Outsourcing is hot; don’t get burned

 I like this article on tele-radiology, it highlight several points that has been floating on my mind (I really need to find a way to manufacture time so I can write articles).
Teleradiology and the outsourcing of imaging studies continue to proliferate, but that doesn’t mean they are always the right answer. Questions often arise over risks and rewards related to the practice, and how those risks and rewards vary among different practice models.

“Outsourcing is a topic we [radiologists] need to understand well if we are to make informed choices about the future of radiology, our practices, and our own careers,” said Dr. Richard B. Gunderman, an associate professor of radiology at Indiana University.

Many hospital operations have been outsourced for years, including billing, payroll, cafeteria, laundry, housekeeping, and medical transcription. More recently, hospitals and imaging clinics have begun outsourcing after-hours interpretations. As of 2005, 20% of all U.S. hospitals were using after-hours radiology services.

Gunderman recently published an outsourcing primer that explores the nature of outsourcing and also defines and discusses the subtle distinctions between outsourcing, offshoring, offshore outsourcing, and inshoring (JACR 2008;5[8]:893-899).

His paper includes guidelines for radiology practices contemplating outsourcing, including an examination of outsourcing risks and risk mitigation. Risks are presented in the context of a hypothetical rural hospital with two general radiologists who wish to outsource neuroradiology, mammography, and overnight emergency studies.

Risks include outsourcing the wrong studies, outsourcing too many studies, choosing the wrong vendor, legal factors, and resistance from in-house physicians.

Risk mitigation involves:

  • carefully reviewing the purpose of the outsourcing venture and specifically designating which studies are outsource candidates;  
  • performing dry runs to see which imaging studies need to be outsourced and how many are likely to be involved;  
  • seeking references for potential vendors and evaluating their approaches to workflow, billing, malpractice, and performance standards; and  
  • verifying that potential vendors are economically stable and pose no legal risks.

The most costly aspects of outsourcing are not financial in nature, Gunderman said.

“As an increasing percentage of radiologic services are outsourced, radiology itself may undergo undesirable changes,” he said.

One such change is the loss of patient contact and the opportunity to build patient-physician relationships. A related problem concerns loss of continuity of care. A patient’s ongoing imaging studies may be interpreted by different radiologists, none of whom sees the process evolve over time.

Outsourcing and related offshoring, offshore outsourcing, and inshoring practices play important roles in the evolving global marketplace, and often promote valuable competition and innovation, Gunderman said.

“Yet outsourcing per se is not necessarily a good thing, and in some cases, its risks and costs may outweigh its benefits,” he said. “Radiologists need to understand these in both the short and the long term.”

Food for thought mates 🙂



  1. Roentgen says:

    I find it comical that an academic radiologist is pontificating about how he thinks outsourcing radiology should head. I have news for him: Outsourcing of radiology will continue despite what he or any other radiologists think. His opinions or “research” on the matter mean very little. The economics of the industry will determine what unfolds in the future, and as history as proven time and time again, the invisible hand will reign supreme. My prediction? 10 years from now 90% of all diagnostic radiology in the private sector will be outsourced. Take that to the bank.

  2. Adam Chee says:

    Hi “Roentgen”,

    To a certain level, I agree with you. Outsourcing in the world of radiology for reporting is inevitable, it will come, the question is when (10 years sounds too long in my opinion).

    But Dr. Gunderman’s article does raise relevant thoughts / points / opinions that is on the back of everyone else’s head, we all know its relevant or have experience it ourselves (to a certain extent).

    Having been working long enough in the world of IT too, I’ve gone through the IT outsourcing craze which has now become a part of the industry’s ‘fact of life’. Granted that there are still (tons of) irks to iron out but lets face it, outsourcing is the new business model of IT Technology Management.

    Ok, back to context. The experience learned from the early stages of radiology reporting outsourcing and outsourcing from the IT industry (after all, teleradiology is heavily IT dependent) can bring forth wealth of information that can help the healthcare industry better rollout tele-medicine and the relevant outsourcing.

    This is a huge topic on its own so I’ll just leave it here for now but with this, I’d like to invite you to read and comment on this article (just to pick your brains)

    Click to access moving-on-to-teleradiology.pdf


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