Hospital Services Performed Overseas

"I'm convinced patient care is improved," said Paul Berger of NightHawk Radiology Services. The company, based in Coeur d'Alene, Idaho, has about 40 radiologists in Zurich and Sydney serving about 600 U.S. hospitals and other facilities, including 16 in Virginia.

But skeptics worry that remote radiology operations may be staffed with one or two U.S.-certified radiologists who approve reports prepared by less-qualified technicians, a practice known as "ghosting."

"The nightmare scenario is you have one or two people with licenses and a room with 25 or 30 computer terminals staffed by people who may or may not be radiologists," said John Haaga, chairman of the radiology department at Case Western Reserve University in Cleveland.

Wipro Infotech, a large company in India that provides a variety of services to U.S. companies, began using non-U.S. licensed radiologists to provide "preliminary" interpretations of images for U.S. hospitals in 2003. Wipro halted the service because of intense criticism but remains interested because the market has only increased, officials said.

"The demand is huge. We get a couple of calls every week," Wipro's T.K. Kurien said. "We'd like to see some kind of process where our guys could provide this kind of service to hospitals in the United States."

NightHawk and several other companies providing the offshore radiology services say they hire only U.S.-trained doctors who are licensed in every state where they have clients and credentialed at the hospitals they serve. But policing the services remains a concern.

"Because of the ease of moving this stuff around, the problem of being able to authenticate who is doing the work is an issue," said Robert Wise of the Joint Commission on Accreditation of Health Care Organizations, which is upgrading its standards for accrediting hospitals in response to the trend.

The companies providing the service, and the hospitals using it, argue that the reports are double-checked each morning by staff radiologists, so questionable interpretations would quickly be spotted.

"We'll find little things here and there, the same way we find little discrepancies amongst our own radiologists," said Russell McWey, chief radiologist at the Virginia Hospital Center in Arlington, which uses NightHawk. "But there's been no major discrepancies."

But some say there are other potential pitfalls, such as possible communication problems when doctors are so far apart and are strangers.

"It's difficult to point out something on an image if you're not actually standing there in the room with the other doctor looking at the same image," said Arl Van Moore, who chaired an American College of Radiology task force that issued guidelines on the practice in February.

Proponents say most conversations between radiologists and emergency-room doctors take place over the phone, even when the doctor is down the hall or at home, making it just as easy to communicate from thousands of miles away.