Use of telemedicine services in radiology and pharmacy may hold down labor costs and expand services for patients, but expanded use of telemedicine could also disrupt other local medical subspecialty providers, including pathologists

Over the past 15 years, pathologists have watched how radiology has been disrupted by the “nighthawk” model of remote teleradiology services. Now, the nighthawk approach to telepharmacy could disrupt pharmacy as well. As this happens, pathologists may be wondering when their medical specialty will see its first “nighthawk pathology” disruptors.

Remote Pharmacists Improve Hospital Drug Delivery

One company bringing the nighthawk model to hospital pharmacy services is PipelineRx of San Francisco, California. Its executives believe that they can make the drug delivery system in hospitals more efficient by filling labor shortages with remote pharmacists, according to a MedCity News article.

PipelineRx CEO Brian Roberts acknowledges that his company is taking a page from the teleradiology playbook. “We figured we could do the same with pharmacies because of the technology and create an environment and monitor prescriptions in the hospital and allocate it to home pharmacists,” Roberts told MedCity News, adding that it can both trim costs while ensuring adequate monitoring for patient safety.

PipelineRx CEO Brian Roberts, MBA

PipelineRx CEO Brian Roberts, MBA, expects the growth of telepharmacies to continue. “There’s no reason why [a pharmacist] needs to be sitting in the four walls of the hospital at periods when demand is fluctuating,” said Roberts, whose company currently is providing its services in 31 states. (Photo copyright PipelineRx.)

It is ongoing improvements in telemedicine technology that make it both feasible and economical for licensed pharmacists working at a central pharmacy site—or from home—to supervise a registered pharmacy technician at a remote telepharmacy site. This is done by the use of video conferencing technology.

“Until a couple of years ago, [hospitals] were still faxing [prescription] orders down to the basement,” Roberts noted.

Telepharmacy a Win/Win for Hospitals and Pharmacists

In the MedCity News article, Roberts described telepharmacy as a win-win for both hospitals and pharmacists since hospitals can save between 30% and 70% on labor costs while pharmacists benefit from working more flexible hours. In addition, PipelineRx’s average prescription turnaround time is seven minutes compared to the industry standard of 20 minutes, decreasing the wait time for patients.

“There’s no reason why that employee needs to be sitting in the four walls of the hospital at periods when demand is fluctuating,” Roberts stated. “We’re able to be flexible and offer the hospital a variable cost model.”

PipelineRX is hoping to build on the success of teleradiology and the nighthawk business model of professional services. Nighthawk radiology services solve hospital-staffing problems through use of nighttime teleradiology coverage. By contracting with subspecialists working in locations such as Hawaii, New Zealand or Australia, nighthawk radiologists working remotely can cover cases in the U.S. during evening hours, weekends or vacation shifts.

American Radiologists Provide Services to U.S. from Half a World Away

The term “nighthawk” to describe remote radiology services comes from a company based in Coeur d’Alene, Idaho, called Nighthawk Radiology Services. Founded in 2001, it originally employed American radiologists living in Australia to provide after-hour services in the United States.

Today, on a company website, it says, “NightHawk’s team of U.S. board-certified, state-licensed, and hospital-privileged physicians located in the United States, Australia, and Switzerland, provides services 24 hours a day, seven days a week, for approximately 1,560 sites or 27% of all hospitals in the United States.” Pathologists should take note that just one teleradiology firm claims to be delivering its services to one-quarter of all the hospitals in this country.

E. Stephen Amis, Jr. M.D., professor and university chair of the Department of Radiology at the Albert Einstein College of Medicine, says radiology “nighthawks” have performed up to par.

“It turned out a lot better than everyone thought initially,” Amis stated in an American College of Emergency Physicians (ACEP) news article.

“Teleradiology is really providing a good service for most hospitals during the night hours when there is a shortage of radiologists. It gives good-quality readings on a very timely basis: Usually, it takes 30-45 minutes between the time the scan is done and a preliminary interpretation is received. Then, the study is double read [by the home institution’s radiologist] the next morning,” Amis continued.

