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When Dr. Zoe Lenard, radiologist and co-founder of Animalius in Perth, Australia, talks about her work, her passion is unmistakable. A self-described “vocational veterinarian,” she knew from an early age that she wanted to dedicate her life to veterinary medicine. Her journey began on a small Angora goat farm in rural Australia, with dreams of becoming a country vet. But during her training in Sydney, she discovered radiology through specialists who seemed to effortlessly decode complex images. That spark led her to pursue a radiology residency in Perth, become a registered specialist at just 30 years old, and eventually co-own her first referral practice.

When a patient faces a major diagnosis—like cancer, cardiac surgery, complex autoimmune disease, or neurological disorder—the treatment choices that follow are often life-changing and expensive. For insurers, these are the moments when clinical accuracy and cost discipline intersect most critically. That’s why forward-thinking employers and payers, including both traditional health insurers and stop-loss carriers, are increasingly investing in second medical opinion programs.

As subspecialists, we all rely on radiology to inform our clinical decisions. Whether it’s an oncologist staging a tumor, an orthopedist assessing a fracture’s healing, or a neurologist evaluating subtle changes on an MRI, imaging often holds the key to diagnosis and treatment planning.

But for many of us, the greatest hurdle isn’t interpreting the images—it’s simply getting them in the first place.

For decades, “ROI” — Release of Information — has been the backbone of how medical records move from one place to another. It served its purpose: ensuring compliance, logging consent, and safely getting data from Point A to Point B.

But ROI was built for a paper-based past — a world of fax machines, CDs, and manila envelopes.

 That world no longer exists.

As cross-border healthcare grows, US hospitals and specialty clinics are increasingly receiving requests for second opinions from patients who are located outside the US. These inquiries often involve detailed medical records in foreign languages. While international patients may submit records directly, failure to require translation into English before submission may create clinical, operational, and legal risks.