PACS Abuse

An observant AuntMinnie poster found this lovely little item from the Cleveland Clinic:

Sub-specialized medical care is the standard of care today. Only an orthopaedic surgeon would perform an anterior cruciate ligament reconstruction, and only a neurosurgeon would remove a brain tumor. It is still common however, for general radiologists with no sub-specialized training to interpret the images that lead to these procedures.

This lack of sub-specialized radiology interpretations previously was necessary because of the need to have a radiologist in close proximity to the imaging center where procedures were performed. Now, through the use of new developments in information technology systems, Cleveland Clinic’s Department of e-Radiology offers sub-specialized radiology interpretations to referring physicians anywhere in the country. Better quality of medicine is possible through the use of interpretations and protocols developed and performed by Cleveland Clinic sub-specialty-trained academic radiologists.

A number of factors made growth in e-Radiology possible, most notably the imaging explosion of the past few years, which is expected to grow at the rate of 8% to 10% per year into the foreseeable future. Two additional factors are the national shortage of radiologists and the rapid developments in information technology that have allowed image interpretation to occur independent of geographical restrictions.
A large portion of the imaging growth is in outpatient imaging, with an estimated half billion outpatient imaging examinations projected to be performed in 2008. In 2002, 84% of magnetic resonance, 64% of computed tomography and 98% of positron emission tomography scans were done on an outpatient basis, and these percentages are expected to continue to increase over the next ten years. Only 67% of imaging is currently done in hospitals, down from 95% in 1980. Outpatient imaging accounted for $14.8 billion in Medicare revenue for hospitals in 2001 and generated $3 billion in profits.

Radiologist shortages have been significantly resolved through the use of teleradiology. Over the past few years, dramatic advances in information technology and the availability of technology in cost-effective pricing, high-speed telecommunication lines have removed almost all geographic restrictions in interpreting images. It is now possible to send digital images securely over the Internet on a virtually real-time basis to radiologists located anywhere such telecommunication lines exist. The radiologist is then able to dictate the images using voice recognition software so that the images and report are available online for the referring physician within minutes via a HIPAA-compliant Web browser.

This is just plain disturbing on several levels. First off, the piece insults general radiologists, who are for the most part quite good at what they do. Will a super-specialized rad be better for the esoterica of his specialization? Probably, but on a day-to-day and head-to-head comparison, I thing we would find that the generalist can hold his own. I am very distressed in this regard by the use of the term "standard of care." This is a legal term, and the Cleveland Clinic is basically saying that the generalists out in the boonies are beneath that standard and are therefore committing malpractice!

Secondly, there is note of the explosion of imaging, but no decrying the self-referral that is inherant in much of the "outpatient" studies that would be included in this designation.

Finally, the anonymous author of this piece is using the advent of my beloved PACS (technically teleradiology, but they have become essentially one in the same these days) to facilitate and even justify their desire to swoop in and snatch exams away from the lowly generalists.

I always advise my gentle readers to "follow the money," and here, this is not a difficult task. Our friend at Cleveland Clinic is telling you that the lowly generalists out in the boonies can't do an adequate job, but in years past, you had to settle for this because they were the only game in town. But wait, we now have PACS, and so we are finally able to help you poor downtrodden masses who have the bad fortune to live somewhere other than Cleveland. Just sign this reading contract, and pay us our fee, and we'll all live happily ever after.

This drivel should be beneath an institution with the stature the Cleveland Clinic. It is an abuse of PACS technology to generate revenue that really belongs elsewhere. AND, it encourages self-referral in a round-about way. I do hope everyone at the Cleveland Clinic will enjoy Hillary-Care which they are helping to bring about with their greedy approach to radiology and medicine.