With PACS being high on many minds, RIS — its highly organized cousin — often takes a backseat. But let it be known, current radiology information systems are a mature, robust, and flexible breed of management systems that can be tailored to the size and needs of any size imaging environment. With features that help increase patient throughput and workflow productivity, it’s no wonder that the U.S. market for PACS and RIS combined is expected to grow to $3 billion by 2010, so says Millennium Research Group. RIS users can’t imagine life without them. Some facilities choose RIS a la carte, while others pair it with an existing PACS, and still others prefer an integrated RIS/PACS. Whatever the choice, the objective of RIS is streamlining patient information and access.
From patient registration order entry, data analysis, management reporting, scheduling and tracking, to billing, integration into PACS and web-based communication with referring physicians, today’s radiology information systems do it all. “Performing an x-ray is a chain, and wherever a link is broken — you will have problems,” says Randall Stenoien, MD, a radiologist and CEO of Houston Medical Imaging. “The RIS follows that chain from the moment a healthcare facility receives the order to pre-registration, authorization, notification, registration the day of the exam, documentation when the exam is complete, radiologist dictation, transcription and final approval.”
HMI, which offers a full array of diagnostic imaging services to the greater Houston community, implemented XIRIS’s RIS (Extended Internet Radiology Information System) in August 2004. The goal of the project? Gain efficiencies, eliminate problems and consolidate office operations.
“We need to be able to run our practice efficiently because reimbursement is down,” explains Stenoien. “We need to be able to image a lot of patients quickly. The technologists need to have access to the information. We need to be able to identify all the problems before the patient arrives, so that when the patient gets here, we can get him or her through smoothly, and by the end of the day hopefully generate more revenue.”
In addition to the RIS, HMI is filmless and stores patient information in an electronic medical record system, making myriad information accessible to radiologists and offsite clinicians. The tight integration of all three systems allows HMI radiologists to read studies for several different, geographically dispersed locations, including clinics in South Texas, Panama and Vietnam. “A hospital in Panama can transmit their images to HMI, a radiologist will interpret the study, and then that [offsite clinician] can view the final reports and images over my RIS/PACS,” says Stenoien.
Patients benefit from the paperless environment because the RIS reduces the possibility for errors to occur or orders to be lost, says Stenoien. “If a patient does not show up, we are alerted so that we can call and notify the referring doctor’s office,” he explains.
Implementation & utilization are a team effort
University Diagnostic Medical Imaging, PC, in the Bronx, N.Y., is a large, privately owned outpatient facility that offers x-ray, fluoroscopy, PET/CT, x-ray, MRI, CT, nuclear medicine, and ultrasound. UDMI has a staff of more than 75 full-time employees, which includes seven full-time, onsite radiologists and onsite transcription. Turnaround time for final report is typically under 12 hours, says Robert Klein, UDMI’s administrative director.
First came PACS, and now UDMI is completing installation of Advanced Data Systems’ Medics Premier RIS. UDMI already uses a billing system from ADS, and the established relationship was one reason why UDMI selected the vendor for the RIS project. “In this day and age when adaptability of your tools to the situation is so important, you need a player that is going to listen to what you need, and to make that change for you quickly,” explains Klein. “I have a vendor that reacts quicker to my individual needs, and that is so important in the area of programming and computer management.”
So far, the RIS is helping UDMI proactively manage patient flow. “If I want to see how many patients are at the exam level of the process, I go to the RIS and click on ‘exam tab,’” says Klein. “I can then see every modality, every patient and every state that they are in. I can then click on the ‘dictation tab’ to see how my doctors are keeping up with the flow of dictation. The system also allows us to see the statistics that support that movement, which include the time it takes to complete certain exams. We can analyze that data to decide if we did a good job getting the patients in the door and through the modalities with prompt diagnosis, reporting and follow-up.”
Analyzing the gross data and being able to create change, and measure that change, is the whole essence of why the RIS is valuable, says Klein. On a daily basis, the RIS information allows UDMI to proactively solve immediate problems.
A goal to be paperless
Diagnostic Clinic of Houston’s imaging department consists of digital radiography, digital fluoroscopy, CT, MRI, mammography, bone densitometry, ultrasound and nuclear medicine. In addition to 20 FTEs in the department, four radiologists read for the practice. DCH performs more than 25,000 exams annually.
