The U.S. Department of Veterans Affairs (VA) has released a report on its investigation into complaints about the provision of teleradiology services in the Pacific Northwest region.
The complaints included several allegations, including those listed below:
- The teleradiology program for the Anchorage VA hospital began before a memorandum of understanding (MOU) had been signed.
- Patients at the Roseburg VA were experiencing delays as radiologists there read teleradiology studies.
- There was no adequate peer-review process, which might make it difficult to detect reduced quality of image interpretation due to the higher workload.
- The VA system didn't properly credential and privilege teleradiology providers.
The investigation found that the teleradiology program indeed did begin before an MOU had been signed, as required by the Veterans Health Administration (VHA) handbook. Teleradiologists had assumed that the MOU was signed, but staff at the Anchorage hospital had not yet signed the document. It was eventually signed by all participating facilities in November 2014.
Investigators were unable to substantiate the charge that delays had occurred in radiology readings at Roseburg due to the facility's provision of teleradiology for Anchorage and Walla Walla hospitals. A review of electronic health records of 25 patients who were chosen at random from June to July 2014 found no evidence of delay. In addition, interviews with radiology staff found "no evidence of delays in radiologic interpretation, misrepresentation of studies, or reports of patient harm."
The investigation did find that the system lacked an integrated peer-review process for radiology, however. While data were tracked by the service chief, there were not integrated with the system's overall peer-review program, and, thus, didn't meet the requirements of VHA policy.
Finally, investigators found no evidence that the system failed to properly credential and privilege teleradiology providers -- the system's staff radiologists who were reading teleradiology studies were appropriately credentialed and privileged, they found.
In conclusion, the investigators recommended that the director of the Veterans Integrated Service Network (VISN) conduct a quality review of teleradiology image interpretation performed during the period when the MOU was unsigned. It also recommended that the director strengthen processes to make sure radiology is integrated into the VISN's peer-review program.
