Canadian Venture Shrinks Waiting Times for Diagnostic Services
Monday, February 2, 2009
Byline: Tom Blackwell
Source: National Post
Her two young children snugly in bed, Dr. Nina Singh pads down to her home office, powers up a $20,000 work station and is soon helping to save lives — thousands of kilometres away.
The radiologist from Burlington, Ont., is part of a new Canadian company that uses, among others, physicians working from home or even far-flung foreign getaways to offer long-distance analysis of diagnostic imaging.
Owners of the controversial venture say they have harnessed high technology and under-employed talent in a way that should be able to shrink chronic waiting lists for MRIs, CT scans and other such examinations.
“There are capacities in the system that are going untapped,” said Ian Maynard, one of the founders of Realtime Radiology along with three radiologists.
“We must be able to come up with a model that would allow radiologists to have a life, but better serve Canadians.”
Critics, though, question the quality of radiology provided by faraway strangers, and lament the fact hospitals are buying the service from a for-profit operation.
Specialists working for the company, launched last month, analyze CT scans, MRI tests and X-rays sent to them by e-mail, then report back to the hospitals that produced the images, sometimes within minutes.
Many of the doctors signed up by the firm– which is competing head-to-head with similar “teleradiology” companies based in India and elsewhere — had retired or decided to work part-time, the firm says.
Their work should help fill chronic gaps in radiology service at under-staffed rural hospitals, and spare all radiologists the increasing demands of night and weekend work, Mr. Maynard said.
Dr. Singh, 36, had earlier decided to cut her practice at Hamilton’s McMaster Children’s Hospital to two days a week so she could spend more time with her son and daughter, age three and two. Now she says she is putting in hours that otherwise would have been lost to the health care system, from the comfort of her home.
Dr. David Vickar, president of the Canadian Association of Radiologists, is skeptical.
Analysis of diagnostic images is best delivered by a specialist at the site of the examination, or at least by someone nearby who has a long-standing relationship with the doctors ordering the scans, he said.
Teleradiology may have a role where a hospital cannot find a local radiologist to fill all its needs quickly, but ought to be a last resort, said the Edmonton-based doctor.
“This should occur under exceptional circumstances,” he said. “This is not something that should be used simply for the convenience of the physician.”
As reported earlier in the National Post, a teleradiology company in India is already providing such service to a Canadian clinic and is on the verge of signing other clients here. There are also smaller, regional Canadian outfits, but Realtime is the first national, large-scale venture, Mr. Maynard said.
Among the 20 radiologists signed up so far are two who are moving to Salzburg, Austria, and have agreed to work from there, and others who are settling in Australia and New Zealand, all for “lifestyle” reasons.
With the time-zone difference, they will be ideally situated to do night work in Canada, Mr. Maynard said. Others are fitting in the Realtime jobs during downtime at their regular hospital practices.
The company’s first clients include a rural hospital that asked not to be identified, and the Huron-Perth Health Care Alliance, a four-hospital group in Southern Ontario. Over Christmas, Realtime replaced vacationing radiologists at the isolated rural facility, with one administrator calling the experiment “very successful.”
Dr. Singh said she developed a close relationship with the hospital’s physicians, despite her initial skepticism about teleradiology and the fact they were halfway across the country.
“It really doesn’t make a difference where you are,” the radiologist said. “I pick up the phone and call the site and say, ‘You know, your patient has a bowel obstruction.’ I’m having a conversation with the referring physician and I could have been sitting in the same hospital and on a different floor.”
But one advocate for public health care said such private companies inevitably end up costing the system more money, if not by charging higher fees than by generating more, unnecessary work. Plus, some of that taxpayers’ money is being funnelled into profit, said Mike McBane, of the union-supported Healthcare Coalition of Canada.
“If you bring in those kind of market distortions into the health care system, it’s going to cost you more and you get less for the money you’re spending,” he said.
Mr. Maynard, however, maintained that hospitals will be charged only what they would receive from provincial governments for radiology service. And the company is working only through the hospitals’ own chief radiologists, he said.
Dr. Ken MacDonnell, 80, of Blind Bay, B. C., was on the verge of taking a long-delayed retirement before agreeing to be part of the Realtime service. With a workstation in his basement office, he is analyzing X-rays, then dictating his findings into a computer, which uses voice-recognition software to translate the words into a written report. It can all be done in an average of 20 minutes.
“If you’re sitting there, they just pop up and you click on the name and the film pops up and you start looking at it,” he said. “This gives me another lease on life…. I think it’s a good way to bring [radiologists] back into the workforce.”