The imaging department installed Swearingen Software’s RISynergy to address certain inefficiencies of the department. Previously, the department operated on an electronic practice management system that was designed more for a doctor’s office, not an imaging department, says Danny G. Cox, RT(R), assistant director of imaging at DCH.
In addition, DCH’s imaging department needed a RIS that was going to work with all of its digital equipment, since the only modality that prints film today is mammography.
A key feature of the RIS that augments departmental workflow is a modality worklist function, which also has been integrated with a voice dictation system and PACS. “There is a front desk worklist, technologist worklist and a radiologist worklist,” says Cox. “When a patient checks in for an exam, his or her name is highlighted that alerts the technologist of his or her arrival. When the technologist completes the study, an alert appears on the radiologist worklist indicating the study is ready to be dictated.” In essence, workflow is managed electronically — with visual cues — and the redundancy of inputting patient information is reduced, mitigating errors.
“Because we do voice recognition, the doctor chooses the study off the RIS and the RIS sends a signal to the PACS to retrieve the images,” accounts Cox. “After the radiologist dictates, he or she electronically signs it and the report drops back into the RIS. The RIS then generates a charge that goes out to billing as well as auto-faxes out the report [to the referring physician]. This really increases our customer service on the patient end as well as the referring physician end.”
The department used to have a 48-hour turnaround time for reports, but the RIS has helped reduced that to under 24 hours. “The process that we have from check in to the finished report is about 80 percent paperless,” says Cox. “The further along we go with this system, I plan to be even more paperless. For me, moving toward the paperless workflow is the future. Filmless, paperless and ease of use are essential to an efficient radiology department. The less clicks the better.”
RIS serves up big on a smaller scale
Premiere Imaging Solutions in Oklahoma City is an IT and billing service support company, as well as a RIS/PACS ASP provider for various imaging centers in Arkansas and Oklahoma. Needing an internet-based information management system to support multiple offices with a volume of more than 20,000 transactions, Premiere implemented RIS Concepts’ web-based RIS.
According to Premiere’s CIO Roy Barney, the ASP model provides a low-cost alternative for smaller-sized imaging providers to be able to have a RIS without a large capital investment. “An integrated RIS/PACS allows you to have a workflow that is conducive to less data input,” says Barney. Minimizing data input reduces errors, increases report turnaround time and allows physicians to view images and reports online.
One center networked to Premiere’s web-based RIS is Imaging Solutions of Tulsa, a four modality center that provides doctors with same-day service by guaranteeing a 24-hour report turnaround. The value of the newly implemented RIS lies in increased data entry efficiencies and better manage day-to-day operations. Reports can be created to determine which exams are taking longer than usual, and the center can make any changes necessary to improve workflow.
Is a RIS essential for a small imaging center? “Yes, if they want to be competitive and gain market share,” opines Barney. The system also automates every step of the imaging exam process — from the front desk to the final report.
Customizing RIS to match workflow
These words were followed closely by Rochester General Hospital when it implemented Eastman Kodak Company’s Carestream RIS. The 585-bed hospital in Rochester, N.Y., performs 175,000 medical imaging studies annually with a radiology department staff that consists of 128 FTEs, 13 radiologists and 13 residents. The RIS automates the entire scheduling, billing and reporting information flow for all radiology exams performed in the hospital.
Several reasons persuaded RGH’s radiology department to implement a RIS. “We wanted to reduce expenses, improve productivity, increase recruitment of physicians, and improve our relationship with the medical staff,” says Pam Moseley, director of RIS/PACS at RGH. Before the RIS, turnaround time for reports could take up to 111 hours.
Scheduling ad hoc, RGH also realized its room utilization was 40 percent. “Now [with RIS] we are scheduling our rooms 100 percent, everyday,” says Mosley. Both ultrasound and CT have experienced a 20 percent increase in throughput, and diagnostic x-ray has seen a 3 to 5 percent gain in efficiencies, she says.
For RGH, the most effective feature of the RIS has been its ability to produce any type of management report the department needs. “I can look up anything,” Moseley says.
Benefiting from the system’s flexibility, RGH has customized its RIS to match workflow. “The screens match the way we work,” explains Moseley. “We did a lot of upfront benchmarking to determine how we work daily — step by step. We put those features into our RIS. The key is being able to design it yourself and being able to monitor it as you go along.
“You need to know your workflow,” Moseley continues. “If you don’t know how you work, you cannot buy the system that’s right for you. And that means analyzing everyone — from the clerical staff to the radiologists.”