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Merge Teleradiology FAQ's
On November 20, 2007, Merge Healthcare announced the launch of Merge Teleradiology. This new division will
provide a teleradiology software application called Merge TeleRead™ and an associated service offering, Consult
PreReads™. During Merge Teleradiology’s RSNA 2007 debut, we answered many questions about this new application/
service offering from Fusion RIS™, Fusion RIS/PACS™ and Fusion RIS/PACS MX™ customers, and also from many non-
Merge customers who will be able to implement our new teleradiology solutions in the future. If you have additional questions or would like information sent to you, click here to send us an email .
The following Frequently Asked Questions (FAQ’s) list provides a comprehensive summary of this exciting new
technology and service.
1. Why did Merge create this new teleradiology division?
2. What exactly is a Consult PreRead?
3. What is the difference between a teleradiology preliminary read, a final read
and a Merge Healthcare Consult PreRead?
4. How does the Consult PreRead process work?
5. What if the U.S. radiologist disagrees with the content or format of the Consult PreRead?
6. How does Merge evaluate the work of its offshore radiologists?
7. What sort of certification do these offshore radiologists have?
8. How are studies assigned to the offshore consulting radiologists?
9. How do Consult PreReads benefit U.S. based imaging centers?
10. What other reasons might a U.S. imaging center consider the Merge Teleradiology solution?
11. What is unique about the Merge TeleRead software application?
12. What other quality measures are related to U.S. imaging centers that employ
offshore image reading services of a U.S. company?
13. Regarding the transmission of patient information overseas for a Consult PreRead, what
specifically is needed to comply with HIPAA, state laws and patient confidentiality requirements?
14. If a Consult PreRead is delivered to a practicing radiologist in one of the U.S. states,
is it legally considered an opinion or a read?
15. Is Merge Teleradiology accredited by the Joint Commission?
16. What do you charge for the Consult PreRead service?
17. When will Merge TeleRead and Consult PreReads be available to Fusion RIS,
Fusion RIS/PACS and Fusion RIS/PACS MX customers?
18. How can I find more information?
Why did Merge create this new teleradiology division?
Our frequent discussions with you, our radiology group customers, and our analysis of the medical imaging reading
market – in addition to the existing teleradiology services market – have identified three major customer goals. These
are:
(1) increasing productivity in the image reading process, (2) enhancing the quality of your diagnostic reports and
(3) reducing overall costs. We at Merge Healthcare believe that our Consult PreRead service, facilitated through our
unique Merge TeleRead application, addresses all of these desires.
Back to Top>>
What exactly is a Consult PreRead?
It is a premium image pre-reading consulting service provided by our skilled radiologists based in India. Its purpose is
to help U.S. radiologists prepare their official, final diagnostic reports. It is NOT a service that will compete in any way
with U.S. radiologists – its purpose is to help them become more productive while enhancing diagnostic quality. A
Consult PreRead is the product of two separate reads sequentially processed by two different offshore radiologists,
thus producing a single findings report. A Consult PreRead report includes references to prior studies, relevant patient
clinical information, extensive measurements of relevant and non-relevant pathology and associated key images. Back to Top>>
What is the diference between a teleradiology preliminary read, a final
read and a Merge Healthcare Consult PreRead?
A teleradiology preliminary read is a narrowly focused and quick interpretation from a U.S. radiologist who is
supporting an emergency room physician after hours. The preliminary read produces a brief findings report that
targets a very specific aspect of the study (e.g., is there a bleed?). What is doesn’t account for is a broader
perspective of the study that also evaluates for any abnormalities not specifically requested. The preliminary reading
radiologist is concerned about speed of service and determination of a very focused aspect of the study, compared
to a final reading radiologist who takes the time to perform a more comprehensive evaluation of the entire study. For
the preliminary reading radiologist, there also is limited or complete lack of access to relevant prior images, reports
and associated clinical data. A preliminary read report is replaced by a final read report the next business day. In
summary, the distinction between a preliminary read and a Consult PreRead is that in the latter the reading
radiologist has access to all relevant priors and clinical data to make a more extensive assessment of the study and
provide a comprehensive findings report.
