Friday, July 13, 2007

OOPS, I Did It Again....
Dalai's Laws of PACS Published!

I'm published again! has graciously posted a revised and expanded version of Dalai's Laws of PACS, accessible here. I guess it was a slow news-day.

I'm waiting for the, um, comments from my friends in IT.

Tuesday, July 10, 2007

Teleradiology Spam

You have to love spam, especially when it comes from unexpected sources. Today, I received this little opus from Dr. Ashish Dhawad, trying to convince me of the joys of using his "Telediagnosys" service operating from India:


TeleDiagnosys is a premier provider of offsite Teleradiology/Nighthawk Reporting Services from American Board Certified radiologists.

If you are a Imaging Center / Hospital - We can provide you with STAT and Routine reports 24 X 7 leading to cost reduction.

If you are a radiology group - We can take care of any additional / overflow work that you cannot handle, increasing your productivity

Our advantages -

1) Attractive Pricing - USD 8 for X Ray, USD 35 for CT and USD 45 for MR

2) Reporting by American board certified radiologists with State licenses and malpractice insurance

3) 24 X 7 X 365 coverage

4) Turnaround time of 30 mins for STAT and 12 - 24 hours for routine studies

5) Fully transcribed reports in required formats can be emailed/faxed at no extra cost

6) US telephone number for emergency calls

7) No minimum guarantees, No Setup fees

8) No PACS to send images??? We can provide you with a complete solution

More details are available on our website -

In case you need any more information including references or trials please contact me on or US Toll Free 800-490-0509.

With Best Regards,
Dr Ashish Dhawad
Chief Operating Officer
Telediagnosys Pvt Ltd
US Tel no: 800-490-0509
US Fax no: 703-991-1426

I went to the website earlier this morning, and it was quite nicely done, with Adobe Flash titles and the like. However, this afternoon, I find the website is down, perhaps due to much traffic or angry complaints spawned by the spam email advertisement. But, the Google-cached version tells us:

TeleDiagnosys Services Pvt. Ltd. is India's pioneering and premier provider of offsite Teleradiology Reporting Services from experienced and eminent doctors with fast turnaround times. We partner with diagnostic centers, individual radiologists, hospitals, medical groups and other entities requiring remote, off-site reading of diagnostic imaging studies. Using a comprehensive approach, we provide the expertise to configure, install and maintain the digital technology necessary to implement remote reading of imaging studies. We also link our clients with well-qualified & well-trained radiologists who are available to provide remote reading and interpretation services. We have the necessary infrastructure and expertise available to provide round the clock, reliable and efficient service to our clients.

I had thought this sort of thing had not caught on in the US, but in looking around the web, there are dozens of companies in India offering similar telerad services. Most claim to use Board Certified U.S. trained radiologists. Perhaps they do. Rather hard to prove from here, isn't it? Does anyone really know who is on the other end of their teleradiology or night-hawk service? Have you actually met any of them?

No matter. What these companies are selling is cheap, available radiology. Whether all of their readers are rads from Haavaard, or if they are all students at the Bangalore High School for Health Sciences, what attracts their US users is mainly the cost savings. I can tell you that Telediagnosys' prices are lower than many out there, and if you look around, you can do even better.

I don't know about you, but to me, this lowest-bidder concept of Radiology is not a particularly comforting thought. Would you base your choice of a surgeon on who will cut on you for the lowest price? Well, as it turns out, lots of folks would do exactly that. There is a new trend of "medical tourism" that inspires those who cannot afford treatment here in the US to go abroad, often to India. This article from the Providence (RI) Journal tells the story:

The first such travelers were looking for cut-rate cosmetic surgery. But today, many include people seeking necessary procedures, including heart bypasses, hip and knee replacements, cancer treatment and dental work. They are finding clean, well-equipped, even luxurious hospitals that meet accreditation standards and often are staffed by American-trained doctors. Catering to an international clientele, they provide procedures at roughly one-tenth to one-quarter of the cost in an American hospital.

Ouch. American medicine has somehow priced itself out of the market. Where did we go wrong? I have to think it is some combination of greed and fear, relinquishing control of what is still (but just barely) the best health-care system in the world to the government, and to third-party payers. The greed factor is obvious, when one looks at self-referral, and I won't bore you with that discussion again. Fear of loss of revenue is certainly a similar emotion that has driven costs up, and led physicians into areas not their own, such as (surprise) imaging, which leads to self-referral. I'm not certain if the government or the insurance company, or the uneasy symbiosis we all share with them has driven the whole system off the edge. What I do know is that costs are exploding, and if we don't fix it, our friends in Washington and Bangalore will do it for us.

Even as a physician, I'm not immune to the ravages of costly medical care. My son just had some diagnostic procedures (EGD, colonoscopy, small-bowel follow-through) for which the hospital bill alone (haven't got the physician's bills yet) was $10,000. Since his doc is in another state, and out of our insurance company's little local network, I might just have to eat that cost. I would not have taken him to India, but for someone who had no good choice, spending, say, $3000, including the trip to India and a little sight-seeing, would have been a very viable alternative.

All of us involved in the U.S. Healthcare field have to do something about this stuff, and quickly. Otherwise, Hillary-Care AND Bangalore General are going to be our future. Namaste!

Thursday, July 05, 2007

Is Speech Recognition a Kickback???

Image credit:

I wish I had come up with this myself, but instead, this comes from one of the many brilliant folks that peruse this blog and otherwise correspond with yours truly. My colleague has suffered through a forced implementation of SR, and notes the following:

Do you know if anyone has ever tried to construe the adoption of voice recognition technology as a kickback to the hospital in violation of federal antikickback statutes? It would seem to me that transcription services are traditionally provided for free by the hospital to hospital-based physicians (except of course the cardiologists and administrators don’t have to use it!) and that the cost of transcription is covered by the technical fee collected by the hospital. In essence we are providing free services to the hospital in return for a hospital contract. I wonder what the lawyers would say.

So do I.