Blurring the Lines: Interfaced vs. Integrated RIS/PACS

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The differences between interfaced and integrated RIS/PACS are no longer cut and dry as industry definitions are redefined and many vendors offer single, integrated solutions with clear benefits.

Determining whether a solution is integrated or interfaced becomes mired in how the two terms are defined within the industry. For some, the difference lies with the inclusion of a broker, or interpreter, between the two systems, communicating Health Level 7 (HL7) messages from the RIS to the PACS. If a broker is involved, the system is interfaced. In this configuration, having an interface broker does serve a purpose, however it can add a level of complexity and cost, due to maintenance or upgrade of the broker.

For others, the main difference is quite simply related to the number of databases used. Interfaced in this case would mean the RIS/PACS have two separate databases; they share one if integrated. In this scenario, the capability to understand DICOM is built into the RIS to manage both the radiology clinical and image workflow.

The definition of an integrated system also has morphed for some into a system with a consistent user interface and a seamless flow of data between the databases—whether it is one or two—and a granular workflow consistency between the RIS and PACS. An interfaced system thus would have a limited exchange of data, not always be immediate.

So what’s a facility to do? In looking for an integrated RIS/PACS, hospitals and imaging centers are looking beyond these differences in definitions and basic questions about brokers and DICOM and HL7, and focusing on systems that will facilitate a paperless environment, systems that improve document management and communication, and overall, improve workflow.

A seamless flow of data

“In the past, the difficulty was that one system was the driver and everything else just responded to those events,” says David Piraino, MD, imaging informatics officer at the imaging institute within the Cleveland Clinic in Ohio. “You simply did not have a consistent user interface.”

With each system, including the EMR, having its own user interface and concepts, users had to learn all the peculiarities of each and transferring data from RIS to PACS could only be done at certain steps. This intermittent approach did not allow the seamless flow of information that a facility like the Cleveland Clinic Imaging Institute—with an annual imaging procedure volume of 1.7 million to 2 million—demanded. The Institute spans multiple hospitals and radiology departments and to ensure the flow of data is not interrupted, a number of software applications, including the syngo Workflow (RIS) and a combination of SIENET Magic (legacy) and syngo Imaging for PACS from Siemens Healthcare, are deployed.

Cleveland Clinic recognized that the next evolution of an integrated RIS/PACS involved interfacing patient content with EMRs. “Ideally, in an integrated system, you would sign-off on a report and immediately the next case would appear. In an interfaced system, you have to sign-off and tell it to go to the next case in the worklist,” he says. “The granularity of how it works begins to break down as you get to the sub-steps in the workflow and have more ‘open and clicks.’” This workflow granularity is an advantage of an integrated system compared to an interfaced. “In a truly integrated system, everything stays in concert,” he says. “Rather than having a delay between HL7 interfaces, you maintain patient exam context in all applications immediately rather than having a single driver and several things that just respond.”

As for any breakdown in communication, Piraino says it mainly occurs between the dictation system and the RIS.  For example, there is about a 10 to 15 second delay between the sign-off in speech recognition and the time it takes for it to reflect in the RIS. This is when everything is working well, Piraino notes. “When it is not working well, the delay can be minutes, during which it is not uncommon for my colleague to try to pick up the case and try to start dictating a study already completed—which interrupts workflow. In the worst case, you could potentially have two dictations on one exam because we have more than one dictation system in use.”

Integrated RIS-driven workflow

An integrated RIS/PACS has helped the MRI Center of Idaho, in Boise, improve workflow processes across its business platform. The center, which performs approximately 10,000 procedures annually, is comprised of