The Merge Consult PreRead is a service that is similar yet, in key aspects, distinct from a final read service. As
mentioned in the preceding question, it involves two Indian radiologists who have studied a case independently (prior
reports, images, clinical data and scanned documents) and collaborated on developing a findings report. They
operate like a final reading radiologist in the United States, except that the study is read by two radiologists in India
and that the findings report is not delivered to the referring physician. A Consult PreRead produces an extensive
findings report with associated marked up key images (measurements, etc.) that is exclusively delivered to the final
reading U.S. radiologist. The U.S. radiologist uses this information for consultative review to facilitate the delivery of a
final report. Therefore, the final delivery to a referring physician includes a triple-read report with extensive
measurements in key images. The benefit delivered should be a higher quality report due to the number of
independent reading radiologists, a more extensive findings report and anticipated higher productivity for the final
reading U.S. radiologist.
A component of the ongoing quality feedback process for the Consult PreRead is that the U.S. radiologist grades
each report regarding the quality of the content and use of language. Therefore, customers in conjunction with
Merge can work cohesively together in ensuring the highest quality radiology findings reports are delivered in the
committed delivery time-frame. Back to Top>>
How does the Consult PreRead process work?
Once a study is transmitted to our offshore reading center, it is subjected to an intensive process involving
prescreening, review of historical patient data and prior studies, selection of key images, measurements, annotations
and generation of a detailed report. These activities are conducted by highly qualified and experience radiologist
consultants. Each diagnostic study is reviewed independently by two radiologists before transmission of the in-depth
findings report and marked key images that comprise the Consult PreRead report. These consultant radiologists are
trained to detect not only relevant pathology, but also abnormal findings and pathology in anatomy adjacent to the
region(s) of interest. The finished Consult PreRead report and key images appear in the designated U.S. based
radiologist’s work queue within minutes of completion of the Consult PreRead at the offshore reading center. The U.S.
licensed radiologist at the customer site then performs a complete, official final read and issues a signed report to the
referring physician. Back to Top>>
What if the U.S. radiologist disagrees with the content or format of the
Consult PreRead?
He or she is entirely free to edit the information within the Consult PreRead report and make other edits deemed
necessary to generate a complete final diagnostic report to their satisfaction. The Consult PreRead report is sent back
only to the originating radiology group. It never goes to the referring physician. Back to Top>>
How does Merge evaluate the work of its offshore radiologists?
We have a Quality Control Improvement Board led by our clinical advisor – a U.S.-licensed and ACR board certified
radiologist who works in conjunction with our Director and Chief Consultant Radiologist based in India. Collectively,
they evaluate our offshore radiologists by assessing both accuracy of interpretation and English language usage. We
also verify that the medical licenses of our offshore radiologists are current, and perform background checks to
confirm their credentials. Employment of this internal checks-and-balances system – in conjunction with the U.S.
customer’s own ongoing empirical feedback to us regarding the India-based radiologists’ performance – ensure high
quality staff and services. Back to Top>>
What sort of certification do these offshore radiologists have?
A board-certified radiologist in the country of India is required to meet rigorous training at a level that is comparable
to that of U.S. radiologists. They are required to complete undergraduate study, an internship and then three years of
specialty training. Prospective radiologists may elect to obtain their training in a university setting or at a teaching
hospital. In India, the training standards are maintained by the overall medical governing body called the Medical
Council of India (MCI). When radiologists pass the University or National Board examination, they can practice
anywhere in India. University-trained radiologists receive the title of M.D. (Radiology) after they have passed the
university’s final exam. In situations in which the training environment is a teaching hospital, the radiologist receives a
DNB (Diplomate of the National Board) of Radiology on completion and passing of the exam from the National Board
of Examinations. Back to Top>>
How are studies assigned to the ofshore consulting radiologists ?
Our Consulting Radiologists are not in a “pool” that assigns work randomly – each U.S. imaging site participates with
Merge Healthcare to evaluate and select a team of radiologists that works specifically on your cases. In this way, you
develop a high level of trust in your radiologists and get to know them and their diagnostic styles. Back to Top>>
How do Cons ult PreReads benefit U.S. bas ed ima gin g cent ers ?
By increasing efficiency, productivity and quality of the entire radiology workflow. An imaging center can “offload” as
few or as many cases as it wishes depending on the day’s schedule – and allow our offshore radiologists to conduct
Consult PreReads for these cases. Pre-reading before the final read by the U.S. radiologist can slash the time needed
to prepare a final report – essentially increasing the final daily case tally for the imaging center in a very efficient
manner. In terms of increasing image-reading quality, it should be understood that on completion of the final read by
the U.S. radiologist, the medical imaging study has been triple-read before the U.S. radiologist sends it along to the
referring physician. Back to Top>>
What other reasons might a U.S. imaging center consider the
Merge Teleradiology solution?
