Teleradialogy Outsourcing Still Cheaper and Patients Benefit

06 Mar 2006, The Straits Times

Question

Name of the Person: Dr Shoen Low Choon Seng

Teleradialogy Outsourcing Still Cheaper and Patients Benefit

Isn't it cheaper and better to have in-house radiologists? 

I READ with interest 'Faster X-ray results, thanks to outsourcing' and 'Teleradiology business began as a joke' (ST, Feb 27). 

I wish to voice two concerns. The X-rays performed at Ang Mo Kio Polyclinic were in the past sent to radiologists in Singapore's tertiary hospitals for reporting and this entailed a waiting time of several days. 

Consequently, the patient had to make a separate visit to the polyclinic a few weeks later for the results. 

This was undesirable and it would seem the rationale for outsourcing was better patient service. Linked to this was probably the ministry's desire to curtail increasing health care costs. Presumably, the radiologists in India charge less per X-ray report than local radiologists. 

However, I question the rationale for spending $2.3 million on a system to send digital images to India for reporting. 

It would be a simpler and cheaper solution to employ an in-house radiologist at Ang Mo Kio Polyclinic. 

With such a service, X-rays would be reported in a timely manner and the patient would have saved the extra trip to the clinic - exactly the same goals that outsourcing has achieved. 

I assume the $2.3 million does not include the fee that Teleradiology Solutions charges for each X-ray report. A Health Ministry spokesman said 'there will be savings, but it is too early to gauge the amount.' It is surprising that we would embark on such an expensive project without at least some projection of the long-term cost benefits. 

My second concern is the legal responsibility of the reporting radiologist in India. In Singapore and elsewhere, doctors practise in an increasingly litigious and unforgiving climate. If a doctor in Singapore makes a mistake, his patient can sue him and he may be censured, made to pay damages, and be barred from practising by the Singapore Medical Council. 

For better or worse, this is the reality of medical practice in Singapore. If a radiologist in India makes a mistake in reporting an X-ray, will she be held for the same legal responsibility as her Singaporean counterpart? 

Can she be sued in a Singapore court, censured, made to pay damages, and be barred from practising by the Singapore Medical Council? I think not. 

These are consequences that all Singapore doctors, not just radiologists, grapple with daily. If a radiologist in India is reporting X-rays of Singaporean patients, should he not be subject to the same rules as his Singaporean counterpart? 

Globalisation is a trend we cannot run away from. Indeed, we should not. We should instead embrace it, as the Health Minister says. Yet, why implement an expensive solution with such high initial costs and no proven long-term savings when a simpler one would have sufficed? I hope we are not embarking on teleradiology just because 'it's there'.

Reply

Reply from MOH 

In "Isn't it cheaper and better to have in-house radiologists?" (ST, Mar 3), Dr Shoen Low Choon Seng asked if it would be cheaper to station a radiologist at Ang Mo Kio (AMK) Polyclinic, instead of outsourcing the reading of X-rays to Bangalore, India, through teleradiology. It would not be cheaper. With 700 X-rays per month, his proposed arrangement would cost the polyclinic over $30 per X-ray just to cover the radiologist's salary. This is much more than what AMK Polyclinic is paying to India. 

As a trainee radiologist, Dr Low should know that teleradiology has a proven track record and has brought sustained benefits to many patients in US hospitals. It is not merely cost savings, but more importantly faster turn-around time and often even better quality reports. Our brief experience so far has already demonstrated these benefits. 

Dr Low raised the issue of legal liability. This is an important issue in any outsourcing arrangement. It was fully and satisfactorily addressed in the US, even within the strong culture of medical litigation there. The key is to ensure that the appointed provider is appropriately accredited. 

In this case, an assessment was thoroughly carried out. The Ministry of Health appointed the College of Radiologists as the accreditation body to determine the provider's suitability. The College conducted a site visit in Bangalore to assess the facilities and processes, and found them to be good. The College also noted that the provider was accredited by the Joint Commission on Accreditation of Healthcare Organisations, the largest accrediting body in healthcare in the US. The College further tested the provider's proficiency and was satisfied with its standards. 

National Healthcare Group which runs AMK Polyclinic is legally accountable to its patients for the quality of its radiological services, including X-ray reports that are outsourced. Indeed, doctors are not new to cross-border consultation. Occasionally, doctors would send tissue samples overseas for reading by foreign pathologists. The doctors who do so remain accountable to their patients here. 

The delivery of healthcare will continue to be further globalised as a result of technology and the Internet. This opens up many opportunities. We should be alive to such opportunities, so that we can bring such benefits to our patients, as pointed out by Mr Paul Chan Poh Hoi in "Outsourcing is the right way to cut costs" (ST, Mar 4). 

Teleradiology and in fact any kind of outsourcing need not necessarily take place across borders. Our public hospitals and polyclinics will readily outsource the reading of X-rays to local radiologists, when they can offer a similar or higher quality service as Bangalore at lower cost. Such competition will be good for our patients.