How can my hospital choose the best software for a remote or second opinion service?

What does an effective second opinion service entail?

In the post-COVID-19 world, most hospitals will be scrambling to reclaim the revenue they missed during the pandemic. Certainly, a good portion of normal operational revenue will revive as patients become more comfortable returning to the hospital for non-emergency conditions and delayed procedures. But making up for the losses arising during the pandemic will be a daunting task.

Hospitals that had relied solely on their bricks and mortar facility will no doubt need to consider their physical location as only a part of the healthcare arsenal they can wield. One important part of the ammunition that every hospital should consider adding is a remote expert or second opinion practice.

The foundation of most remote or second opinion practices is a software platofrm coordinates the interaction among the hospital and its patients as well as with its physicians.  Choosing the right software starts with the consideration of what will be required to successfully and profitably operate this new practice area.

Getting this part right is important. Below are some considerations for selecting the right software.

  1. The software you select should be web-based so that it is accessible in any location on any equipment at any time. This gives your most important resource, your physicians, the flexibility they need to ensure that handling remote opinions can fit into their already busy work day. Of course, all storage, access and transmission to and from the system as well as who and how patients, doctors and administrators operate the system must be secure.
  2. Patient Self Service. The more Patients and referral sources can initiate requests for second opinions without having to talk to a human the more scalable and the less the administrative burden. An intuitive, easy to use patient interface will go a long way towards improving your throughput.
  3. Electronic gathering of prior clinical records. It’s important for the system to be able to automate the assembly of the patient's prior records. This is often one of the most time consuming and tedious parts of a practice, starting with obtaining medical release forms. Having these forms patient-generated and transmitted electronically to identified sources who may have access to the patient’s prior records, will save a lot of time. Then enabling prior providers to upload these records electronically, rather than faxing or mailing, hastens the process. Electronic collection avoids the tedious and error-prone process of figuring out which forms are for which patients, especially for medical images whose patient IDs will differ among providers. By tagging these automatically to a case, the administrator is relieved of a big burden.
  4. Tracking Case Progress. The system should be able to identify cases along the completion continuum, to enable the administrator to ensure that the case progress is as expected. Keeping track of where a case is, enabling updates along the way, and gently prodding the responsible parties to complete their assignments can increase efficiency.
  5. Coordinated access, viewing and reporting. Reviewing physicians should have access to a complete consolidated case record and view them in the system without requiring specialized hardware or third-party software. Having the complete record in front of the physician, no matter where they are located, makes it much easier to gain a complete understanding of the case and leads to better opinions. The system should also enable them to generate the opinion/report.
  6. Accept structured and unstructured data of any format. The more different types of documents and files the system is able to accommodate the better. These should include DICOM images, pathology images, text or .pdf formats. Electronically capturing some of these large, hard to handle data, will simplify and speed the process along.
  7. Real time patient video conferences. With recent changes in insurance coverage, the best remote medical systems enable consults between reviewing physicians and patients from within the system, while the physician is reviewing the case. Rather than have to delay a review or cause the physician to have to separately reach out to the patient, having the facility to initiate and complete a face-to-face remote session can be critical when there is missing or confusing case information.
  8. Collaboration among physicians. Physicians, subspecialists, referring physician, primary care and others, must be able to collaborate and share their findings and opinions electronically as a case is reviewed. Often, complex cases may need to be shared among different disciplines or jointed reviewed by a group such as a tumor board.
  9. Embedded messaging. Communication among physicians, to patients and hospital administrators should be able to be accomplished right from within the system. The less the user is required to go outside of the system to communicate, the more secure and efficient the process.
  10. Integrated Billing. Most remote or second opinions require an out of pocket payment. The system should be capable of identifying, communicating and collecting this fee. Generally, patients who are requesting remote or second opinions are not already part of the hospital’s health record system, making it difficult to generate a separate bill for this service. Unless the patient is admitted or scheduled for a procedure, there is little need to rely on the bulkier hospital systems to handle the billing for this service.
  11. Case Exports. The information included in a second opinion case should be able to be ported electronically to the hospital’s electronic health record system as well as available to the patient for his or her further access and use. If the patient is admitted or schedules a procedure, you will need an easy way to import these records to your internal records systems.
  12. Electronic referrals / Third-Party Access for Other Institutions or Referral Services. If you want to establish a network among related institutions, it would be helpful if the system could accommodate volumes of referrals by enabling them to seamlessly refer patients to the hospital using a similar interface. The preference is for the architectures to be set up in a parent-child relationship between the parent (hospital) and the child (referring institution or concierge).  The  child will want to view all of the data and the status of cases for the patients it is referring. The parent will want to restrict the referers view to only their own patients. A hospital with an active set of referrers should enable those sources with software that directly integrates with their own second opinion system.
  13. Rich Second Opinion Case Reports. Final second opinion reports should include graphics, tables, attached documents, key images (in picture format), and complete background of the authors of the opinion. Reports should include the date of each review, the specific author of a section (if multiple authors) and the date of any revisions or addenda. Reports should also include the capability of generating prescription scripts and tests.


The list includes many of the most important features of a remote or second opinion system. Not all systems have all of these features.  If you focus on which are the most important to your particular organization at this stage of your remote or second opinion maturity, you will be rewarded by increased efficiency that will enable you to scale and deliver these opinions in a way that ensures your growth and contributes to your institution’s profitability.

Purview's Expert View aims to offer many of these services for providers to offer second opinions or remote consultations on patient cases. Click below to learn more! 

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