RIS-driven Workflow Simplifies a Complex Practice

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Sponsored by an educational grant from GE Healthcare

Radiology & Imaging Specialists  |  Lakeland, Fla.

  Radiologist Scott Fargher, MD, reads PET images on a GE Healthcare Centricity RIS-IC workstation at one of Radiology and Imaging Specialists’ imaging centers in Lakeland, Fla.

Radiology and Imaging Specialists in Lakeland, Fla., is a complex radiology practice. The group provides professional services for four hospitals in central Florida and operates five geographically diverse imaging centers. Its 17 radiologists interpret 500,000 studies for more than 100 referring physician offices annually. In addition, Radiology and Imaging Specialists leases its image management system to another practice.

The practice’s complex configuration is profitable in the booming central Florida market, but it does present significant challenges. COO and CIO David Marichal explains, “When I arrived in 2003, the practice had no RIS or PACS. There were too many workflow inefficiencies for a standard standalone PACS.”

Marichal realized that web-based RIS architecture could address many of the practice’s challenges by providing a consistent view of the practice from any location.

In 2004, Radiology and Imaging Specialists deployed GE Healthcare Centricity RIS-IC, integrating the system with a third-party PACS. The transition to RIS-driven workflow reinvented the practice; it facilitates streamlined workflow for all users, which, in turn, trims expenses and improves service.

The first step: workflow analysis

Radiology and Imaging Specialists was mired in inefficient workflow prior to installing Centricity RIS-IC; however, simply purchasing a system does not guarantee optimal results. The practice deployed RIS and PACS concurrently and built its workflow around the synergy of the two systems, designating Centricity RIS as the workflow engine.

The rationale behind RIS-driven rather than PACS-centric workflow is simple. RIS begins and ends the work process. Radiology workflow starts with scheduling and ends with billing; PACS can not handle those tasks. RIS puts information in the hands of every decision-maker—from the radiologist to the scheduler and the technologist, says Director of Informatics Sal Tejeda.

Radiology and Imaging Specialists undertook a thorough workflow analysis prior to deployment, examining every step of every process of its business. One of the top complaints of employees? Paper and the requisite paper shuffling in a non-automated practice.

Prior to the RIS/PACS deployment, scheduling and billing required multiple phone calls and considerable paperwork. Both drained efficiency. In contrast, the ideal scheduling and insurance workflows are based on solid, efficient processes that allow a practice to capture all necessary information for authorizations and pre-certifications. RIS/PACS automates theses key workflows; the practice is confident that staff has efficiently gathered all information needed for both reimbursement and patient safety. In addition, items like patient allergies and contraindications are visible across the system to prevent problems.

RIS-driven workflow also helped the practice improve physician workflow, allowing it to deliver everything radiologists need to accurately interpret the study in the minimum number of clicks. The patient record and images are available in a single location. RIS/PACS also separates studies for referring physicians who complete their own interpretations. Images are in a distinct worklist and don’t cross-contaminate radiology workflow. “Everyone is happy,” Marichal says. “The patient exam and report distribution are timely, which satisfies patients and referring physicians. And we know we will be paid. These aren’t mutually exclusive benefits.”

From paper-driven to film-free via IT

Technology is the ticket to the transition from inefficient, paper-heavy radiology to streamlined, digital workflow. Radiology and Imaging Specialists invested heavily in technical infrastructure to support its RIS/PACS implementation.

Its sophisticated network infrastructure is built around a fiber optic network that connects all of the practice’s imaging centers. Recently, the practice upgraded from a VPN mesh to a hub and spoke-straight VLAN configuration. The hefty network also supplies bandwidth needed to share workload among radiologists. Because the web-based system provides consistent, universal access across imaging centers and at radiologists’ homes,