Teleradiology provider expectations: SLAs, QA, reporting

The contract is signed, the first studies route tonight, and the selection spreadsheet is already filed away. What happens next is the part almost no buyer's guide covers: what a teleradiology provider owes you in ordinary operation, month after month, and what falling short looks like early enough to act on.

This page sets the operating expectations: the service model, the SLA mechanics, the reporting rhythm, escalation when something breaks, and the QA cadence a quality committee will ask about. Selection is covered in the how-to-choose guide and the company comparison; this is for running the relationship. The expectations below are also a fair audit of AstraRad, and each section notes what we commit to so you can hold the page against the SLA it links.

What service model should a teleradiology provider run?

The service model is everything the SLA sits on: who reads what, when, and how studies move. Five elements should be explicit in the agreement, and vague answers on any of them predict friction by month three.

Element	What to expect	The red flag
Coverage window	Stated hours per day and days per year, with staffing model named: staffed shifts or on-call	"24/7 coverage" with no staffing detail
Routing rules	Studies route by modality, body part, and priority to a defined reader pool	One general worklist for everything
Report tier	Final signed reports, or preliminary with stated hours; never discovered later	Tier varies by hour without being written down
Reader roster	Named, credentialed, licensed in your state, with changes notified	"Our network" as the only answer
Account contact	A named person who knows your facility, reachable on a stated schedule	A ticket queue as the only human interface

The report tier deserves its own sentence because it moves your staffing budget: preliminary overnight reads mean your own radiologists re-read every overnight study in the morning, and the cost of that second touch belongs in the comparison you ran before signing, as the STAT vs preliminary vs final breakdown works through. AstraRad's model on all five rows: staffed US shifts around the clock, routing by modality and body part to a fellowship-trained subspecialist, final signed reports at every tier, roster changes notified, and a named account contact. The mechanics are on how we work.

What does a real SLA look like?

An enforceable SLA has four parts, and most vendor SLAs in this market are missing at least two.

Tiers with numbers. STAT, urgent, routine, each with a maximum turnaround. AstraRad's are STAT under 4 hours, with 2-hour and 1-hour STAT on request at a higher multiplier, and routine 24 to 48 hours.

A clock definition. The number means nothing until you know when it starts and stops. Last-image arrival to radiologist signature is the honest pair; watch for clocks that start when the radiologist opens the study, which quietly excludes queue time, the thing you are actually buying protection against. Published field data shows what disciplined operations achieve: a two-year retrospective study of a multistate teleradiology service in emergency pediatric neuroimaging, published in BMC Emergency Medicine, reported a mean CT turnaround of 37.5 minutes.

A compliance percentage over a stated window. The tier is the contract; the compliance rate is the performance. Ask for the trailing figure and the window it covers. Our tier definitions are published on the SLA page.

A remedy. Service credits, a cure period, then termination for persistent breach. An SLA without a remedy is a brochure. Converting a vendor's published numbers into contract language is its own skill, and the vendor claims verification guide includes the wording that survives negotiation.

Monthly reporting: what arrives without being asked

The reporting rhythm is the clearest single tell of a provider's operational maturity, because a provider that measures itself has the report already built. Expect, monthly and unprompted: turnaround by tier against the SLA targets, the compliance percentage, volume by modality and site, the discrepancy log with classifications and dispositions, and a short note on what changed because of the findings. Quarterly, expect a business review: trend lines, staffing changes on your account, licensing updates, and anything that will affect the next quarter.

Two uses for that packet beyond vendor management. First, your own accreditation and quality committee obligations: outsourced reads sit inside your quality program, and a monthly packet you can forward is the difference between an easy survey question and a scramble. Second, reconciliation: quarterly, pull five studies from your own PACS and check your recorded timestamps against the provider's clock. Definitional drift is small, silent, and worth a standing 20-minute calendar entry. The arithmetic of auditing an invoice against the same data is covered in the hidden fees guide.

AstraRad sends the monthly quality report as standard: turnaround by tier, SLA compliance, the discrepancy log, and the resulting actions, against the tiers the SLA page publishes.

How should escalation work when something goes wrong?

Three lanes, three clocks, and the agreement should name all three.

Clinical escalation: minutes. A suspected critical finding gets a phone call to a live member of the care team within minutes of recognition, documented on the report with time and recipient. This is a patient safety requirement with teeth: timely critical results reporting has been a Joint Commission National Patient Safety Goal area since 2005, and the ACR Practice Parameter for Communication of Diagnostic Imaging Findings sets the professional standard for nonroutine communication. A portal flag is not a phone call. Ask exactly who calls, whom they call when the ordering clinician is off shift, and where the attempt is documented.

