The COVID-19 pandemic has shifted radiologists to at-home workstations, and imaging practices will very likely see a permanent shift to remote reading of exams.

During a webinar hosted last week by SIIM, a panel of healthcare IT experts spoke about their experience with offsite workstations both before and after the pandemic shifted the majority of nonessential work to people’s homes.

“I think it’s going to be difficult to pry these home workstations from anyone at this point,” said Carl Swanson, senior director of imaging technology at MedStar Health, which is located in the Baltimore-Washington, D.C. area. “Anytime we’ve given a home workstation out, the probability it’s coming back is really low.”

Swanson said the healthcare system had made the shift to teleradiology over the last few years as practices have merged and there has been the need for additional evening shifts.

“We were fortunate, in a way, that this change had started,” Swanson said. “We were also fortunate in that we were planning the deployment of another 16 workstations on the shelf that we could deploy relatively quickly. I see that most of those workstations deployed remotely will probably stay deployed. And … we’ll probably start encroaching on maybe a one-to-one, or close to one-to-one, other than breast imagers, with radiologists that have remote workstations.”

Ryan Fallon, manager of imaging technology services for the Johns Hopkins Health System, said remote reading has become part of a recruitment strategy, and that while it had started out as a luxury to give radiologists work/life balance, it is now a key part of their program.

“We’re hiring full-time readers in Colorado, Nebraska, North Carolina, Massachusetts,” Fallon said. “I think you’ll probably see a lot more of that happen in the future, where you won’t necessarily have to have these location-based, on-premise readers. I think it may provide some innovation and optimization in terms of worklist and workload balancing, for specialty reading particularly. Within our current reading worklist solution, we may see the ability to route studies from community hospitals to a subspecialty reader who’s employed by a partner academic center, but may actually be several states away. I know some of the software already is working toward that with varied success, but I think it’s going to ramp up.”

Don Dennison, a consultant who specializes in imaging informatics, who has worked from home himself for several years, said the COVID-19 pandemic will hasten the adoption of telehealth services and institutions will likely see a rise in productivity.

"A year from now, we're going to look back on this and there's going to be all kinds of things that we believed were not possible, that turned out to be quite possible with a little bit of concerted effort," Dennison said. "There have been people who have advocated for telehealth in general for years, and not gotten much change in the institutionalized practices of health systems, who are now the shining stars. There have been people who have been advocating for public health analytics for years and now they're on the front page."

The panel addressed the protocols in place to ensure radiologists are getting work done, and the bandwidth requirements.

Fallon said they have a remote reading rotation built into the radiologists’ schedules, and some monitoring being done.

“We’re able to see when users are logged on, we’re able to see when they’re signing the reports,” Fallon said. “There’s a baked-in accountability to our teleradiologists, having used this remote reading program for the past three years.”

Dennison noted that appropriate bandwidth is key to a successful teleradiology program, with the lowest bandwidth around 10MB and the largest around 100MB, with virtual private networks (VPNs) necessary for security.

Fallon said his facility requires remote readers to have at least 50 Mbps download speeds, though some users go down to around 10 when using the VPN, in which case they switch to an “internet streaming mode” of loading studies. To help, the system is shifting to a radiology-focused VPN.

“Because we weren’t consistently getting that 50 megs, we work with users to make sure that they have business class internet with high network availability speeds, and then also we’re pivoting to using our own radiology-focused VPN,” Fallon said. “We’re just rolling it out today to all of our users, but in our testing, we’re seeing much better speeds without having to share that bandwidth.”