The Digital Decision

Considerations when choosing a RIS/PACS strategy

Many factors drive healthcare facilities to transition from analog to digital radiology workflow. Some organizations use this transition to improve productivity, workflow efficiencies, and information access. Other organizations make this transition to reduce report turnaround time to referring physicians or enhance the healthcare experience for patients. Still others strive to reduce overall imaging expenses or streamline business practices.

Regardless of your reason to adopt a digital radiology workflow or reinvent your existing digital workflow, it is important to focus on your healthcare facility’s individual objectives when evaluating the vast array of choices in the marketplace. Here, we will review factors you should consider to gain the most potential benefit from the systems that support your digital radiology workflow.

Multi-System vs. Single-System Approach

In the early stages of digital radiology, it was common for radiology vendors to focus on a core competency, such as RIS or PACS, and provide a system that supported a focused subset of the radiology workflow. As the radiology software industry continues to mature, there has been a general industry shift toward developing packaged solutions that address all activities in the radiology workflow.

Vendors who once offered only a RIS or PACS system are now offering combined solutions branded as interfaced or integrated systems. As a consumer, it is important to delve further to determine exactly what each vendor means by these terms so you can gauge their impact on your workflow objectives.

Communication Between Separate Systems

In many RIS/PACS solutions, the terms “interfaced” or “integrated” reflect a communication requirement between two distinct systems with separate databases. This communication requirement may be an HL-7 interface that connects systems developed by different vendors, or it may be a private communication protocol to connect a vendor’s modular product offerings into an extended system. While it is a great benefit to connect software systems to support all actions in your radiology workflow, it is important to recognize that process adds a level of complexity to your workflow and introduces additional points of failure into your system.

Software vendors, such as Charleston, S.C.-based Avreo, offer an alternative to this integrated solution by providing a single database system that supports features common to traditional RIS, PACS, and dictation/transcription systems. This approach simplifies the system and reduces potential points of failure due to communication errors between systems.

Segmentation of Data

Interfaced and integrated RIS/PACS solutions generally do not share a common database. This data segmentation can be problematic for several reasons. First, some radiology data is available in only one system, which may reduce your ability to access data when needed. Additionally, some radiology data must be constantly synchronized between the systems, which adds a level of complexity and introduces the opportunity for error. For example, if you update the spelling of a patient’s name in the RIS, the RIS must then communicate this change to the PACS.

Data segmentation and synchronization is not an issue for RIS/PACS systems that share a common, well-structured database. This improves access to information in all points of your workflow because data is no longer designated as RIS- or PACS-centric information. It also eliminates synchronization errors within the radiology workflow.

Impact of Upgrades and Maintenance

If you choose to interface RIS and PACS systems from separate vendors, you should consider the impact of software upgrades or routine maintenance on your radiology workflow. For example, if your PACS vendor offers a software upgrade, you should evaluate this upgrade in advance to confirm that it will not disrupt information flow between the RIS and PACS systems in your workflow. 

Single-system RIS/PACS solutions generally reduce the impact of upgrades and routine maintenance on your radiology workflow because the upgrade addresses the whole system instead of one component within the system.

Essential Software Applications

Another consideration for your digital radiology strategy is the number of software applications required to access information at various points in your radiology workflow. Many RIS/PACS solutions offer a RIS-specific software application to schedule appointments, manage insurance, register patients, and manage other tasks, while a separate PACS software application provides access to image-centric content. This approach unnecessarily segments your workflow and blocks access to information, which directly undermines a potential benefit of a combined RIS/PACS solution.

By choosing a solution that addresses all phases of your radiology workflow with a single software application, healthcare providers and staff have better overall access to the information that they need. Instead of forcibly segmenting the workflow by the features available in the software application appropriate to a specific user type, healthcare facilities can logically tailor information access based on each individual’s responsibilities.

For example, a staff member responsible for scheduling appointments can receive access to these necessary functions, but a practice manager or radiology manager can access all information within one application to proactively manage the workflow. This level of information access can be very helpful for smaller healthcare facilities where staff members may wear multiple hats of responsibility.

A single software application approach also increases usability by reducing the number of software applications that healthcare professionals must learn. For example, the process to locate a patient record in the RIS software application may be very different than the process to locate the same patient’s studies in the PACS application. A single application approach offers a common user experience, which makes it easier for healthcare professionals to learn and use the system.

Planning for Adequate Network Resources

In addition to choosing the specific systems that support your digital radiology workflow, it is very important to evaluate your available network resources, which is the foundation for successful workflow in a digital environment. When implementing a RIS/PACS solution, your healthcare facility is typically responsible for establishing and managing the network that transports the data in your RIS/PACS system. If your healthcare facility is adopting a filmless radiology workflow for the first time, it is very important that you carefully evaluate your data transport requirements to ensure the network has adequate bandwidth.

Bandwidth refers to the volume of data that a network can transfer in one second. Networks with a higher bandwidth can transfer more data in the same amount of time. In your digital radiology workflow, this means that a network with a higher bandwidth can transfer large digital radiology studies more quickly to the requesting healthcare professional’s workstation.

The bandwidth available on your network will have a drastic impact on your satisfaction with your RIS/PACS strategy. When planning your RIS/PACS network, you should consider the following questions:

• Where will the radiologists read studies?   
  
• Where will other healthcare professionals require access to images and radiology information?
• Where will you store the images, reports, and database?
• Where will you archive the images?
  

Your answers to these questions will help determine the requirements for your Local Area Network (LAN) and Wide Area Network (WAN). The RIS/PACS vendor you choose can provide specific network recommendations based on your image volume and usage. However, the larger the amount of available bandwidth, the more space for information to travel on your network, which is critical in most RIS/PACS strategies.

To get the most out of your RIS/PACS solution, it is very important for each digital imaging modality to support DICOM Store, Print, and Worklist Management. Worklist Management support is critical because it allows the RIS/PACS system to send patient and order information to the modality, which reduces or eliminates the need to retype this information.

Moving Forward

Transitioning from an analog to a digital radiology workflow provides a fantastic opportunity to evaluate the effectiveness of your radiology workflow process and pinpoint improvements that you want to make. With all the choices and options in the marketplace, the process to identify a simple, yet robust solution that fully supports your streamlined radiology workflow can be overwhelming.

Avreo is working to simplify this process. Beginning in 2000, Avreo developed interWORKS from the ground up as a complete Radiology Workflow Solution. interWORKS incorporates RIS, PACS, dictation, transcription, and automated report distribution services as a single application, single database system. This approach provides the features a busy practice or hospital needs to operate efficiently while avoiding the common drawbacks of traditional RIS/PACS solutions.

– Alison McKee is the technical writer for Charleston, S.C.-based Avreo’s sales and marketing department. Direct all questions and comments to editorial@rt-image.com.