teleradiology a race? How is the food at your fast food restaurant? Fast food will kill you. Fast teleradiology may kill your client’s pets. A 2-4 hour turnaround time is fairly standard these days. Faster than that seems to be the point of diminishing returns.
4. A lack of speed also kills: Gone are the days of 3 day turnaround times. If your provider is not offering you the turnaround time necessary to run your practice it is time to look elsewhere. In the past, it took several days because you had to mail films. At the top end, a 24 hour turnaround is not too much to ask these days.
5. Wishy Washy Reports Part 1: Don’t underestimate the value of a long term relationship with your radiologists. When we know you and we are comfortable with you, we will go out on a limb for you and tell you what we really think. When we don’t know you, you get a laundry list of possibilities. Wishy washy reports result when you jump from provider to provider.
6. Wishy Washy reports Part 2: Wishy washy ultrasound reports are a special case. We hear about wishy washy ultrasound reports all the time. I know that your ultrasound vendor told you that you could make all of this money on your ultrasound…and you could learn ultrasound on 2 normal beagles on a weekend short course…and all you needed to do was send your images off for review. Unfortunately, this is a fantasy. Ultrasound takes hours and hours to learn. Ultimately, ultrasound teleradiology is 90% dependent on the user obtaining the images and 10% dependent on the person interpreting the images. Don’t expect too much from teleultrasound as a screening test. If you get a wishy washy report, many times that means the interpreter has no idea what you sent to them but still wants to charge for their time. Many teleradiologists do not accept ultrasound studies.
7. Your local radiologist is on the road and can’t read your films: It is great that you have an association with your radiologist. Unfortunately, many mobile radiologists are not able to provide the timely turnaround time you need for day to day cases. This, however, does not mean that you need to abandon your local radiologist. Don’t cheat on them and go to a teleradiology provider behind their back. Have an open discussion with them about the situation. In most cases, you can set up an “overflow” teleradiology workflow so a teleradiology service can read your urgent cases and you can continue your relationship with your local (mobile) radiologist. If your mobile radiologist is not configured to receive images, there are several services that can assist them.
8. Read the fine print: Too many people call us asking to get out of contracts with their teleradiology providers. If you want to sign your life away – call the mafia. At least you will get protection.
9: Communication, communication, communication: Radiologists are not oracles, seers, or mythical creatures that know and see all. As such, our reports are not handed down from the heavens. If you ever have a question on a report, call your radiologist. If you have a question that was not answered or you question an interpretation contact the radiologist. Teleradiology is a two way street. The more communication you have the better the relationship and the more you will get out of your teleradiology experience.
10: Garbage in = Garbage out: You have heard this before. Be sure to send a good signalment and history with your images. Playing games with the request in order to obtain an interpretation that is unbiased by the clinical history is unwise. Radiologists count on the clinical history to constrain what might otherwise be an exhaustive list of differentials and does not provide for an optimized search given the vast number of images that radiologists are provided each day. Be sure to include any specific questions you have for the radiologists. Failing to provide an adequate history will also result in wishy washy reports.
Bottom line: Choosing a teleradiology provider is as important as choosing your digital radiography system. Most veterinarians who are unhappy with their provider either have unrealistic expectations or chose a teleradiology provider that did not provide an adequate service.
** Full Disclosure - This article was difficult for me to write. I generally try to remain objective with my commentary. The nature of this piece is such that I cannot be entirely objective. As such, I would like to disclose my associations with the Sight Hound Radiology Group (member and part owner) and the Shadowsmiths Imaging Consultants Group (member and part owner).