Pathologists Watch Local Radiology Groups Lose Contracts to Remote Radiology Companies

For rural hospitals, teleradiology has been a way to improve patient care. Instead of sharing one traveling radiologists, hospitals outside major population areas can route images, ultrasounds and CT scans over the Internet to a central teleradiologic practice whose team of radiologists and subspecialists are on-call day or night.

Of course, over the past 15 years, there are pathologists who watched their colleagues in the radiology group practice serving the same hospital lose their contract with the hospital when a nighthawk radiology company came in and underbid the radiology group for all the hospital’s radiology and imaging services. These pathologists know how disruptive the teleradiology business model can be in some settings.

Thus, if telepharmacy gains the same level of acceptance by hospital administrators as teleradiology, then there is the possibility that outsourcing pharmacy via this business model becomes more common.

In turn, that makes hospital and health system administrators more comfortable with outsourcing essential clinical services. If companies organized to offer telepathology services appeared on the scene, they may have a ready reception by hospital administrators who like the idea of reducing the cost of professional pathology services while improving access to a wide range of subspecialist pathologists.

In the field of telepharmacy, PipelineRX seems to be growing. According to the company’s fact sheet, PipelineRx now has more than 120 clinical telepharmacists, of which over 65% have either a post-graduate year one (PYG1) or post-graduate year two (PYG2) advanced residency degree.

The company currently operates in 31 states but is able to operate in 46 states. Their client hospitals range from 25-bed critical access facilities to 722-bed academic medical centers.

In December 2014, in a story published by MedCity News, the company said that it had 150 total employees and that “more than 30 hospitals have adopted its SaaS approach, while more than 200 hospitals, ranging from 25-bed critical access facilities to academic medical centers, have used the company’s pharmacists.”

Pathology at a Distance Emerges

As hospital administrators become increasingly comfortable with outsourcing medical radiology and pharmacy functions, they could see value in adding pathology to their telemedicine services. There will continue to be a need for histotechnology capability at the originating hospital to gross the tissue, create glass slides and then convert them to digital images. However, pathologists working remotely could read and interpret the specimens.

Pharmacy personnel

Pharmacy personnel deliver medical prescriptions electronically; remote delivery of prescription drugs is a feature of telepharmacy. (Image and caption copyright Wikipedia.)

Because digital pathology is growing slowly and has technical hurdles still to overcome, it may take some time before nighthawk telepathology emerges as a trend. However, the demand for telemedicine seems unlikely to recede.

“The business case for telehealth is self-evident,” wrote Edward D. Rickert, a Chicago-based health law attorney, in an Inside Counsel article. “The Affordable Care Act has created millions of new healthcare consumers, and President Obama’s November 2014 Executive Action on Immigration will add to the burdens imposed on some state governments to provide healthcare to a new set of eligible beneficiaries. New and innovative ways to provide quality healthcare cost-effectively to more people is needed, and telehealth has emerged to answer the charge.”

Setting aside all the barriers to the adoption of telepathology that exist in most states and at many hospitals, what nighthawk radiology and telepharmacy services are doing is getting hospital administrators more comfortable with outsourcing these types of clinical services. In that sense, as it becomes more feasible to offer remote pathology services to hospitals and companies organize to do that, hospital administrators will be more willing to negotiate and enter into these types of deals.

—Andrea Downing Peck

Related Information:

Small Town to a Big City–7 Telemedicine Practices from a Rural Hospital

It is After Hours – Who’s Interpreting That Study?

PipelineRx Takes Telemedicine to Hospital Pharmacies

Improving Access in Healthcare Through the Use of Telemedicine, Telepharmacy and Telenursing

NightHawk Radiology Brings Overreading from Down Under

Digital Pathology White Paper: Pathology Innovators Use Web 2.0 to Boost Productivity and Create Clinical Value

More Clinical Pathology Laboratories are Purchasing Digital Pathology Systems

Pathologist and Radiologists Head Toward a Collision…or Will It Be a Collaboration