There are many times when imaging centers are faced with study backlogs or they need to balance the workload
when radiologists are on vacation. In addition, radiology practices are seeing increasingly high volumes of complex
studies, such as cancer cases and those requiring extensive measurements; studies that can be very time-consuming.
By accessing Consult PreReads, our customers should be able to improve quality and accelerate the turnaround time
of the final reports. Also, because the Consult PreRead transcribed report is provided to the U.S. based radiologist,
overall transcription costs should be reduced. Back to Top>>
What is unique about the Merge TeleRead software aplication?
While Consult PreReads represent the human expertise part of the Merge Teleradiology equation, Merge TeleRead
reflects the technological sophistication and experience component. Unlike any other teleradiology provider on the
market today, we fully integrate image reading (i.e., Consult PreReads) into your Fusion RIS, Fusion RIS/PACS or Fusion
RIS/PACS MX workflow. The process is as easy as dropping studies in a special teleradiology RIS worklist located with
your site’s standard RIS worklists. With one click, studies for which you want a Consult PreRead are transmitted to our
offshore reading center. Alternatively, you can simply specify automated routing for certain studies and have the
process occur behind the scenes. In contrast to this seamless workflow, the traditional teleradiology workflow usually
requires many manual steps and significant data entry that can slow workflow and increase the likelihood of human
error. Back to Top>>
What other quality measures are related to U.S. imaging centers that
employ offshore image reading services of a U.S. company?
Merge Teleradiology application and service offerings are under the auspices of U.S. law. Accordingly, all contracts
are with the U.S. entity, Merge Healthcare, which provides the customer with the benefits of contracting with a U.S.
entity. Secondly, as a U.S. company, customers are within their right to visit our offices, meet with our executives and
examine our public records. An added safeguard at the offshore imaging center is a security system, comprising
sophisticated password access and biometric readers (coming shortly), that is designed to ensure that the information
in our reading center is secure. The workspace is restricted to only those who need access and the security
environment ensures that no patient information can be copied, printed or duplicated. We also sign HIPAA
agreements and manage our business around protecting patient confidentiality. Customer information is stored in an
ultra-secure tier III server in Atlanta, Ga. Back to Top>>
Regarding the transmission of patient information overseas for a Consult PreRead , what specifically is needed to comply with HIPAA
agreements , state laws and patient confidentiality requirements?
Concerning HIPAA, your practice is required only to post your Notice of Privacy Practice. Typically, as long as your
organization is authorized to use and disclose patient information for the purposes of patient treatment, healthcare
billing and operation of your business, no further actions under HIPAA will be required. Merge Teleradiology will be a
Business Associate under HIPAA and we will provide a Business Associate Agreement on request. Many of the U.S.
states do not specify more stringent mandates than those of the HIPAA regarding the transmission of patient
information. Because Merge Teleradiology cannot provide legal advice to you, you must consult with your legal
representatives to the extent you believe necessary. Back to Top>>
If a Consult PreRead is delivered to a practicing radiologist in one of
the U.S. states, is it legally considered an opinion or a read?
A Consult PreRead is a premium imaging pre-reading consulting service delivered to a U.S. licensed radiologist who is
rendering a final read on the patient’s study, the Consult PreRead is an opinion. A Consult PreRead is not a preliminary
or final read. Back to Top>>
Is Merge Teleradiology acredited by the Joint Comission?
Yes. On November 27, 2007, we announced that the Merge Teleradiology division had been awarded the Joint Commission’s Gold Seal of Approval™, by demonstrating compliance with the Joint Commission on Accreditation of
Healthcare Organization’s national standard for healthcare quality and safety. This means that we have established
our systems and processes to support the Joint Commission’s strict licensing and credentialing verification, especially
in regard to healthcare quality and patient safety. We go beyond those standards with other types of verifications and
references to ensure the highest level of Consult PreReads. Back to Top>>
What do you charge for the Consult PreRead service?
If you are a Merge customer with our Fusion RIS™, Fusion RIS/PACS™ or Fusion RIS/PACS MX™ solution, please contact
your Merge sales representative for more information. Back to Top>>
When will Merge TeleRead and Consult PreReads be available to Fusion RIS,
Fusion RIS/PACS and Fusion RIS/PACS MX customers?
We plan to begin offering this application/service package to you in the first quarter of 2008. Back to Top>>
How can I find more information?
We will be happy to have one of our representatives visit your facility, which will enable us to assess your business
operation and determine if our service fits with your organization and the value proposition we offer. Send us an
email if you would like to receive the Merge Teleradiology brochure upon publication in the next few weeks. Back to Top>>
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