Learning Curve

Companies that see outsourcing as an easy way to offload commodity work are missing out on powerful improvements that must be achieved by working closely with service providers, says Professor Robert S. Huckman.

The radiologist in outsourcing

Some parts of the teleradiology model are very similar to outsourcing in areas such as electronics, business processes, or software development. The health care client, usually a hospital, sees the need for a reasonably defined service, but cannot provide the service on an efficient scale. Service providers see the opportunity to consolidate this volume and reach the scale necessary to efficiently serve a wide range of customers.

That’s how it works in teleradiology in the United States. Radiologists from an external service provider are distant from their home or reading center. When new exams arrive, they are randomly assigned to radiologists, who must be licensed in the state and accredited at the hospital where the exam was performed. The random assignment of studies to an accredited and available radiologist indicates that the teleradiology industry sees its product as a commodity – that is, two qualified radiologists are expected to read the same image in the same way.


The researchers studied data from OutsourceCo (a pseudonym), a leading provider of third-party teleradiology services in the United States, with more than 1,400 customers, primarily hospitals and radiology group clinics. The 97 radiologists involved in the study were all certified and licensed to practice radiology in the United States.

The data set included 2.7 million tests read by radiologists for 1,431 clients over a period of 30 months. Almost 85% of the scans were computed tomography scans; about 10 percent were ultrasound; and X-rays, MRIs, and nuclear medicine were responsible for the rest.

The images were analyzed from the reading of the radiologist, the client (hospital or clinic of the radiology group) of origin, the proposed anatomical area, and the reading time.

The results

The results showed that the experience between a radiologist and a client was worth it. It was found that a radiologist’s experience in reading exams from the same client and in the same anatomical area produces the greatest increase in efficacy, with an additional 1,000 cases of cumulative experience, reducing a radiologist’s subsequent weekly production in increases of 7.4 %.

Productivity is extremely important in this scenario. Many tests are sent from hospitals in an emergency, so faster analysis can lead to faster decision-making and better patient outcomes. Obviously, outsourcing companies also benefit from processing multiple scans.

The effectiveness benefits of shorter reading times do not appear to impair clinical quality; the number of “contradictions” is low.

The researchers point to previous research to explain why. The repeated experience helps the service provider to learn the client’s standard procedures, generally improves communication and coordination, and creates the opportunity to transfer knowledge between them.

Progress is not only reaching individual radiologists, but also outsourcing activities. Huckman explains what happens when an outsourcing company gains experience with a client. Let’s assume that the company has 20 radiologists. Dr. A reads the first 200 exams at the hospital and develops a lot of experience and efficiency with the client. So she and Dr. Beach read half of the next 200 exams at the same hospital. The two doctors have already acquired individual experience with the hospital, but also with the outsourced company as a whole. While other radiologists read more cases from the hospital, Dr. A’s greatest experience

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