Establishing priorities for buying RIS, optimizing the EMR for radiology and evidence-based radiology were among the priorities discussed at the SCAR U session on IT on Thursday at SCAR. Janice Honeyman-Buck, PhD, of University of Florida instructed participants on the ins and outs of buying or upgrading a RIS. Katherine P. Andriole, PhD, of Brigham and Women's Hospital provided suggestions geared toward optimizing the EMR for radiology. And Ramin Khorasani, MD, MPH, of Brigham and Women's Hospital focused on evidence-based radiology.
Honeyman-Buck provided a thorough overview of the issues and pitfalls of purchasing a RIS. She divided RIS into three categories: simple, more complex and complex.
The simple RIS orders and schedules studies and manages reports. Typically, a stand-alone system that doesn't interface to other systems, the simple RIS includes two to four workstations. A more complex RIS adds functionality such as a billing module or an interface to the billing system, film tracking and image checkout. It grows to 10 to 20 workstations. A very complex RIS is defined by interfaces and may offer interfaces to HIS and PACS as well as a web interface for report access and patient tracking tools. It may include more than 100 workstations.
"Step one," says Honeyman-Buck, "is to specify what you want." Hospitals and imaging centers should form a task group composed of key users including IT and billing staff, radiology administration, technologists, radiologists, film librarians, patient registration staff and the PACS administrator.
The task group needs to write specific goals to include in the RFP. Which work processes should be automated? "Use the exam workflow to look at processes," recommends Honeyman-Buck. She offers sample goals and objectives:
- Integrate and automate front office and billing processes with electronic claims submission to accelerate cash flow and reduce lost charges
- Interface with PACS to integrate images and reports
- Increase referring physician satisfaction
- Process more patients with the same FTE count
Objectives should be measurable, and the RFP should include all requirements such as order entry, ICD9 support and inventory management. Sites upgrading a RIS should list needed features and specify migration of current data and when and who completes the migration. The RFP should detail expected performance -- such as a query for the patient record should return results in less than two seconds. Hospitals need not specify how requirements must be met unless they have specific needs like a running on 10 megabit network.
Honeyman-Buck suggests assigning a weight to each requirement to facilitate ranking of proposals. Other components of the RFP include institutional background, installed systems that must be interfaced, timelines and a proposal format.
After proposals are received, the task group ranks each requirement with higher ranking for the best system. When scores for each requirement are multiplied and then added, the group will have a clear numerical 'winner.' Still, a buyer-specified demonstration with real data is essential before a contract based on the RFP is written.
Honeyman-Buck concludes with 10 mistakes to avoid when buying a RIS:
- Not using a structured process
- Not defining needs
- Hiring a consultant with a bias
- Too much attention to bells and whistles
- Not including key users in the selection process
- Buying more than needed
- Allowing the vendor to drive the process
- Letting the 'powers that be' choose the system
- Confusing the salesperson with the product
- Not using the RFP process
Andriole outlined the functionality and technology necessary optimize the EMR for radiology. She listed components of the EMR, important features for radiologists and key implementation issues.
The EMR is a multi-faceted system that includes the HIS, CPOE, RIS, PACS, report generation systems, decision support and teaching files. "Radiologists need to be aware of healthcare enterprise information management systems. PACS and RIS can increase workflow and reduce costs, but radiology can't eliminate film and paper without embracing other systems, integrating with IT and disseminating knowledge enterprise-wide," Andriole said.
To understand radiology and the EMR, radiologists should understand functions of its components. The HIS is the point of patient entry into the healthcare system and contains