Dr. Ramesh Avna records his findings from a group of images at St. Vincent Mercy Medical Center. The hospital dropped its longtime local radiology provider for a California company.
Having CT scans, magnetic resonance imaging, and other diagnostic tests for patients in one city read by radiologists in another is an evolving technological feat.
But Mercy Health Partners recently caused an uproar among some local doctors - particularly those at its former longtime provider, Consulting Radiologists Corp. of Toledo - when it contracted with an out-of-town management group that takes a different approach to the use of so-called teleradiology.
Unable to reach an agreement with Consulting Radiologists, Mercy hired Imaging Advantage LLC of Santa Monica, Calif.
One key difference is that Imaging Advantage radiologists working at Mercy will not reread interpretations done overnight by the teleradiology firm it uses. That saves time, although it eliminates a second look, said Dr. Imran Andrabi, president and chief executive of St. Vincent Mercy Medical Center.
The aim, Dr. Andrabi said, is to reduce the wait for final test results. Mercy hospitals had used teleradiology, but a second radiologist reread the final reports, he said.
Dr. David Cervantes, president of Consulting Radiologists, said radiologists reading electronically transmitted images elsewhere do not have relationships with local doctors.
"We're not just locked in a room for 10 hours a day reading films," he said. "We're actually involved with patients and physicians, and that is what I think is going to be lost in all of this."
From left, Drs. Teppe Popovich, Kenneth Cook, and Ramesh Avna, of Imaging Advantage, discuss a case at St. Vincent Mercy Medical Center.
The change at Mercy has reverberated at the University of Toledo's Health Science Campus, the former Medical College of Ohio. UT has pulled its radiology residents from Mercy's hospitals because the Consulting Rad-
iologists' physicians are also on UT's medical faculty.
Anger, rumors, and innuendo have swirled since Consulting Radiologists - which has had doctors on staff at St. Vincent since the 1950s but had not had contract talks with Mercy for a year - was told in mid-May that it would be replaced a little more than two weeks later.
To date, Imaging Advantage has about 15 radiologists, all of whom have at least 90-day contracts, at Mercy's three Toledo-area hospitals, and it is working to permanently fill positions by early September, Dr. Andrabi said. More radiologists are working at Mercy now than before, he said, and all off-site test-reading is done in the United States.
M. Naseer-Uddin Hashim, chief executive officer of Imaging Advantage, said the firm has radiologists on site or on call around the clock at Mercy's local hospitals, and only selected tests will be read by board-certified radiologists at a teleradiology firm overnight. The goal is to keep the backlog of unread tests down with the help of a teleradiology firm, he said.
"We want the doctors here to be reading as much as they can," Mr. Hashim said.
Imaging Advantage does not reread reports from teleradiologists, which in part cuts down on the work doctors at the hospitals have, Mr. Hashim said. "You want to make sure when the doctors come in they have a clean slate," he said.
Teleradiology has benefits and drawbacks, said Dr. James Borgstede, past president and past board chairman of the American College of Radiology. "With all the discussion about teleradiology, you have to talk about patients first," he said.
On the plus side, the technology allows for medical opinions from experts, whether they are across the country or across town, Dr. Borgstede said. But it has the potential to make radiologists a commodity, eliminating their ability to determine if tests were needed and performed correctly as well as to consult directly with doctors, he said.
That is the biggest fear of Dr. Cervantes of Consulting Radiologists.
"Unfortunately, teleradiology is taking an ugly turn," Dr. Cervantes said. "It's no longer aiding radiologists. It's replacing radiologists."
But Dr. Andrabi said that by contracting with Imaging Advantage, Mercy not only will get test results more rapidly but also will have access to other advanced technology.
For example, Imaging Advantage has a contract with Massachusetts General Hospital for three-dimensional radiology rendering services, with images from other hospitals sent there to be converted, he said.
Imaging Advantage plans to extend the service to Mercy, where radiologists will read images converted into 3D at Massachusetts General, Mr. Hashim said.
The arrangement will allow Mercy doctors to tell more quickly what problems patients have without the Toledo system having to invest money and time in technology, Mr. Hashim said.
Consulting Radiologists was invited to join Imaging Advantage if it closed its own Toledo imaging center, which would have resulted in 30 employee layoffs and ended the firm's work at St. Luke's Hospital in Maumee, Dr. Cervantes said.
The 19-physician practice was hiring some radiologists to help at St. Luke's, where it began working this year, but they no longer are coming to Toledo, Dr. Cervantes said.
Eight others have left, retired early, or taken sabbaticals for reasons related to Mercy, he said.
Individual radiologists from the practice were offered permanent or, if they preferred, trial jobs with Imaging Advantage, but none has accepted, Dr. Andrabi said.
He stressed that Mercy continues to value the care that Consulting Radiology radiologists provide and first tried to negotiate a contract three years ago.
The University of Toledo's decision to pull its radiology residents who did rotations at Mercy hospitals means that radiology residents will receive training at St. Luke's. UT also is considering establishing a program at another hospital.
Dr. Andrabi said he has spoken to various UT officials about the decision, which he doesn't agree with but respects.
Dr. Lee Woldenberg, UT's radiology resident program director, said Mercy didn't notify the medical school of the change and violated its letter of agreement. Consulting Radiologists' doctors are part of UT's faculty and they can't be easily replaced, he said.
"We're supposed to plan and do things together," said Dr. Woldenberg, chairman of UT's radiology department. "This isn't a minor thing to end up with no faculty there."
Toledo Radiological Associates Inc. provides radiology services locally for Mercy's rival, ProMedica Health System.
The 80-year-old practice's radiologists work at Toledo, Flower, and Bay Park Community hospitals as well as at several local outpatient imaging centers.
Contact Julie M. McKinnon at: