RIS IN THE 21ST CENTURY
Improvements in radiology information systems have been driven by newer technologies, such as PACS (picture archiving and communications systems), voice recognition software and electronic medical records (EMR). And a must of any effective RIS today is scalability to change with the department and enterprise.
"With new technology comes an amount of interfacing that needs to be streamlined and centralized toward the new EMR," explains Travis Turner, manager of radiology and director of PACS at Catskill Regional Medical Center, a 175-bed facility in Harris, N.Y., that uses Misys Healthcare Systems' Misys Radiology. "Having a RIS is key to this ultimate integration."
Basic RIS applications include patient registration order entry, data analysis, management reporting, scheduling, tracking and transcription functions. Newer versions include compliancy with industry standards, such as Integrating the Healthcare Enterprise) and HIPAA, integration with PACS and HIS (hospital information systems) and mammography support, and are more user friendly to minimize training.
"When RIS first hit the market, the systems were designed more for the department manager to capture information so they can report things that were happening within the department," says Don Taylor, product manager for Siemens Medical Solutions, Novius Radiology. "Now with the integration between systems, the RIS is more focused for the radiologist and for the referring physicians to get them information in a timely fashion."
Radiology information systems with distributed architecture are appealing to customers today as patient volume increases and the referring community demands quicker access to information. "The change has come about where radiology departments require more access to more clinical information than they may have in the past," opines Taylor. "As automation has expanded, there is a greater reliability in making sure that patient information is available at the same time you are trying to provide a diagnostic review."
The Internet is an integral force driving radiology information beyond department walls. A Web-based component is the main reason Indiana University Radiology Associates Inc. (IURA), a radiology practice of 70 radiologists in Indianapolis that interprets radiographs for multiple facilities, implemented Ximis Inc.'s Xiris, a Web-based RIS.
"The RIS is our foundation," says Rita McFarland, director of medical imaging at IURA. "We could not function without it because it distributes our workflow, houses reports, and distributes our reports automatically. The Web-based component is important because we can access it anywhere - this is extremely important for our referring physicians."
The RIS also helps IURA carefully monitor workflow. "Let's say a patient goes to one of our networked imaging centers for a study and the referring physician needs the report the next day," explains McFarland. "We monitor to see when the study went to the reading room and when it got read by the radiologists to make sure the referring physician has that report. Our out-reach staff monitors this and continuously looks at the unread worklist."
While IURA's nucleus is its two main imaging centers, it also offers an outreach service that is a profitable addition to the practice, which according to McFarland, would not exist without the RIS.
One of the goals of an automated healthcare system is to meet the unique criteria of any-sized facility and positively augment productivity, guaranteeing that patients are given the best care possible. Donna Seay, director of operations at Western Imaging Center in Culver City, Calif., praises the flexibility of their RIS because it meets the unique requirements of the multi-modality, independent imaging center. Needing a RIS that was affordable and more schedule-centric than billing savvy, Western Imaging Center installed Swearingen Software's RMS RIS.
"We need a good scheduling package that will be flexible because we have particular exams that we only want to do during certain hours," says Seay. "It allows us to look at the department as a whole, which is a valuable tool for managers and supervisors. We can pull up the entire department and look at the next day to see where the gaps are and where staff is needed most. You know what your volume is for the next day."
Upgrades are key to propelling workflow continually forward - but only if they don't disrupt workflow in their implementation. Seay stresses that the process, which at her facility typically takes a couple of hours, is least disruptive to workflow when accomplished early in the morning.
Upgrading a RIS for a larger institution and healthcare delivery network, such as Scripps in San Diego, Calif., is a different story altogether. Scripps includes five acute-care hospitals, four of which use Siemens Novius Radiology. Annual maintenance on the RIS costs the four facilities a total of $150,000 to $200,000, says Jean Balgrosky, CIO of Scripps. Upgrading the system to a more recent version of Novius will cost about $2 million. "It is pretty much standard practice in the healthcare IT [information technology] world to stay within two current releases of the software," explains Balgrosky.
