Integrated RIS-PACS: Is it the Right Choice?

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Digital imaging has focused attention on picture archiving and communications systems (PACS), the masterminds of storing and managing digital images. While PACS enables radical changes in how an imaging center or radiology department manages its business, the intelligence features of the radiology information system (RIS) manage department workflow.

RIS has always been crucial to managing critical imaging business functions such as order entry; patient scheduling, tracking and billing; and inventory control. But an integrated RIS/PACS gives IT managers access to more complex data that can be used for advanced business planning, such as which modalities are most profitable, which referring physicians are most active, employee productivity levels, which time periods are the busiest, and patient throughput rates.

If a healthcare facility can leverage the strengths of RIS and PACS by creating a seamlessly integrated RIS/PACS, the result is a productivity tool that can drastically change the way an organization is managed.

The rise of PACS has influenced the RIS market by creating the need for a more robust and functional RIS. More than 80 percent of U.S. inpatient facilities and hospitals already have a RIS, says market research firm Frost & Sullivan. And North American PACS adoption will grow about 15 percent per year for the next few years (Frost & Sullivan). With growth that strong, a lot of eyes are focused on the synergy and future of RIS-PACS.


Two major issues that drive any discussion of RIS/PACS integration are data protocols and database sharing.

Digital Imaging in Communications and Medicine (DICOM), the transmission protocol adopted for PACS product design, was developed for image management. Health Level 7 (HL7), the standard adopted for hospital information systems (HIS), including RIS, is used for the management of patient information. HL7 can't read DICOM data, which means that RIS can't manage PACS imaging data unless it has a DICOM interface.

In addition to protocol differences, older RIS/PACS systems consist of separate databases - one for patient images and one for patient records. Patient data in the PACS database may not be an exact duplicate of the same data entered in the RIS database. If patient's name or other demographic data is entered differently in the two databases, the system can't correctly access all relevant records.


A "brokered" or "interfaced" RIS/PACS has a DICOM interface that's known as a PACS broker or a gateway. The PACS broker is a separate device combining hardware and software that interprets DICOM data for the RIS. A PACS broker requires its own database - creating yet another point of failure on the network and further degrading data integrity.

In "brokerless or integrated" RIS/PACS, the capability to understand DICOM data is built into the RIS, which eliminates the additional database. The most obvious benefit of an integrated database is improved data integrity. But there is one downside to brokerless PACS - if your system is integrated, it's harder to replace one part of it if you're unhappy with performance or want to upgrade.

Some RIS/PACS systems may appear integrated because they have a common user interface and workstations. Similarly, a solution may be touted as a brokerless PACS because there's no additional equipment needed. However, in some cases, even though there is no visible PACS broker and the end user sees a common interface and shared workstations, a separate database is required and is built into the RIS/PACS. "The real question is: how many different databases are there?" says Sheri Giles, an independent RIS consultant. "How many instances of the patient data and images are stored?" 

For a RIS and PACS to be truly integrated, the system must be brokerless and use a single database. "Many vendors are claiming to provide a totally integrated/brokerless RIS/PACS solution, but upon further scrutiny one may find that the level of integration is not as intimate as one would expect," says Jim Maughan of Maughan Consulting, a PACS/RIS consultant. "It might not be a brokerless PACS, but an interfaced PACS/RIS that's controlled by fewer vendors."


Efforts to improve the way computer systems such as PACS and RIS share healthcare information began in 1998 with the formation of Integrating the Healthcare Enterprise (IHE), a joint initiative by Healthcare Information