Dr. Michael Esposito – Practicing Diagnostic Radiologist; President and Founder of PACS Harmony, LLC

Radiology is a continuously expanding field, creating a shortage of radiologists to interpret the increasing volume of exams. The shortage can be attributed to various reasons but decreasing reimbursement and the fear that artificial intelligence will eventually take away jobs are among them. In the short term, it leaves practices needing to outsource exams to teleradiology providers.

There are many challenges when outsourcing your exams to a teleradiology service. The challenges can be categorized into two groups which I call “non-technical” and “technical.” Two important non-technical issues that come to mind are cost and quality. Cost has become less of an obstacle and can be readily negotiated. Over the past decade, I have noticed that reimbursements have continued to decline. Quality is harder to ensure and even the best groups can have weak links. Unfortunately, it is often months before quality issues are even detected.

Notable technical issues that have come to my attention over the span of my career are the optimal delivery of relevant prior studies and sorting measures to determine which cases are sent. These issues can derail teleradiology services or lead a group to make a decision to hire someone to cover a less desirable shift – sometimes at a large premium.

The delivery of studies to be read by teleradiologists is simple and has been successfully done for years. The harder part is the timely delivery of relevant prior exams and their reports. Nothing makes a radiologist smarter than having a patient’s prior exams and reports in their possession. Workflow management systems need to be able to filter which relevant priors will be automatically sent with each exam to be read. This will greatly improve the quality of the interpretation, especially with incidental findings. Teleradiologists tend to get paid per click and sometimes seem to be in a hurry, which risks lowering the quality of work being performed.

Determining which cases will get sent only matters if you are not sending “everything” to teleradiology services. Many groups will send overflow if they get behind or are not able to keep up with daily demand. If the latter is the case, you need a solution that allows you to choose what stays with your groups and what goes to external groups. Requirements that should be factored in when deciding what cases should be sent to teleradiologists include subspecialty, turnaround time, ordering physician, insurance, licensure and credentialing. These factors can be incredibly important to your radiology groups, both professionally and financially.

There are a few solutions that come to mind that accomplish some – but not all – of the above. At PACS Harmony, we have created a workflow orchestration engine and universal worklist that allow you to easily manage and control your cases. The comprehensive solution optimizes what cases are sent out and which teleradiologists receive them. We invite you to take a look and regain control of your teleradiology workflow.

Michael Esposito, M.D. is a practicing radiologist, two-times former group president of RIS Imaging, Inc., former Medical Director of South Florida Baptist Hospital, Baycare, and a successful entrepreneur. He attended the University of Florida for his undergraduate degree in Chemical Engineering, the University of South Florida for his Medical Degree and conducted his fellowship at Duke University. Dr. Esposito founded PACS Harmony, LLC in 2009 to develop a software solution to fill a gap in workflow at his own radiology group practice. PACS Harmony was granted U.S. patent #9,727,935 in 2018 for workflow orchestration and equitable case distribution (load balancing). Today, PACS Harmony enables intelligent workflow orchestration for leading commercial PACS and enterprise imaging portfolios.


Submit a Comment

Your email address will not be published. Required fields are marked *