Night-hawking x-rays 'risky'

Outsourcing radiology services to overseas contractors over the internet raises significant risks to patients - including the inability to hold an individual accountable in the event of misdiagnosis, some hospital doctors say.
Dr Deborah Powell, general secretary of the Resident Doctors' Association, said yesterday that the interest being shown by district health boards in sending x-rays offshore for analysis could have negative implications for both New Zealand radiologists and their patients.
Hawke's Bay Hospital hired on overseas contractor mid-July to read x-rays after half the health board's eight fulltime radiologists quit in May. Its after-hours x-rays are now read by radiologists who may be in places such as India, Lebanon, Pakistan and Australia.
The practice is known internationally as "night hawking" - using radiologists in a different time-zone to get work done out of business hours.
"One of the biggest risks to the public is that patients will not have the opportunity to hold an individual accountable if their condition is misdiagnosed," Dr Powell said.
A spokesman for the New Zealand branch of the trans-Tasman College of Radiologists, Andrew Long, of Christchurch, said radiologists used overseas should be licensed in New Zealand.
"No New Zealand-registered radiologists are part of the overseas organisation being used by Hawke's Bay DHB," he said. "The college is also unaware of any New Zealand radiology providers being asked to tender for this service."
Dr Long said "tele-radiology" had potential to improve patient care in many communities, by giving immediate access to a specialist, and professional supervision from an off-site radiologist.
But the radiologists were responsible for quality standards both at the NZ hospital and offshore, and "any radiologists practising tele-radiology should be appropriately licensed in the jurisdiction of the transmitting and receiving sites".
The Medical Council was responsible for ensuring that medical practitioners were registered and safe to practise, he said.
Medical Council chairman John Campbell, who has predicted the outsourcing of x-rays could open up the possibility of some pathology analysis and reading of cervical smears being done offshore, said patients should be warned their x- rays were being read overseas.
He said the council had accepted the use of overseas radiologists as a short-term solution, but said standards were variable in some countries.
The Hawke's Bay District Health Board said it did not matter whether the American-registered radiologists reading its x-rays during a six-month trial were in Beirut.
"What matters is the quality of the reports they give and the qualifications of the radiologists, and they could be anywhere in the world," said DHB acting chief executive Win Bennett.
"Most of them ... are done by people in the States, some have been done elsewhere in the world."
Special software allowed x-rays, MRI and CT scans to be sent over the internet, and a report to be received in about 20 minutes - the time it would normally take if a radiologist was based at the hospital.
Any plain films - which did not require dye - which came in after-hours could be sent overseas, Mr Bennett said. The following morning the DHB's own radiologists reread the reports, which ensured a quality check.
The scheme was a "win-win situation" for radiologists who were often overworked, and for patients because they still received a high-quality service, he said.