Telework that Works: Teleradiology and the Emergence of Nighthawk Radiology Groups

Abstract

Information technology enabled remote work is typically seen as an imperfect substitute for spatial proximity (Armstrong and Cole 2002, Gaspar and Glaeser 1998, Olson et. al. 2002). For night radiology, however, the use of teleradiology applications to create a new type of radiology group appears to have facilitated improvements in productivity, lifestyle, and quality of interpretations. This paper describes the diffusion of teleradiology applications in the United States and the "nighthawk" radiology groups that have consequently emerged. The emergence of nighthawk radiology groups - a new type of radiology group which specializes in doing night reads - has had important ramifications for the delivery of radiological services in the United States. Based on interviews, site visits and direct observation of radiologists, the introduction of nighthawk radiology offered a series of benefits without threatening the quality of radiology services rendered remotely. This research found that nighthawk radiology groups emerged, not out of a deliberate program of reengineering, but out of a reaction to a particular set of historical circumstances. The lessons that can be learned from the study of nighthawk radiology, however, are relevant to a host of industries with work tasks that can be easily relocated, but where relocation is seen as conflicting with quality concerns. The professional nature of radiology work, as well as the updating of quality assurance programs, played a crucial role in assuring quality, while shaping the outcomes of the use of teleradiology to outsource and offshore American radiology services.