Singular Benefits: Integrated RIS/PACS Delivers

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Sponsored by an educational grant from GE Healthcare and HP

Case Study: Memorial Sloan-Kettering Cancer Center |  New York, N.Y.

  Kate Lynch, radiology IT & PACS manager, and Peter Kijewski, PhD, attending physicist and PACS project director, in the radiology department library at Memorial Sloan-Kettering Cancer Center in New York City.
Memorial Sloan-Kettering Cancer Center in New York City epitomizes the large-scale filmless radiology enterprise. The cancer center was an early PACS adopter and first deployed digital image management in 1998. Today, the center completes more than 305,500 imaging studies annually at its five main locations and is virtually filmless. Nearly 150 radiologists read images for Memorial Sloan-Kettering. PACS pervades the enterprise. One hundred imaging systems feed images into the PACS. The center houses about 70 diagnostic radiology workstations and 400 PACS workstations. Plus, nearly 9,000 personal computers are equipped with web-viewing capabilities. All told, PACS represents a tremendous IT maintenance and management responsibility for this enterprise focused on cancer diagnosis, treatment and monitoring.

Memorial Sloan-Kettering aims to streamline RIS/PACS processes with the implementation of an integrated GE Healthcare Centricity RIS/PACS. “RIS and PACS were developed independently, but it is important to bring the two systems together,” says Peter Kijewski, PhD, attending physicist and PACS project director. The integrated model can bring significant IT efficiencies including streamlined support and reduced costs.

The cancer center first considered replacing its RIS with an integrated model in 2002, but decided to put the project on hold because the desirable information systems did not offer synergy with Centricity PACS at the time.    

Fast forward to 2006. GE acquired IDX Systems Corporation. Centricity RIS-IC offered synergy and integration with Centricity PACS, and Memorial Sloan-Kettering decided to deploy the new RIS. The goal is to merge all functional components into a single system, including embedded voice recognition to minimize the requirements for moving data between systems and interfacing various systems. The implementation is a work in progress, but ideally, RIS-driven workflow will direct the navigation and events within the system.  

An IT boon

The new integrated RIS/PACS is expected to deliver significant benefits at Memorial Sloan-Kettering Cancer Center. All users benefit from the upgrade, but the primary payoff is in terms of IT infrastructure and support, says Kijewski.

“There will be one instance of each patient and exam, which means users won’t need to pass through multiple systems to complete a case. There will be one user interface for both RIS and PACS,” adds Kate Lynch, radiology IT & PACS manager. Currently, radiologists primarily interact with the PACS interface, viewing all reports and images in PACS and completing dictation via a PACS-integrated, but separate, voice recognition system. An embedded dictation system with voice recognition will lead to improved workflow, enabling radiologists to access lab interfaces to enhance the protocoling process and providing more flexible worklists. Technologists, who use both systems in their daily workflow, will no longer need to move between the RIS and PACS to complete cases and verify images.

IT maintenance and support needs should drop with the streamlined system, says Lynch, freeing staff to work on other projects. Consider, for example, business continuity. In the current environment, IT must provide high availability and disaster recovery for three distinct systems: RIS, PACS and voice recognition. “When the functions are integrated into a single system, we can transition to a single support infrastructure for major radiology applications,” explains Kijewski. Take a look, too, at the center’s dictation application. It requires three distinct onsite production servers in the computer room and then an additional three mirrored servers for business continuity at the offsite location.

IT also requires test systems. PACS needs three test systems: a test system for current production, a test system for the next software upgrade and a test system for a planned major forklift upgrade for improved capacity and compatibility with RIS/PACS. An integrated RIS/PACS/voice solution streamlines the server burden and frees up real estate in the computer room.

The new configuration should streamline image retrieval, too. As a dedicated oncology hospital, Memorial Sloan-Kettering physicians are heavy users of prior studies. The center also adds patient studies acquired at other locations to its PACS and ensures that all current and previous images are online and available. “Memorial Sloan-Kettering is a major tertiary institution and therefore many patients present with outside studies their physicians wish to submit into PACS,” Lynch says. “Having a combined RIS/PACS will minimize much of the data duplication and present a common view to the exam data that is lacking today. Our RIS displays the submission date of the study, while PACS displays the date/time stamp for the original acquisition. These contradictions can be confusing. If both times were available and labeled correctly in one system, it would be simpler.”

