“The time zone advantage is huge,” says Dr. Maheshwari. With the 12.5-hour time difference between the United States and India, Teleradiology Solutions’ radiologists work regular day shifts and are able to cover 10-20 hospitals simultaneously, depending on how busy their client hospitals are.
“You don’t have to have one radiologist who stays up all night to be able to read two CT scans and one X-ray, who will [then] be groggy the next morning for his [or her] regular day shift,” she says. It makes a lot of sense from the standpoint of human resource efficiency to not waste several nights of several doctors covering multiple hospitals.” Dr. Maheshwari reports that American hospital staff are often pleasantly surprised to find a “cheerful, awake” radiologist on the other end of the phone line.
Despite these benefits, however, Dr. Maheshwari and her colleagues have noticed a political backlash stemming from the outsourcing of U.S. jobs to Asia that colors Americans’ reactions to overseas teleradiology. In her company’s first two years, some physicians questioned the company’s level of quality and lashed out because it is located in India, reports Dr. Maheshwari.
“Our work speaks for itself,” she says. “We have not lost a client, and, in fact, our hospitals have managed to grow because they have been able to take their radiologists off the night shift, and they take on more day work.”
Like several overseas teleradiology companies, Teleradiology Solutions retains a staff of U.S.-trained radiologists and goes through the same licensing and credentialing (they are JCAHO-accredited) as American companies.
The company now has 40 U.S. hospitals as clients and includes in its client mix some remote hospitals in India and Singapore, where the Ministry of Health is experiencing a similar shortage of radiologists.
Filling an ICU Gap
Shortages of specialists—and federal mandates to improve access to care—have spurred the growth of telemedicine in remote rural areas. Wade notes that multi-hospital systems are now installing remote electronic ICU care programs, where intensivists simultaneously monitor ICU patients in several hospitals from a central location. Preliminary studies have demonstrated both improved clinical outcomes and heightened hospital performance with programs such as VISICU Inc.’s eCare Manager software, which features built-in online decision support, adverse events alerts, and outcomes tracking. One 2004 study documented a 27% reduction in severity-adjusted hospital mortality for ICU patients, a 17% reduction in ICU length of stay, and a savings of $2,150 per patient, even after accounting for initial capital outlays to install the eICU system.4
SHM President Mary Jo Gorman, MD, MBA, is now chief executive officer for Advanced ICU Care, headquartered in St. Louis, Mo. Using VISICU’s patented software platform, the new company currently contracts with two community-based Midwestern hospitals to deliver real-time intensivist rounding and decision-making support.
Saint Clare’s Hospital, located in north central Wisconsin, was opened by Ministry Health Care in October 2005 with the intention of creating a tertiary referral center, says Dr. Bailey. To be competitive in the market, the hospital needed to provide a full-service intensive care unit. He explains, “[Unfortunately,] we are in an area that is suffering from the same kind of recruitment drought in pulmonary and critical care medicine as everyone else—and ours is accentuated because we are not in a large city, and we are not a teaching hospital.”
Advanced ICU proved a good fit for addressing the hospital’s ICU needs. The hospital “went live” with eICU in January and no longer has to send patients to sister hospitals with on-site intensivist coverage, says Dr. Bailey. Saint Clare’s staff intensivist works regular day shifts, and the hospitalist group co-manages the ICU with Advanced ICU’s staff the rest of the time, providing 24/7 coverage. ICU mortality, after adjusting for Acute Physiology and Chronic Health Evaluation (APACHE) scores and other severity indices, is also below predicted numbers.