Integrated RIS delivers boon to physicians, patients

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Researchers have found that implementing a disciplined collection of background clinical information all along the clinical service chain through use of a RIS, in combination with a PACS, allows for quicker interpretation times and improved service to patients, according to an article published in the October issue of the Journal of the American College of Radiology.

“Until now, no existing research provided a clear picture of how a filmless clinic [one using a PACS] benefits from a commercial RIS,” said Atanu Lahiri, a PhD candidate at the William E. Simon Graduate School of Business Administration at the University of Rochester in Rochester, N.Y., and co-author of the study.

“Our results prove that the positive impacts of a RIS go beyond its ability to automate minor tasks and to replace papers with computers,” he said.

Lahiri and co-author Abraham Seidmann, PhD, the Xerox professor of computers and information systems and operations management at William E. Simon, investigated the impact of a RIS on the total report turnaround time and on its various components, such as the radiologist interpretation, transcription and review turnaround times.

The duo examined the effects of a RIS (Kodak Carestream) installation at Borg Imaging, a network of freestanding imaging centers with seven locations in upstate New York. The group employed 140 staff members and 13 radiologists at the time of the study.

According to Lahiri and Seidmann, the RIS was used by the schedulers to input the following information:

  • Order notes from the referring physician (e.g., a patient’s complaints about pain);
  • Insurance and copayment information via a link with an EHR or practice management system;
  • Information on the referring and other consulting physicians;
  • Any prior outside studies;
  • Special handling (e.g., the patient has breast implants) and special preparations required (e.g., the patient should not eat before the examination);
  • Patient safety (e.g., the patient is pregnant or claustrophobic); and
  • Medical history depending on modality.

“For example, when a MRI study is being scheduled, a properly configured RIS can automatically prompt for relevant information on contrast media sensitivity and look for recent data on kidney function,” the authors wrote.

The authors waited a little over a year after installation to collect their post-RIS data sample in order to ensure that the practice had overcome any issues with system adoption. This data was compared with report interpretation, transcription and turnaround time prior to the RIS deployment across different modalities in the practice.

The duo noted that RIS had little impact on the turnaround time for MRI. On the other hand, turnaround times for mammography studies declined significantly.

“Since the introduction of a RIS, the number of mammography cases delayed in the practice decreased from 8 percent to 2.5 percent,” said Lahiri.

The authors wrote that this reduction in delayed cases translates to approximately a 10 percent increase in the radiologists’ revenue generation rate, equivalent to a gain of $50,000 per year per radiologist.

“A properly configured RIS asks patients relevant questions about their health history and current conditions at the time of scheduling,” said Seidmann. “Thus the necessary background clinical information is collected before the exam goes to the radiologist for interpretation—decreasing the amount of time a patient has to wait to have their images read. Once imaged, patients typically get their results within two to three hours after being examined.”

However, a RIS is only as efficient as the workflow that drives it.

“In conclusion, new information technologies provide significant business value only if they are leveraged to implement effective workflow process innovations,” wrote Lahiri and Seidmann. “Our results prove that successfully leveraging a RIS requires a reorganization of the way in which both medical and administrative information is collected, organized, and presented along the radiology workflow.”