Teleradiology SERVICES

Those are among the mistakes made by radiologists under contract with Radisphere, an Ohio-based national firm that signed on with Adventist Health Central Valley Network six months ago to provide imaging analysis services at hospitals in Hanford and Selma, according to Dr. Salma Khan, a radiologist who worked in Hanford under Radisphere's tenure.

Radisphere is responsible for analyzing all the X-ray, CT scans, mammograms, ultrasounds and other images taken at the hospitals. The majority are read by Radisphere radiologists electronically from locations scattered nationwide.

Adventist Health's idea was to save the hospital money and provide a wider pool of specialized radiologists to better serve patient needs and meet doctors' hopes for better care than was being offered by local providers.

But problems are starting to surface.

Khan, a mammography specialist and chief radiation safety officer during her time in Hanford, said that doctors were routinely bringing her CT scans, X-rays and other images for re-review because they didn't trust Radisphere's readings. Most of the initial Radisphere scans were being read remotely, with results being sent back digitally. Khan said she found many errors, including bone fractures that came back as normal, large tumors that were missed and, in one case, pneumonia mistakenly identified as a tumor.

Khan said there was no way to know where the radiologists viewing the images are located to contact them about discrepancies. The company has a 1-800 number to call to report issues.

"This is big. There are a lot of doctors complaining about it," Khan said.

In a written statement responding to the complaint, Adventist Health Central Valley said, "As with any partner, including previous radiology groups, we hold Radisphere accountable for quality and performance. Strict measures are in place to ensure proper oversight and patient safety and that discrepancies are handled quickly and appropriately."

Dr. Frank Gavini, a cardiologist who is chief of medicine at the three hospitals, acknowledged problems with Radisphere, but said the company is in the early stages of the contract and could till straighten things out.

"We are actively working on this problem because our reputations are at stake," said Gavini, speaking as a doctor and not for Adventist Health.

The decision to go with Radisphere was made because of dissatisfaction with the previous system, where radiologists were employed from a network of local providers. Gavini said that service wasn't as good as expected, calling it "pretty patchy." He said it spurred the switch to Radisphere, a national company that promised to duplicate the function of a community-based radiology provider and do it better.

But Gavini acknowledged growing doubts about Radisphere, saying he's not sure if choosing them was the right decision.

"We're still debating whether this group needs to be here or not," he said.

When asked about the mistakes identified by Khan, Radisphere argued in a written statement that its use of specialized, remotely located radiologists reading a high volume of images is more accurate than general radiologists reading fewer images. The company defended its record in Hanford and Selma.

"Few radiology groups have a formal quality-assurance procedure, but we are following our standard process for reporting our results to Adventist Health's administration and senior medical staff. Individual medical discrepancies are reviewed and investigated, and we remove any radiologist that fails our quality standards. But the discrepancies occurring at Adventist Health are significantly below national averages and we believe this is due to the quality of radiologists we have in our network," said Dr. Peter Franklin, chairman of radiology at Radisphere, in a written statement.

Adventist Health's decision to hire Radisphere isn't unique. It's part of a growing trend of remote-imaging analysis. But the concept is not without its detractors. Remotely done corporate "teleradiology" is the subject of a wider concern among doctors about the need for direct contact between physicians ordering the exams and radiologists doing the analysis.

Because Radisphere's idea of a centralized, mostly off-site radiology provider is a departure from the community-based model, there's a lot of debate about whether it will work, said Douglas Smith, president of health care consulting firm Barrington Lakes Group in Barrington, Ill. The company mainly represents community-based radiology practices.

Smith said he wasn't surprised to hear that the Radisphere plan has hit some snags.

"These groups like Radisphere have in the past been viewed as a supplement to a (community-based) radiology group. I think the viability of the model is yet to be fully understood," he said.

The original Radisphere concept was to have several radiologists full-time at the hospitals to supplement the off-site readings. But the company has struggled to bring full-time staff to Kings County. Khan said that by the time she left, Radisphere had only one full-time radiologist in Hanford.

It's always been tough for small rural hospitals to attract good radiologists to move to those areas, Smith said. Turning to companies like Radisphere with specialized services was seen as a way to attract more specialist doctors, he added.

But the jury's still out on whether Radisphere is going to work out.

"Are they going to have bumps along the road? I think you're seeing it," Smith said.

The reporter can be reached at 583-2432.
By Seth Nidever
Original: http://www.hanfordsentinel.com/news/local/article_0aae5108-96c1-11df-aaf2-001cc4c03286.html