RIS/PACS in the Imaging Center: Shifting from Best of Breed to Best Practices

Shifting from Best of Breed to Best Practices

 Dynamic Medical Imaging in Columbus, Ohio, utilizes GE Healthcare Centricity RIS/PACS IW (formerly Dynamic Imaging IntegradWeb RIS/PACS).

Integrated RIS/PACS is the hot ticket in radiology these days. With mounting pressure on imaging centers to do more with less, a single RIS/PACS solution can provide the helping hand that many centers desperately need. Integrated solutions are designed to improve workflow processes, can help boost the bottom line and for sure bring greater efficiency.

Integrated RIS/PACS delivers increased efficiencies, says Lisa Adams, director of operations for Radiology Associates in Daytona Beach, Fla. Improvements come on several fronts. Integrated RIS/PACS eliminates duplicate data entry, streamlines service and support and simplifies system management and administration. There is a caveat; RIS/PACS is not a magic wand. Securing its benefits takes planning and continued support.

What can RIS/PACS deliver? What supporting infrastructure is necessary? How can imaging centers optimize the deployment? Health Imaging & IT posed these questions and more to a few pioneers in the field and learned:

The Rationale

  • Consider tangible measures of success. Take for example Dynamic Medical Imaging of Columbus, Ohio. The center boasts a collections rate of more than 90 percent. “We attribute that to GE Healthcare Centricity RIS/PACS IW [formerly Dynamic Imaging IntegradWeb RIS/PACS],” says Center Administrator Dennis Schiraldi. The system does not allow a scheduler to progress to a sequential step if any item is incorrect. “It’s imperative to billing.” The elimination of duplicative data entry is a major plus of RIS/PACS; it’s more efficient, trims the potential for human error and facilitates cleaner claims.
  • Do the math. 1 vendor = 1 united product = streamlined support and management. When Radiology Associates relied on separate RIS and PACS solutions, the center never knew if software updates to one product would have a negative affect on the other. For example, an update as simple as a middle initial field in the RIS might alter PACS data and affect the integrity of the database. “As a business, we had to keep a very close eye on updates and their unintended consequences,” recalls Adams. System babysitting is not an optimal use of the IT department.


  • Set the stage for success. Make sure that all players—radiologists, technologists, support staff and administrators—have a sound understanding of the goals for the new system and communicate them to the vendor. “It may be hard to determine goals, especially if this is the first deployment,” admits Don Hubbard, controller of North State Radiology Medical Group in Chico, Calif., an Amicas Vision Series RIS/PACS site.
  • Think of RIS/PACS and the network as a single project; don’t sacrifice workflow because of bandwidth constraints or costs, says Tim Gould, PACS administrator for Radiology Associates of San Antonio in Texas. The 10-center practice upgraded to a 100Mb fiber network with a 1 Gb backbone to the business office prior to deploying Merge Healthcare Fusion RIS/PACS in April 2006. Similarly, North State Radiology Medical Group invested in a robust network infrastructure three years prior to its RIS/PACS deployment.
  • Create a detailed project plan that analyzes the workflow impact at all levels, says Adams, whose center deployed DR Systems Dominator RIS/PACS late in 2006. The shift from a paper-based to paperless environment requires additional PCs and system access for new users, which translates into training and inventory management. Remember workflow analysis should be ongoing as support staff may cling to old ways like printing paperless forms.

System Evaluation

  • Schedule a vendor-less site visit, or a couple of visits, at facilities similar to yours. This can help first-timers determine goals and opens the door to a more honest assessment of system pros and cons for all buyers. Tap into your professional network and association contacts for information. Use the site visit to determine additional areas for improvement, too. For example, another practice may use a more efficient patient scheduling process. Look at workflow, the clinical and professional team members involved in assessment and implementation, and get feedback on challenges and pressure points.
  • Trade up, but don’t trade off. “Many sites fall into the bells-and-whistles trap and forget they have processes that work well,” notes Gould. For example, most well-established practices use solid scheduling management processes; a RIS/PACS that requires dramatic changes to successful processes can impede rather than improve workflow. “We looked for a product that did not require the practice to adapt. Instead, we insisted on a system that adapted to our way of work,” says Gould. For example, the practice retained its sub-two-minute scheduling process when it deployed RIS/PACS and gained the configurable worklist management critical to radiologists.
  • Remember, the devil is in the details. Ancillary emails and conversations about details like physician requests or changes in the schedule are workflow busters. Does the system eliminate extra phone calls and emails? How does it replace these steps?
  • Think experience and integration. Look for an established vendor that can demonstrate successful integration with other systems such as the practice billing system.
  • Ask the right questions. The industry is rapidly evolving with changing documentation, accreditation and regulatory requirements. Look for a proactive vendor/partner, says Adams. Ask how many upgrades or enhancements the company releases annually. Find out how the vendor determines essential upgrades; do they consult end-users or rely on an internal group? And how large is the research and development department? A vendor’s ability to adjust its systems to external forces is a function of its R&D budget.
  • Don’t overlook user buy-in. Radiology groups and other clinical users should be comfortable with the platform. For example, the center loses some benefits of RIS/PACS and paperless workflow if physicians continue to fax paperwork.

Integrated RIS/PACS offers imaging centers a much-needed lifeboat in the current climate. The trick is finding the right boat and using it to navigate to clear waters. Here’s to smooth sailing!