Operational escalation: under half an hour, any hour. A study stuck in routing, a missing prior, a bridge that dropped: your night technologist needs a human who can fix it, on a number posted at the console, with a stated response time. This lane gets no marketing attention and decides more of your team's lived experience with a provider than any other row on this page. Test it during the pilot by placing a call at 1 a.m. and timing the response.

Contractual escalation: written and staged. Miss patterns trigger remedies in sequence: the monthly report flags the miss, credits apply, a cure period runs, and termination follows if the cure fails. Staging matters because it makes enforcement usable; nobody terminates over one bad week, so a contract whose only remedy is termination has no working remedy at all. If it does come to an exit, the switching guide covers running the transition without a coverage gap.

What QA cadence should you expect from a teleradiology provider?

A working quality program has four visible parts, and every one should be documented in the agreement, never merely described on a call.

1. A sampling rate for peer review. A defined fraction of reports gets a second read, blind, by a different radiologist. AstraRad double-reads 1 in 20, blind to the first read, and the double-reading methodology explains why blind is the load-bearing word.
2. A discrepancy classification. Minor versus major, defined by clinical significance, with the definitions written down.
3. A recurring review meeting. Every major discrepancy reviewed case by case, closed with the reader who signed, on a monthly cycle.
4. Client-facing results. The rates and the log reach you in the monthly packet. A quality program whose outputs stay internal is indistinguishable from no program.

Context for reading any vendor's numbers: ACR RADPEER is the field's peer review framework, and ACR states that no scoring benchmarks have been established, so there is no official rate to beat; the RADPEER scoring guide unpacks what the scores do and do not mean. Compare providers on whether a rate, a method, and a meeting exist at all, and on whether you receive the evidence.

The first 90 days set the pattern

Expectations start before steady state, and the early weeks predict the later ones.

Window	What a good provider does	What you should do
Days 1 to 15	Credential files delivered; licensure verified for your state; integration test studies flow	Verify two reader licenses yourself against the state board lookup
Days 15 to 45	Paid pilot reads on real studies; routing rules tuned; escalation contacts posted	Run the 1 a.m. operational escalation test; time an addendum request
Days 45 to 90	First two monthly reports arrive unprompted; discrepancy log includes pilot volume	Reconcile five studies against your PACS timestamps; hold the first review call

A provider that hits all six left-column rows has shown you its operating culture. One that misses the first monthly report in month two will not improve in month twelve, and it is far cheaper to act on that signal inside a pilot than after full cutover.

What your provider should expect from you

The relationship runs both ways, and the facilities that get the best service from any teleradiology provider are the ones that hold up four obligations of their own.

Clinical history on every order. A one-line indication changes reads. "Fall, left hip pain, on warfarin" produces a different level of scrutiny from "pain," and interpretation quality studies consistently trace a share of discrepancies to absent history. If your ordering workflow strips the indication before the study routes, fixing that feed will do more for report quality than any vendor change.

Priors, reliably. Comparison studies are half the value of many follow-up reads, oncology and pulmonary nodule work above all. Agree at onboarding on how priors travel: pushed with the study, queried automatically, or fetched on request, and who is called when a prior exists but did not arrive. A provider reading without the prior you have on disk is producing a worse report than you paid for, and the failure is in the pipe, on your side of it as often as theirs.

Volume forecasts for the swings you can see coming. A new referrer group, an added scanner, a seasonal clinic opening: two weeks of notice lets a provider schedule readers instead of absorbing the surprise into your turnaround numbers. Per-report contracts like AstraRad's carry no volume commitment in either direction, and a forecast is still the difference between a smooth month and a fast apology.

Feedback through the channel, not around it. When a referrer questions a report, route the question through the provider's stated clinical channel so it lands with the signing radiologist and enters the QA record. Complaints that travel through the sales contact evaporate; questions that enter the discrepancy process change reader behavior and show up in the monthly log you review.

None of this excuses a provider that misses its SLA. It does mean that when the monthly report shows a slipping number, the review call should look at both sides of the interface before either side reaches for the contract.

The one-page expectations sheet

What you are owed in ordinary operation: a service model in writing with staffed coverage, routing rules, and a named contact; an SLA with tiers, a clock definition, a compliance percentage, and remedies; a monthly report you never have to request; three escalation lanes with three stated clocks; and a QA program with a sampling rate, classifications, a meeting, and client-facing results. None of this is exotic. All of it exists at providers that measure themselves, and the absence of any line is information.

AstraRad's version of the sheet is published rather than promised: tiers and their definitions on the SLA page, per-report pricing with no minimums on the pricing page, and the monthly quality report above for every client. To see the whole package against your own volume, a written rate card and the written SLA terms arrive together, one business day after a request.