More than half of all hospitals now send their X-rays, CT scans, MRIs and other images to outsourcing companies who then forward the images to individual radiologists, according to Jonathan Clark, assistant professor of health policy and administration, Penn State. However the study, which was done in collaboration with the Harvard Business School and the University of North Carolina at Chapel Hill and published in the journal Organization Science, notes that this widespread use of "teleradiology" services may backfire if the experience gained by reading for many hospitals turns out to be less valuable than repeatedly reading images for just a few hospitals.
A release from Penn State quotes Clark as saying, "There is debate out there about whether or not we should be outsourcing this kind of work. Some say that one CT is the same as another, so it doesn't really matter if the CT is coming from Hospital A or Hospital B; what matters is that the person reading the image has the right training and experience. The other side of the debate says that radiological images are not commodities and that the process is more nuanced than simply exchanging bits of information over the information super highway. From this perspective a radiologist's performance will improve as he or she learns the nuances of reading images from a particular hospital."
The release reports that in order to determine whether learning and performance improvement are customer specific, the researchers examined the experience and productivity of 97 radiologists reading more than 2.7 million images from 1,431 hospitals. The team found that the radiologists' prior experience with repeat customers had a greater effect on performance than his or her overall experience reading the same type of image for other customers. Paradoxically, though, the researchers also found that the customer-specific knowledge gained by individual radiologists is aided by the variety of customers with whom a radiologist has experience.
The implication is "not that we shouldn't outsource," Clark said. "Rather, our findings provide guidance to outsourcers in terms of how they might think about designing the work of their radiologists to maximize productivity. For new customers, an outsourcing firm may wish to keep individual providers relatively more focused on serving a specific customer. As organizational experience accrues with a specific customer, however, such dedication becomes less critical . . . Our findings may be particularly important, given the growing use of telemedicine and the uncertainty associated with delivering health care in a virtual way. In the setting we studied, teleradiologists are often reading emergency cases, where speed and productivity can be critical, so it is important for outsourcing radiology firms to understand how they might design their operations to improve performance and ensure a rapid response for each customer."