In Brief: Advances in medical imaging technology are changing the way radiology services are provided.
The Biden administration announced earlier this year that the COVID-19 public health emergency will officially end on May 11. But for hospital leaders, fallout from the pandemic continues. Workforce shortages, supply chain constraints, and increasing demand for clinical care, all of which have intensified in the past several years, are prompting many hospitals to rethink their models of care.
These realities are particularly acute in the field of medical imaging—a high-demand, high-revenue clinical service that generates downstream care in nearly every specialty.
The Need for Innovation in Medical Imaging
Similar to other clinical areas, medical imaging remains affected by capital constraints, physician and technologist shortages, and overall staffing pipeline concerns. These challenges create operational inefficiencies for this 24/7 service line, but they also make medical imaging an ideal environment for technological innovation.
Many hospitals are stepping outside of their comfort zones and considering nontraditional solutions such as remote scanning. While remote scanning is being explored across several imaging modalities, it is gaining the most traction in MRI. Remote scanning offers organizations a way to accommodate changing employee preferences and expectations to work remotely while enabling organizations to increase access, improve throughput, and offer more complex scans.
How It Works
Remote scanning allows the patient receiving an MRI to be at a different location from the technologist performing the MRI. Typically the patient is accompanied by a support staff member trained in MRI safety, and the MRI technologist may be at another hospital or fully remote. This process is made possible by equipping MRI machines with the proper software and instituting workflows for optimal and safe care coordination.
Interview Findings: Remote Scanning for MRI
For many organizations, remote scanning may be a novel concept. To better understand organizational perspectives, ECG conducted interviews with a diverse range of hospital leaders—from small rural and Critical Access Hospitals to large integrated delivery networks (IDNs). All of the interviewees were intrigued by the concept, and a few were in various stages of piloting or implementing remote MRI services. And across the board, the interviewees reported similar challenges in their imaging departments:
Shortage of Technologists
One common challenge is a shortage of highly skilled technologists who can complete complex scans (e.g., cardiac). For health systems with multiple MRI centers, patients frequently need to be transferred to a location where such staff are available. In other cases, hospitals do not have any technologists who are fully trained or comfortable completing complex scans, so patients are referred to outside organizations and often must travel longer distances to receive care.
Staffing Limitations
Leaders also expressed concern about the inability to fully staff shifts, which results in reduced community access and throughput capabilities. While staffing shortages are more prevalent during second, third, and weekend shifts, there are multiple facilities that routinely block daily schedules due to an inability to staff MRI units. This leads to several compounding effects.
- Remaining staff are often stretched to cover more shifts and work longer hours, leading to call-outs, retention issues, and recruitment challenges.
- As organizations are unable to accommodate patients, patient wait times increase, patient throughput and care coordination deteriorates, length of stay is adversely impacted, and outpatient revenue decreases as organizations eventually lose patients to out-migration or lost referrals from providers.
Unsustainable Short-Term Fixes
Understaffing often leads to overwhelming pressure to require on-call or overtime shifts or offer unsustainably high sign-on and shift bonuses. In many cases, the few staff members who were available to cover shifts throughout the day were the same team members who were required to be on call. This can lead to staff burnout, which may drive turnover and further perpetuate staffing challenges. As organizations are increasingly competing with one another for talent, sign-on bonuses are rising to unprecedented levels, sometimes reaching $30,000 paid over two to three years.
Benefits and Concerns
Remote scanning is not a panacea. But by equipping themselves with these capabilities and utilizing internal or contract staff, organizations stand to improve access to both inpatient and outpatient MRI services. This in turn will lead to tangible effects on overall care coordination, patient experience, and financial performance.
Additionally, remote scanning can improve staff engagement by providing more coverage to alleviate pressure on existing staff. Organizations also have an opportunity to contribute to their employees professional development by offering remote continuing education and more advanced training support.
While there are many arguments in favor of remote scanning, there are just as many concerns. The industry leaders we spoke with raised many of the same questions:
- “Who’s in the room with the patient and positioning them?”
- “Does this jeopardize accreditation?”
- “How much does this cost?”
- “What software is necessary on our MRI units to utilize remote scanning capabilities?”
- “What’s the return on investment?”
- “Will this affect the quality of care the patient receives?”
- “What happens in the event of an emergency?”
There are no stock responses; answers depend on the operational and strategic goals, as well as the risk tolerance, of each organization. The American College of Radiology (ACR) states that for an MRI, either two technologists or one MRI technologist and one individual with the MRI personnel designation must be able to communicate within earshot of each other.
In the case of remote scanning, the remote individual conducting the scan is an MRI technologist and is always able to communicate with the other staff member in the room. The person in the room with the patient could be:
- Another MRI technologist.
- A technologist of other modalities.
- A technologist aid or nurse aid.
- Another person trained in MRI safety and workflow.
The choice is a matter of organizational preference.
Safety Considerations for Remote MRI
Organizations should approach remote scanning by engaging their designated radiologist leader for MRI and other clinical leaders and referencing internal safe-practice guidelines. The ACR offers general guidance on the development of an MRI safety program, noting that “the use of remote MRI system operations does not, in any way, diminish the obligations of the site to provide safe MRI care.” This means that the onus for developing and defining safety standards for remote scanning falls on the individual organization.
If a facility implements remote scanning with a technologist aid on site, there must be adequate documentation outlining this individual’s training and responsibilities, including protocols for medical emergencies, quenches, emergency power-offs, and other such scenarios. Organizations must also consider and put in writing their policies and practices for patient screening, positioning, and coil selection and be prepared to demonstrate that there is no compromise in patient safety.
Several organizations have already facilitated the safe deployment of remote scanning programs and are now enjoying the benefits of a remote MRI technologist capable of operating up to three scanners at once. The graphic below offers a few considerations for organizations contemplating the use of these programs.
The Future of Medical Imaging
Advances in medical imaging technology are changing the way radiology services are provided. The demand for medical imaging is expected to increase in the coming years, at a time when many hospitals are experiencing supply chain disruptions, workforce shortages, and declining operating margins. To meet the anticipated increase in medical imaging volumes in the face of these challenges, some hospitals have already begun embracing remote scanning—particularly for MRI procedures.
Remote MRI scanning offers many benefits, including the unique opportunity for patients to more consistently receive care sooner and closer to home. Organizations should strongly consider how and if remote scanning can augment their immediate and long-term clinical, operational, and strategic goals.
ECG has a depth of expertise in radiology and medical imaging services. Organizations contemplating this undertaking should seek an external consulting partner with experience in enterprise strategy, performance transformation, and managed care, along with an understanding of the unique demands of imaging services.
Edited by: Matt Maslin, Dara Khan
Published March 29, 2023