The integrated Centricity framework will level IT service and support. “There is tremendous variability in service and support from different radiology companies,” confirms Kijewski. Not all vendors adhere to a well-structured support model that appropriately documents and records incidents or follows a clear escalation plan. “We’re trying to focus on a single vendor with good support,” he says.

Interoperability presents another area with room for improvement. Every healthcare enterprise houses different technologies in its implementations; they all require reliable communication among systems. The problem, says Kijewski, is that systems are not necessarily designed to work well together. Unfortunately, Integrating the Healthcare Enterprise (IHE), HL7 and DICOM do not provide a complete solution. The issue is magnified at Memorial Sloan-Kettering because it is a large installation across multiple locations.

While some clinicians may promote best-of-breed solutions, the IT burden of the best-of-breed approach may outweigh the benefits, says Kijewski. “It’s very difficult to manage four to six vendors that all support radiology applications.” For example, it can take months or longer to resolve a seemingly simple multi-vendor IT communication glitch.

“When there’s one vendor, the burden of developing a solution falls on one party,” explains Kijewski. The single-vendor approach reduces or eliminates problems caused by different systems trying to communicate with each other, which, in turn, allows the system to focus on higher level needs like business continuity and disaster recovery.

What’s more, the single-vendor model is more cost-effective. “Working with multiple vendors, support teams and different technologies require staff time and effort, which translates into cost. At the end of the day, best of breed is a much more expensive system,” opines Kijewski.

The single-vendor approach also facilitates business growth. Kijewski explains, “We are very rapidly growing with multiple imaging centers under construction. We will require an IT performance uplift as we bring new centers online. This is easier to do with a single system than it is with several disparate systems and vendors.”

RIS/PACS: The big picture

Integrated RIS/PACS is the wave of the future, and, at the same time, it is a work in progress. “Any customer considering RIS/PACS needs to be cognizant that the product will undergo an evolutionary process. Benefits will take time to develop,” Kijewski says.

Kijewski and Lynch recommend that colleagues evaluating new systems ask and answer the following questions:
  • Is the system truly consolidated, or does it merely glue together various components?
  • What benefits are available? When will benefits be available?
  • Is the company in the market for the long haul? Can the system grow with the hospital or enterprise?
Integrated RIS/PACS is a long-term project—an investment—rather than an acquisition. It requires a solid vendor committed to the undertaking. The gains, however, are significant, particularly for the IT department as it reduces the IT burden, facilitates streamlined business continuity and cuts overall costs.

Taking Voice Recognition to the Next Level
Memorial Sloan-Kettering Cancer Center in New York City first deployed its current voice recognition solution in 2003, beginning with nuclear medicine and interventional radiology and bringing the system to other areas over a six-month period. “The initial implementation was challenging,” admits Peter Kijewski, PhD, attending physicist and PACS project director, “because the voice recognition system and PACS were not integrated at first.”

Today, however, the center is a voice recognition success story—with 95 percent of its dictating radiologists self-correcting, which has improved report turnaround time and cut costs. Despite completing in excess of 300,000 exams annually, the radiology department employs only two part-time transcriptionists. Kijewski attributes the hospital’s success to a variety of factors: improvements in the voice recognition system, better integration between PACS and voice recognition, use of a PACS workstation reading model and radiologists’ willingness to adapt to the new system.

The next step, says Kijewski, is to deploy GE Healthcare Centricity RIS/PACS with embedded voice recognition. “It will bring smoother workflow for radiologists.” For example, under the current model, the systems appear unified to radiologists. In reality, however, multiple steps take place in the background to move data from the voice recognition solution to RIS and then to PACS. Embedded voice recognition eliminates the extra steps and the delays that occur as data are transferred between systems. In addition, the new system will simplify IT support by reducing the number of distinct systems to be maintained.

Integrated RIS/PACS/voice is a winning combination that delivers benefits to radiologist end-users and IT staff—as well as physicians, referring physicians and patients who get vital information more quickly and efficiently. It streamlines processes for all users, driving increased efficiencies and reduced costs.