"The upgrade project is very carefully planned at each site," says Balgrosky. "We have a team for the upgrades themselves and we create very detailed plans in terms of the data that need to be entered into the new system."
An upgrade of this size requires that the institution work on the system as quickly and efficiently as possible to minimize downtime. Balgrosky says Scripps planned the upgrade to begin at 8 p.m. on a Saturday night so they would be up and running first thing on Monday morning. "All of the activities that take place between [that time] are kept track of and loaded into the upgraded system," adds Balgrosky.
Mammography support is one of the components of the upgraded RIS at Scripps. Newer editions of RIS typically come equipped with a MQSA-compliant tracking module. It is one of the added applications to Merge eFilm's upgraded RIS Logic Module. Merge eFilm is an example of the consolidation trend happening in the industry to provide customers with more "start-to-finish" services. Primarily a PACS company, Merge eFilm acquired RIS Logic Inc., rooted in RIS, in July 2003. The company now offers an integrated RIS/PACS package called Fusion that costs anywhere from $250,000 to $1 million; the standalone RIS Module costs between $100,000 and $500,000.
"Whenever a facility is doing a mammogram, they have several regulations they have to follow in terms of process and procedures," says Tim Kilbago, vice president of product innovation at Merge eFilm. "The physicians must assign an ACR category number to the study before it is complete. Based on that assignment, certain things happen in the workflow, which the software automates. For example, if it's a four or five, the physician has to follow up because that's a recommendation for a biopsy. The physician needs to be able to follow up with the biopsy, track the results and run a report. In addition, as a provider of mammography services, you have to send a reminder letter to the patient and tell her that it's time for her annual screening. The [RIS] facilitates a worklist for reminder letters depending on how you want to run it"
Physicians, administrators and chief executives at Fairview Health Services in Minneapolis, Minn., were all in agreement that implementing a RIS was really just a cost of doing business. Since the integrated delivery network includes seven hospitals, 33 clinics and 29 specialty clinics, and conducts more than 500,000 exams annually, they decided to implement IDX Systems Corp.'s Imagecast RIS. The product is targeted toward integrated delivery networks, large hospitals and academic medical centers.
"We trained more than 650 employees on the RIS by the time we had all of our sites implemented," says Pat Berger, IMS director for Fairview. While two of the hospitals were already accustomed to workflow with a RIS, four of the facilities transitioned entirely from "paper and pencil" environments, says Berger.
What was essential to the implementation? Training. "We worked closely with our vendor to develop training plans," explains Berger. "We did surveys of all of our users for their PC literacy. In many cases, we actually had to do PC basic courses for them before we could even do RIS training. We tailored our sessions to their needs. We did technologist training, file training, radiologist-specific one-on-one training and also trained some of the nurses who worked in radiology."
For a delivery network of Fairview's size, Berger says a couple features were absolutely necessary from their RIS, including online reporting, centralized scheduling and study management. Fairview also created common standards of practice to be an enterprise-wide system, such as one physician identifier, one patient medical record and one set of procedures to define a radiology exam for every site at Fairview.
IMPROVING PATIENT CARE
"The uses of these tools have allowed just incredible gains in productivity for the technologists and radiologists and provide the services for a shorter amount of time," says Kevin Junck, PhD, chief of radiology informatics at University of Alabama Health System (UAB). Every healthcare provider strives to maximize their investment, and for UAB it meant installing Cerner Corp.'s RadNet RIS since the emergency room and operating room already use Cerner systems.
"The idea of having all of these departments together in one system to provide information to the clinicians was very attractive," notes Junck. "If the ER has determined that the patient has an allergy, we can see this in radiology. Once the lab comes online [with Cerner], these values will be available to the technologist and have an impact on what types of exams we can perform. In CT, if someone has renal kidney problems then we do not want to be doing anything with large amounts of contrast."
RIS IN THE 21ST CENTURY