RIS: At the Center (But Behind the Scenes) of Radiology's IT Sprint

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Synapse RIS with color-coded exam worklist can be ordered according to report status, modality and other characteristics. Screenshots provided by Chuck Christian, CIO for Good Samaritan Hospital in Vincennes, Ind. and Fujifilm Medical Systems, Stamford, Conn.

As radiology practices tack on increasingly advanced applications and move closer toward seamlessly tying together all patient information via the EHR, RIS serves as the nerve center of radiology's workflow, feeding PACS and driving connectivity. The result is ever faster, more comprehensive and integrated provision of patient care by radiologists—all thanks to a system which, in some practices, radiologists might themselves never directly use.

Efficiency and integration are the central RIS missions at present, with meaningful use (see sidebar, page 21) playing an important role for these ventures. RIS offers a panoply of functions useful to radiologists from the time a patient schedules an exam to the sending and receiving of images from previous studies. And although the inability to communicate between different proprietary systems has remained a persistent challenge to radiologists looking for as much information for patient diagnosis as possible, some administrators have opted for the best-of-breed approach, preferring to connect systems on their own—and reaping tremendous benefits from doing so.

A radiologist-less RIS

"One of the advantages RIS has over other systems is that it's a single platform, from scheduling and tracking all the way through billing—you only have to deal with one system. RIS is really the most important, but the least sexy, information system for radiology," avows Alberto Goldszal, CIO at University Radiology Group, a group of 65-radiologists servicing much of New Jersey.

Despite his preference for RIS on the back end, Goldszal has not deployed RIS to drive radiologists' visible workflow. "The reason is simple: speed. As far as radiologists are concerned, speed is my No. 1 goal… RIS performs a lot of functions for a lot of people, but it does this at the expense of speed." RIS serves as the hub of back-office jobs for University Radiology, capturing all patient information and feeding the necessary clinical data—patient images and information—for radiologists to launch on PACS.

"So for us, the way we drive the system, radiologists rarely, I dare say never, log directly into the RIS. That doesn't mean they don't go to the RIS every day—the RIS is the one system that starts all orders and reports—but my radiologists access all the images and dictate the reports using two systems only: the PACS and the dictation system," Goldszal explains.

Not all radiology administrators choose to utilize the RIS in this way. At allRadiology Solutions in Sebring, Fla., RIS serves as the springboard for radiology cases, where the group's radiologists pull exams off of a common worklist, which can be dished out according to urgency of exam, exam time or a radiologist's subspecialty, according to Shawn Zimmerman, CEO. On top of this, for the group's night-time teleradiology staff, integration with hospital systems pulls patient information from orders to automatically distribute exams according to pre-determined criteria, speeding up and simplifying workflow tremendously, Zimmerman says.

Administrators also commonly use RIS for real-time and monthly reporting, with color cues helping staff to track patients' progress and waiting times, says Charles E. Christian, CIO for Good Samaritan Hospital in Vincennes, Ind., and vice chair of the policy steering committee for the College of Healthcare Information Management Executives (CHIME). In this way, Christian emphasizes how crucial RIS has been to improving productivity for radiologists, from the perspective of providing hard data, paperless workflow and, equally important, integration with other hospital information systems (HIS).

Integration without seams

The lack of integration of patient information and hospital systems between specialties has posed an impediment to care, at times leaving gaps in patient histories or leading to repeat studies. More often, however, hospitals and outpatient facilities are merging all patient information—including images—into one virtual place, the EHR. For organizations with an EHR, RIS typically deposits reports into patients' EHRs as soon as they are signed.

Still, many radiology groups report hanging at the whim of their vendor's proprietary systems, leaving