Each year I have the opportunity to spend a few days attending a continuing medical education course on advanced computed tomography (CT) organized by Elliot Fishman of the Department of Radiology. It is a fabulous course and is about the closest I get to practicing radiology these days, so it gives me an opportunity to get a snapshot of what's going on in my former medical specialty. Not only are the advances in imaging technology spectacular, but the pace of innovation is continuing.
Perhaps in another column I'll have an opportunity to talk about the impact of imaging technology on medicine and health care overall. But in one of the hallway conversations with several radiologists during the meeting, I stumbled on a development in radiology that was even more startling to me than these medical advances: "nighthawks."
Radiologists are responsible for providing prompt emergency imaging services 24/7. With the introduction of multidetector CT scanners, allowing rapid imaging of large areas of the patient, emergency radiology volumes have increased exponentially. The effective use of CT has been shown to decrease hospital admissions by 28 percent. It has changed the surgical management of ER patients by 40 percent, so that, from an outcomes perspective, the effective deployment of CT appears to be substantiated.
Simultaneous with an increase in after-hours exams, the workload per radiologist during daytime hours has also increased, not so much due to total imaging volume, but primarily because of workforce shortages. Over the past three years, many radiology groups covering small and even mid-size hospitals have found it difficult to provide effective 24-hour coverage.
Enter the “nighthawks,” a generic moniker applied to groups of American-trained diagnostic radiologists located in India and Australia who provide immediate diagnostic interpretation of CT images obtained in emergency rooms after hours. These images are shipped in digital form via broadband networks overseas from U.S. hospitals, enabled by a set of open digital imaging standards developed by the American College of Radiology more than a decade ago.
One of the largest of these groups is NightHawk Radiology Services based with five radiologists and 10 support staff in Australia, with an administrative office in Coeur d'Alene, Idaho. These physicians are certified by the American Board of Radiology and licensed in the particular state of the hospital locale where the CT images originate.
It has been argued that the use of global outsourcing for night-time emergency imaging studies is cost-efficient and improves patient care. Because the nighthawks collect imaging exams from multiple hospitals, each radiologist can be fully occupied during the nightshift, as it were. And because the nightshift is really the dayshift with the 12-hour time difference between Asia and the United States, the radiologists are not subject to fatigue resulting from long on-call hours or upsetting their diurnal biologic clocks. And finally, accuracy of image interpretation is correlated, up to a point, with the volume of cases, so these nighthawks are able to keep a keen eye with a large volume of emergency CT studies to review.
Nighthawk radiologists outsourcing imaging to Australia? What’s next? Nintendo surgeons in Thailand performing robotically controlled laparoscopic surgery in Baltimore? It sounds farfetched, I know, but remember: Hopkins surgeons actually performed robotic kidney surgery in Thailand via telemedicine a few years ago.
Nighthawks: Global Outsourcing Comes to Radiology
Each year I have the opportunity to spend a few days attending a continuing medical education course on advanced computed tomography (CT) organized by Elliot Fishman of the Department of Radiology. It is a fabulous course and is about the closest I get to practicing radiology these days, so it gives me an opportunity to get a snapshot of what's going on in my former medical specialty. Not only are the advances in imaging technology spectacular, but the pace of innovation is continuing.
Perhaps in another column I'll have an opportunity to talk about the impact of imaging technology on medicine and health care overall. But in one of the hallway conversations with several radiologists during the meeting, I stumbled on a development in radiology that was even more startling to me than these medical advances: "nighthawks."
Radiologists are responsible for providing prompt emergency imaging services 24/7. With the introduction of multidetector CT scanners, allowing rapid imaging of large areas of the patient, emergency radiology volumes have increased exponentially. The effective use of CT has been shown to decrease hospital admissions by 28 percent. It has changed the surgical management of ER patients by 40 percent, so that, from an outcomes perspective, the effective deployment of CT appears to be substantiated.
Simultaneous with an increase in after-hours exams, the workload per radiologist during daytime hours has also increased, not so much due to total imaging volume, but primarily because of workforce shortages. Over the past three years, many radiology groups covering small and even mid-size hospitals have found it difficult to provide effective 24-hour coverage.
Enter the “nighthawks,” a generic moniker applied to groups of American-trained diagnostic radiologists located in India and Australia who provide immediate diagnostic interpretation of CT images obtained in emergency rooms after hours. These images are shipped in digital form via broadband networks overseas from U.S. hospitals, enabled by a set of open digital imaging standards developed by the American College of Radiology more than a decade ago.
One of the largest of these groups is NightHawk Radiology Services based with five radiologists and 10 support staff in Australia, with an administrative office in Coeur d'Alene, Idaho. These physicians are certified by the American Board of Radiology and licensed in the particular state of the hospital locale where the CT images originate.
It has been argued that the use of global outsourcing for night-time emergency imaging studies is cost-efficient and improves patient care. Because the nighthawks collect imaging exams from multiple hospitals, each radiologist can be fully occupied during the nightshift, as it were. And because the nightshift is really the dayshift with the 12-hour time difference between Asia and the United States, the radiologists are not subject to fatigue resulting from long on-call hours or upsetting their diurnal biologic clocks. And finally, accuracy of image interpretation is correlated, up to a point, with the volume of cases, so these nighthawks are able to keep a keen eye with a large volume of emergency CT studies to review.
Nighthawk radiologists outsourcing imaging to Australia? What’s next? Nintendo surgeons in Thailand performing robotically controlled laparoscopic surgery in Baltimore? It sounds farfetched, I know, but remember: Hopkins surgeons actually performed robotic kidney surgery in Thailand via telemedicine a few years ago.
