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 them unable to fully manage or communicate their data, at least not for an additional cost. This has led many to trek down the single-vendor route. Goldszal, in contrast, advocates the best-of-breed model.

"It is important for anyone buying RIS to not be held hostage with a product that works well, integrates well with that standard line of products, but does not work well with other platforms… When you buy a RIS, you are really signing up to co-develop the major workflow steps with the vendor. If you're expecting the RIS to be ready out of the box, and some are, you really ought not to expect to solve your major problems," Goldszal argues. He attests that radiology is ahead of the health IT curve when it comes to integration and standards-based interfaces like HL7 and DICOM, and that practices should be bullish about leveraging their systems using these interfaces.

Meanwhile, some practices prefer less demanding paths to integration. At allRadiology Solutions, after vendor shopping for several months, Zimmerman chose to connect with the group's eight affiliated hospitals by way of an integration engine, which more or less serves as a traffic cop, he says, distributing information and reports between the group's RIS, PACS and voice recognition system, as well as to hospitals' EHRs.

At Good Samaritan, Christian is in the process of implementing and connecting a new RIS and CVIS, along with other non-clinical HIS. Christian strongly advises that radiology administrators do their homework on integration before inking any contracts. "You have to have conversations with vendors related to integration and functionality," he says. "How easily can that vendor do what you are looking for? How many times have they done it before? What is their track record with other clients? What's their record according to the industry research?"

Looking ahead

RIS has helped radiology achieve some impressive results, including more efficient workflow, vastly improved quality assurance reporting and, for a growing number of radiologists, instant access to patient images, information and priors. And as policymakers, providers and IT specialists push toward more comprehensive and integrated care, RIS will no doubt continue to serve as radiology's root system, albeit buried under the layers of the other systems powered by RIS.

Radiologists & Meaningful Use

Radiologists do not sit in the driver’s seat of meaningful use (MU) for IT, but that makes their relation to the program no less complicated. To begin to comply with Centers for Medicare & Medicaid Services (CMS) MU regulations—which offer $44,000 per eligible provider on a sliding slope until 2015—radiologists must demonstrate meaningful use of certified EHR technology. One of the major complications for radiologists is that although CMS allows certain specialties, including radiology, to be excluded from some non-radiologic uses of the EHR, MU still requires that the EHR technology be certified for all uses, according to Michael Peters, director of legislative and regulatory affairs for the American College of Radiology (ACR) and Barbara F. Rubel chair of the Radiology Business Management Association (RBMA) technology task force. Moreover, just because an affiliated hospital meets the MU requirements does not mean that the radiology group does as well. Although radiology has in many ways stood at the front-end of progressive health IT, Rubel expresses concern that the RBMA’s preliminary survey findings indicate that, “basically, radiologists are nowhere with regards to meaningful use,” an unpreparedness that will eat into practices’ incentive payments and, eventually, their reimbursements. Radiologists and the ACR are espousing a different model. In May, testimony to the U.S. Dept. of Health and Human Services (HHS) HIT Policy Committee (HITPC) Meaningful Use (MU) Workgroup on “Meaningful Use and Specialists,” Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston, stated, “EHRs would facilitate specialty care much more efficiently if there were alternative MU measures and EHR certification requirements focused on improving imaging care. CMS should allow radiologists to satisfy specialty objectives instead of other requirements that have no bearing on radiology practices.”