Remote Second Opinion programs are growing. Here's what you need to know.

RSOs allow patients and existing providers to access specialist consults for complex cases without the need for in-person encounters. Patients or referring providers request an RSO and a specialist or subspecialist reviews the case and either confirms a diagnosis and proposed course of treatment, or recommends further testing or new treatment plans based on specialty expertise.

The most common populations who use RSOs include patients with complex or life-threatening conditions and patients in rural areas.

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RSO companies offer a variety of service models to facilitate specialist opinions. Service companies rely on administrative staff to procure all relevant documents and pass these to specialists, while software companies optimize technology to streamline labor-intensive document consolidation. Both service and software companies transfer patient records and clinical information to the specialist for review.

Access to specialty care is limited in large parts of the United States. Many patients who opt for an RSO lack specialists in their immediate geographic area. There are 30 specialists per 100,000 people in rural America, compared to 263 in urban areas. However, RSOs apply to all patient scenarios—including in urban areas where patients or providers seek expert consultations for complex, or rare diagnoses from the most appropriate specialist.

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This disparity is particularly true in oncology, where only 7% of all oncologists practice in rural areas. A 2019 Advisory Board survey of cancer patients showed the most important feature when deciding where to seek cancer care is “a doctor who specializes in my care.”

Some data suggests that RSOs may result in changes in more than 80% of initial diagnoses. However, more conservative estimates indicate that an RSO can affect initial diagnoses or care plans in 20-40% of cases. RSO consults broadly impact not only patients, but other important health care stakeholders.

 RSOs consist of five main stakeholders: patient, local provider, specialist (sometimes referred to as the ‘expert’), payer or employer, and RSO company. Providers may launch their own program, or can partner with RSO companies to use their software and services to streamline the end-to-end process.

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The RSO workstream requires a patient or local provider to initiate a case. Then, a provider—with or without an RSO company—compiles all relevant documentation (e.g., imaging files, labs, pathology records). This is typically the most time-consuming part of the process. After compilation, an assigned specialist reviews the records and the initial clinical question(s). The specialist bills the patient for his/her services and delivers the remote second opinion typically within two weeks of receiving all the files.

 While RSOs help patients connect to appropriate specialists around the country, launching an effective program requires clinical and administrative leaders to overcome four main barriers. These barriers include clinician education, organizational buy-in, workflow integration, and reimbursement. Any provider organization should proactively address these challenges when starting an RSO program.

 RSOs can result in diagnosis confirmations, adjustments, or care plan changes. A confirmed diagnosis brings peace of mind to patients and local providers, while the latter two bring clarity and confidence to the patient and local provider.