Can Radiology Prosper Without RIS?

When opening a new imaging outpatient center or expanding and improving on current services and business capabilities, it is hard to imagine an operator can prosper without a Radiology Information System (RIS).
Picture Archiving and Communications Systems (PACS), or some form of digital image archival and distribution, has been the best enabler for radiology as a whole; that is, up until now. RIS in the form of a radiology business and process management system is following the same general business path, albeit somewhat behind the PACS business cycle by a decade or two. They are both difficult to quantify in terms of improved efficiencies and cost savings or revenue generation. It is a given that PACS is essential to managing a portion of the radiology process, and to maximize efficiencies across several steps of imaging. RIS is important for managing the total radiology business process and maximizing efficiencies in that overall process. By understanding the opportunities presented by better process and business management, revenues can be maximized.
In the past, RIS has proved advantageous for operating an imaging department. But looking ahead, RIS will be as essential as PACS, at least in terms of maintaining and maximizing the business. This may raise eyebrows and deservedly, questions too. To that end, four questions that immediately come to mind and require exploring are:
1. Does RIS bring additional value (a la PACS) to the enterprise?
2. Which one should be implemented first?
3. Why is RIS needed at this point in time?
4. Does RIS bring as much value as PACS to the enterprise?
In today’s imaging world, PACS, in some form or another, is considered a requirement and from a practical standpoint, it a prerequisite to opening on par with imaging modality presence. The question really translates into: Which system will benefit the operator’s financial revenues and especially profits at the fastest and most durable rate or slope?
To determine quantitative value of any system for purchase, it is best to perform an ROI analysis. Ask any CFO, department manager or practice owner and they will agree that performing an ROI on systems as elusive as PACS and RIS is more than just a challenge. PACS has experienced a longer legacy of justification and other capabilities such as film storage cost and processing savings. The more intangible factors are costs or savings from lost film, speed of delivery improvements and personnel reduction.
RIS, with less time in the analysis and proof bucket, is even more elusive than PACS. That is generally the case until one owns a RIS. After RIS implementation, it is highly probable to show filled gaps in the schedule, increased patient throughput, decreased exam times, faster report turnaround time, more patient referrals and improved, as well as, expeditious billings.
Which One Should be Implemented First?
If thoroughly analyzed, this question may prove to be the most difficult of the questions to answer. The reality is that the question is rarely asked and the answer is more often dictated to the enterprise, based on previous commitments, vendors’ schedules, budgeting and financing, among other reasons. And that previously determined answer is almost always PACS first, RIS second. But, if the enterprise is in the neutral position of not having already implemented a PACS, then the following information should be considered.
Most, if not all, digital acquisition devices — along with their workstations — have some type of limited storage capabilities that could allow two or three months before additional storage is required by the enterprise. Additionally, a PACS system touches very few people and processes in a radiology practice, and those it does affect are primarily the radiologists, the technician, indirectly dictation and if implemented, the RIS. The RIS touches or is connected to everyone and every process involved in the practice and department. This includes the patient, referring, receptionist/scheduler, technician, radiologist, dictation, transcriptionist, administration, HIS (if available), billing, auditing and PACS. RIS controls process management, evaluation and improvement. With so many entities at stake, it stands to reason that from an implementation standpoint, one would want the processes that touch and control so many contact points and variables in the radiology environment installed and operational first.
Is it essential to have a sophisticated PACS be 100 percent operational because it improves and speeds a portion of the radiologist’s workflow? Or is it better to have a basic RIS installed because of the multitude of processes and workflow that it influences and/or controls? It identifies supplements, supplants, controls and reports on and touches every single individual within the enterprise, several on the outside, and on a multitude of occasions. It also touches and acts as the main interface with other essential radiology systems such as PACS, HIS, dictation, transcription and billing.
Why is RIS Needed Today?
Why would one have a 21st-century system for archiving and communicating patient images and have no system in place for managing patient information and EPR other than paper and pen?
On the one hand, in its most basic form and understanding, RIS improves upon the existing efficiencies within an organization. Obviously, radiology has existed without RIS for decades, and in many cases, can still remain functional without it. But the healthcare environment is changing rapidly, reimbursement is decreasing and imaging operations are being forced to become leaner, meaner and more efficient.
As radiology services are viewed increasingly as a commodity, the service must possess differentiators. RIS is a key differentiator in that it gives any practice a lower cost of service, decreases the amount of time that referring physicians need to spend scheduling, reduces the patient image process time and provides faster results and reports. With the prevalent shortage of radiologists today, productivity of this limited resource group must be maximized for the overall good of healthcare to decrease proliferation of studies into nonradiology such as CT for cardiology. For example, with RIS comes faster report turnaround time, increasing the value of radiology CT, allowing the internist to beat the sub-specialist to the patient and, therefore, they are more likely to retain the patient.
RIS is the key to improved efficiency and is currently the most effective way to get a handle on operations. Let’s examine its components in an ideal sense and piece by piece:
• The scheduling function allows the referring physician, the patient and scheduler to maximize output by spending less time on the phone and/or in person and by entering patient information faster and more visibly. It also supplies the required information for an efficient billing operation, negating the requirement for multiple entries and the consequential errors associated with them.
• The workflow manager affords the technician, the radiologist and the transcriptionist the ability to track the patient process and anticipate their next step and workload.
• The report editor allows the physician and transcription to tie dictation to PACS and to the referring physician. Management reports, produced at the back-end of the system, provide the capability to measure performance, including such factors as gaps in the schedule, cancellation reasons, the time the patient is on the table, report turnaround time, referring trends and exam trend analysis.
RIS vs. PACS
It is extremely difficult to put a price on the benefit of PACS versus RIS, and therefore, extract a precise dollar amount in the overall positive effect or ROI on the business. Conversely, in an ideal environment not subject to preconditions, a case can certainly be made that whenever possible, the RIS should be implemented before a PACS. Why is a RIS needed in today’s environment? RIS is one of the most powerful enablers, providing the best and least troublesome avenue to measure and manage the radiology process and its efficiencies.
Lost revenue, conceived at the very first date of operations, is gone forever, and in some cases, so are the patients and referring physicians. Without RIS, those businesses — of any but the smallest scale – will suffer unrecoverable losses in capital and decreasing efficiencies. They will eventually turn from a functional to a dysfunctional state and no longer be able to prosper in the marketplace.
John P. Wellbank is CEO of Colorado Springs, CO-based InStar Systems, a leading provider a range of radiology practice management solutions to the diagnostic imaging industry, including its proprietary and fully integrated RIS. He can be reached at 719-448-9957 or by e-mail at [email protected].