In the beginning, there was film and paper reports. After quite some time, radiology information systems came on the scene, speaking Health Level 7, and then PACS joined in, speaking yet another language, DICOM. While the two could communicate through an interface broker, that added a layer of cost and complexity to the relationship. And now, there is integrated RIS-PACS - speaking one language and bringing harmony to health images and information everywhere (well, at least that's the intention).
Designing an integrated radiology information system-picture archiving and communication system means making the RIS and the PACS talk to each other - seamlessly. Often, the two systems continue to each have their own database, especially if the RIS and PACS each come from separate vendors. But a variety of RIS-PACS product offerings, like that of Stentor, make use of a single database.
Stentor makes use of Imaging Suite, an IDX Corp. workflow product that helps a RIS work with any PACS. When combined with a Stentor PACS, the two systems communicate through the HL-7 protocol, allowing the RIS to drive the workflow. "It is truly an integrated RIS-PACS," says Matt Long, vice president of marketing for Stentor.
Siemens Medical Solutions also offers an integrated RIS-PACS that features a RIS-driven system with a single worklist that is generated at initial registration. The latest version of the Cosmos system, first shown at RSNA 2003 and then launched at the Society of Computer Applications meeting in May in Vancouver, has attained FDA approval. The system is in beta testing at several sites and should be generally available in late 2004.
VitalWorks also is actively involved in RIS-PACS integration. "Integration is probably [our] biggest project," says Kevin Collins, CTO. VitalWorks' systems use IHE (Integrating the Healthcare Enterprise) standard integration profiles to produce a base level of integration. These profiles establish a common means of communication among systems. "You should be able to [share data automatically] over an Ethernet cable," he says.
Gary Jump is the CIO of Our Lady of the Lake Regional Medical Center in Baton Rouge, La. He applauds the safety and convenience of the integrated RIS-PAC system the hospital recently purchased from Cerner Corp. "There are no interfaces; orders are immediately available in radiology," he says.
Jump appreciates the way the online work queue helps clinicians manage their workflow. "Images are immediately available to all medical staff via the web [as part of] the electronic record," he says. This eliminates the need to switch from system to system in order to view images, read patient notes, and respond to work orders.
For example, a radiologist will see an image appear in his or her work queue, read the image, and dictate the findings - all from one system. The dictation is sent immediately to transcription and is electronically attached to the patient record, eliminating rejections from the transcriptionists because they cannot identify the patient.
In the emergency room, physicians can use the wet read functionality to add their notations to an image for a radiologist to consider along with the image itself. Radiology requests also are automatically posted to the ER tracking board, allowing for better management of workflow.
Improved workflow is not only a benefit for radiologists and referring physicians using RIS-PAC systems, but also for radiologic technologists. "Technologists used to have to log into the RIS to make sure a bill was created, then send the images to the radiologist through the PACS," says Teresa David, global product manager of RIS and RIS-PACS for GE Healthcare. With an integrated RIS-PACS, a log-in to a single system is sufficient for the technologist to manage all parts of his or her workflow. "We've collapsed those two steps; much [more] work can be done in a single step," David says. The additional work that is possible includes the on-the-fly recording of notes from the technologists regarding information gathered during the exam, difficulties encountered, and other information that will be useful to the radiologist as he or she reads the images.
Adoption of an IDX/Stentor RIS-PACS has meant a dramatic increase in efficiency for The Milton S. Hershey Medical Center in Hershey, Pa., says Douglas Eggli, director of medical imaging, information technology department, and chief of the division of nuclear medicine. One very important