سازش و هزینه های پنهان در مورد برون سپاری Teleradiological
Teleradiological outsourcing can be considered part of the Bcommoditization^ of radiology [1]. Teleradiology may solve some problems relating to resources or cost, but the effects of reducing the radiologist’s role to simple provision of an interpretive report are complex. In the current issue of European Radiology, Graham and colleagues [2] report a single-centre UK survey of referring clinicians’ perspectives regarding outsourced radiology reporting. Disparities were found between in-house and externally-sourced reports, related mainly to issues of trust of outsourced reports. Direct discussion of queries with in-house radiologists was considered useful in the vast majority of situations, whereas only a small minority of referrers contacted external reporting radiologists with queries. An ESR survey in 2016 found that outsourcing is practised to some degree in 70.8% of ESR National Member countries [3]. One reason for the growth in outsourcing is a major discordance between rapidly increasing imaging workload and much slower growth in radiologist workforce. This imbalance may be due to a variety of factors such as a lack of flexibility in central governmental planning, reimbursement regulations, professional incentives in national health systems, or increasingly strict regulations of working hours and compensations [4]. Between 2010 and 2016, the numbers of CT and MR studies performed in England increased by over 30%, with only an increase of 3% in consultant radiologist numbers. Unsurprisingly, the proportion of UK radiology departments outsourcing some reporting to external providers (usually within the private sector) increased from 33 to 78% in the same period [2]. This discordance between workforce and workload growth is mirrored in many countries. Inevitably, many healthcare systems lag substantially behind demand for services, leading to the need to implement practices that may be viewed as imperfect, but represent pragmatic solutions to a demand-capacity mismatch. There are other drivers of increasing radiology outsourcing, not all based on poor planning or inadequacy of resources. Provision of on-call services from a central hub covering a number of institutions, utilising the availability of subspecialist opinions from a different centre and provision of specialist radiology interpretations for remote locations with insufficient activity to merit on-site radiologist presence are all good reasons for remote reporting and use of teleradiology [5]. Teleradiological outsourcing carries the potential for some compromises in quality of patient care. If the off-site radiologist does not have access to a patient’s prior imaging studies, the relevance and quality of reports generated will diminish. The ESR 2016 survey confirmed that offsite access to PACS/ RIS systems is definitely available in only 48.9% of circumstances, and definitely not available in 15.7%. Other major disadvantages of off-site reporting included insufficient communication with the off-site radiologist, and their unavailability to participate in multidisciplinary meetings (MDMs) [3]. In a recent paper on value-based radiology, the ESR has highlighted that the ease of availability of radiologists for direct consultations with referrers is one of many possible measures of radiology’s contribution of value contributed to patient care [6]. MDMs have grown as contributors to radiologists’ workload in recent years; this is laudable, recognising the centrality of our specialty to patient care, but has introduced challenges. While many referrers require little preparatory work before MDMs, review of available imaging (often from multiple institutions) is time-consuming for a radiologist. Preparation for a 1-hour MDM often requires about 2 hours of a radiologist’s time [7].