In the middle of the night, while emergency-room doctors are treating patients at hundreds of U.S. hospitals, a few dozen radiologists working thousands of miles and many time zones away are lending their expertise to help the ER physicians in America make life-or-death decisions within minutes.

From a state-of-the-art facility in Sydney, Australia, teams of American-trained and board certified radiologists, who were relocated and are employed by NightHawk Radiologist Services, read electronically sent digital X-rays, CT scans, MRIs, and other medical images of accident victims or suddenly ill patients being treated in the wee hours of the night at about 500 U.S. hospitals.

These NightHawk radiologists, who are working during the day and early evening in Australia, provide off-hour and overnight coverage to U.S. hospitals that would otherwise need to schedule much-in-demand U.S.-based radiologists to work all-night shifts or be awoken at home for emergency reads.

The U.S. hospitals send encrypted patient scans to NightHawk via a HIPAA-compliant, secure VPN. Within seconds, workflow software routes the scans to the most appropriate NightHawk radiologists based on medical specialty, workload, and credentials, such as whether a NightHawk doctor is licensed to practice in the state the U.S. patient is based.

Most of NightHawk's radiologists are licensed in multiple states. Among those are Dr. Dean Batten, an American-born, board-certified radiologist who completed his residency in Philadelphia but relocated to Australia to work for NightHawk a little over a year ago. Batten is licensed to practice in 40 states; NightHawk has a central credentialing office in Idaho that helps its doctors process the paperwork and other requirements for licensing.

"The technology and quality of the images we have [at NightHawk's Sydney facility] is better than what's available at many of the U.S. hospitals, many [of which] don't have a lot of IT support," Batten says. No specialized hardware or software is needed by the hospital or radiology group sending the patient scans, and images can be transferred to NightHawk via T1 or Internet connections.

The reading stations for NightHawk's radiologists are equipped with image compression and transfer technology using the Digital Imaging and Communications in Medicine standard, as well as voice-over-IP telecom capabilities, Web-hosted image management, and report distribution services. The stations also provide voice-recognition capabilities for dictation by the NightHawk experts of radiology reports, which are converted to text for the U.S.-based doctors. The reports are faxed to most of the U.S. hospitals; however, secure access via the Web is also available.

Typical turnaround times for the NightHawk preliminary evaluations and reports are 20 minutes. U.S. radiologist groups or hospitals that contract with NightHawk typically have their radiologists give the scans a second read and prepare the final report the next day, so patients benefit by having a double read of their scans.

Doctors in the United States can communicate directly with NightHawk doctors via E-mail or toll-free phone lines, "which happens frequently in complex cases," says Dr. Marc Silver, an attending radiologist at Diagnostic Imaging Inc., a 32-physician radiology group in Blue Bell, Pa., that 2-1/2 years ago contracted its overnight coverage to NightHawk.

Diagnostic Imaging provides radiology services to Philadelphia's Frankford Hospital, which has 600 beds at three campuses. Diagnostic Imaging's own doctors work from 8 a.m. to 10 p.m. local time. However, NightHawk radiologists take over for the 10 p.m.-to-8 a.m. shift, providing radiological coverage to Frankford Hospital, which has one of the busiest ERs in Philadelphia, Silver says.

The arrangement has allowed Diagnostic Imaging to stop shuffling doctors' schedules to cover overnight shifts. "When radiologists worked overnight, they'd need time off the next day," Silver says. The elimination of overnight shifts also makes it easier to schedule Diagnostic Imaging doctors for weekend duty, he says. The biggest boost overall has been a quality-of-life improvement for Diagnostic Imaging--for both existing staff and the company's ability to attract new radiologists, a medical specialty that's in short supply in the United States. "Because of this service, it's easier for us to recruit," Silver says.

The contracted radiologists down under also benefit from quality-of-life improvements from the outsourcing relationships, NightHawk's Batten says. "I don't have to stay up all night," which was often the case when Batten was a resident at the Philadelphia hospital where he trained and worked 12-hour shifts during 14-day-in-a-row cycles, he says. Most importantly, patients benefit by having fully alert radiologists evaluating their medical images during overnight emergencies, he says.

"Radiologists on night call burn out," says Chris Huber, NightHawk's VP of operations and co-founder of the 3-1/2-year-old, privately held company.

Radiologists needed in the United States are paid on average about $400,000 a year, Huber says. NightHawk bills its radiology department or group customers per scan.

NightHawk doctors also benefit by the higher volume of scans they read and the experience gained from that, Batten says. For instance, a NightHawk radiologist might see eight pulmonary embolisms a night, "instead of maybe eight a week in a hospital in Iowa," Huber says. In fact, a few hospitals in the United States, including Brigham & Women's in Boston, send their radiologists to NightHawk's Sydney facility for specialty emergency training, Huber says.

Batten says NightHawk recently opened a reading center in Zurich, Switzerland, which lets the company extend coverage overnight to U.S. hospitals on the West Coast.

This story was modified Nov. 5.