Her face illuminated by the fluorescent white glow of two computer monitors, Dr. Jenna Liu examined a CT scan of a car crash victim's stomach.
Liu, a radiology resident at UC San Diego Medical Center, scanned through shots of the patient's kidneys, noting the abnormal fluid around one.
It wasn't long before the phone rang. A fax had arrived.
"That's NightHawk," Liu said.
In a time zone 17 hours ahead, a radiologist in Australia, working for a company called NightHawk Radiology Services, had been sitting before the same images. He functioned as a nighttime supervisor a world away, and through the fax confirmed her preliminary diagnosis: The patient's kidney had a small tear.
Hundreds of hospitals around the country are engaging in a new form of outsourcing -- employing physicians abroad to assist doctors on staff -- whether to confirm a preliminary diagnosis or make it themselves.
For now, such medical outsourcing is mainly confined to radiology, because digitized images can be transferred nearly as easily as photos can be e-mailed. But doctors and experts say the practice will inevitably spread to other medical fields.
NightHawk doctors are located in Australia and Switzerland. Other companies -- including International Teleradiology, based in Australia -- have physicians in France, England and the Middle East, said Barbara Fitzgerald, a company spokeswoman.
"There's no doubt that NightHawk or NightHawk-like companies are going to become more commonplace in the future," said Dr. William Bradley, who heads the radiology department at UC San Diego and helped launch the Idaho-based company.
James Bentley, a senior vice president of the American Hospital Assn., agreed.
"Historically, you had to be in the presence of the patient to do an examination," he said. Now, "you can do that at any place."
Moving diagnostic or interpretive skills offshore is just another step along a continuum, said Dr. Blackford Middleton, chairman of the Center for Information Technology Leadership, a Boston-based research organization that focuses on how information technology can improve the quality of healthcare.
Nurse practitioners and others have gradually taken over certain aspects of patient care that were once solely doctors' responsibilities, Middleton said. Now technology could allow for further substitution, from anywhere around the world.
A debate is brewing about whether this marks an advance or a wrong turn.
