Rebirth of PACS/RIS

If you would have asked radiologists about the future of radiology information systems (RIS) five to 10 years ago, there is a good chance that they would have told you that RIS was a dying technology. Because RIS systems were merging with other technological platforms, many radiologists did not expect the systems to be around. But now many physicians are trying to meet the Stage 2 meaningful use (MU) criteria to take advantage of Medicare and Medicaid incentive payments and prepare themselves to be in compliance when the criteria become requirements. RIS and picture archiving and communications systems (PACS) are experiencing a technological rebirth that will usher the next generation of these products smoothly into 2013. 

Interfacing PACS/RIS and EMR/EHR

One push in technology will be to allow PACS/RIS the ability to interface with hospital and physician office electronic medical records (EMR). According to Paul G Nagy, Ph.D., M.D., it is not unusual for a patient to be sent for imaging and it is unclear to the radiologist what needs to be imaged and the reason. Radiologists often do not have access to a clear order or adequate patient medical history (prescriptions, allergies, previous lab work and tests, etc.) to conduct radiology tests efficiently or to make a proper diagnosis. This cannot be the case in the future, especially with Stage 2 MU criteria urging physicians to decrease the cost and patient exposure to radiation associated with repeat tests. Nagy suggested that in the near future, radiologists will get to the point where they will not make a diagnosis without access to the patient’s electronic medical records. 

One solution to this problem is that PACS/RIS vendors will have to look for ways to make the systems vendor-neutral. Now, many PACS/RIS are vendor-specific, and if a hospital has an EMR from one vendor and the radiology department has a PACS/RIS from a different vendor, the two systems cannot interface. By making PACS/RIS systems vendor-neutral, radiologists can gain quick access to pertinent patient medical records from any EMR system that is connected to a given network. 

Another way this issue is being addressed is with the use of remote viewing systems, which allow physicians’ offices and hospitals to access their servers and patient records over the Internet (often via a Web-accessible cloud server). While many PACS/RIS are programmed to work with internal servers, some physician offices are investing in cloud servers for their practices because they can eliminate the need to maintain and upgrade their own servers, reducing IT costs. Radiologists can expect to see cloud-based PACS/RIS as a growing trend.

Better Images and Reporting

Stage 2 MU requires wider access to PACS images and reports, including interfaces with patient EMRs. The requirement calls for access to diagnostic quality images, rather than low-resolution images. The images and reports will need to be easily accessible through a certified electronic health record technology (CEHRT). The hope is that this will increase workflow efficiency. 

RIS will need to be able to report critical findings and allow multiple users to view images and tests simultaneously, enabling better collaboration, reviews and second opinions. These reports and images will also need to be vendor-neutral so that multiple physicians can have access to them. 

Building Relationships 

Nagy stated that in a recent survey, more than 70 percent of physicians said they had iPhones and about 60 percent said they had or utilized iPads. Taking this increase in the use of this form of technology into consideration, radiologists can expect several new features to be introduced on newer systems in the coming year.

PACS/RIS vendors will have to look for ways to allow the systems to interface with the iPhone, iPad and other smart phones. This will allow radiologists access to images whenever and wherever they are. This will also provide patients immediate access to their reports.

This interfacing will lead to what Nagy said is one of the most exciting new features coming to PACS, and that is the ability to provide teleconsultation via Skype, iChat and other mediums. Doctors will be able to do peer review and perform second reads without being present in the office or having images brought to their clinics. With next generation systems radiologists will be able coordinate schedules and tests via an iPad or an iPhone, and find ways to incorporate voice and video teleconsultation, making it easier for physicians to collaborate. 

Workflow Efficiency 

The Stage 2 MU criteria require that physicians are able to data mine records to generate lists of patients by condition for quality improvement, reduction of disparities, research or outreach, and also for preventive/follow-up care and patient-specific education resources. In order to do this now, radiologists have to manually search through reports and images to pinpoint specific results or diagnoses. 

PACS/RIS are seeing advancements in natural language processing, which allows physicians to speak specific phrases that are used repetitively and the system will automatically enter a full text finding into RIS report fields. This helps minimize the time it takes physicians to enter data or deliver a critical report. PACS/RIS vendors are including databases of diagnostic terms to quickly and efficiently search workflow indexes. Radiologists will now be able to pull phrases that occur over and over in a clinical note, identify abnormalities quickly and have the ability to match concepts and synonyms, and detect negation.

The newer generation PACS/RIS will also allow for dashboarding, which will enable radiologists to keep tabs on data generated in their PACS/RIS and offer a higher level of efficiency. Radiologists will be able to view multiple patients’ tests and work lists simultaneously and see which doctors are viewing what tests. PACS/RIS vendors will be adding more to the dashboard for the purposes of data mining, including options to track billing, number of patients and length of time a patient spends in the office. These additions will help make decisions on staffing and purchasing. 

With numerous advances in PACS/RIS to help with workflow and efficiency, it is clear that these technologies will be here for the long haul. To ensure that radiologists stay educated on the changes and advances, there are certain steps that they need to take. 

Look for advanced training. Radiologists should look for advanced training within the PACS/RIS systems to make sure they understand the technology and that they are utilizing all of the featured benefits that their specific systems offer. 

Make sure your IT department is qualified. IT departments should be properly staffed with professionals who are qualified and certified in PACS/RIS administration and management. The American Board of Imaging Informatics (ABII) offers an imaging informatics professional certification program and awards the certified imaging informatics professional designation. These programs set a national standard for imaging informatics, and will ensure that IT professionals are trained to administer the technical support needed to properly utilize PACS/RIS. 

Maintain relationships with IT vendors. Having a relationship with PACS/RIS vendors will be vital to understanding the systems and making informed decisions. These relationships will keep physicians informed on the advances or even declines of particular products and companies. Radiologists will be able to stay ahead on PACS/RIS trends and they will have first-hand knowledge about how particular vendors are weathering changes in the economy and in technology. 

Be aware of emerging technology. There are many emerging technologies that have the ability to benefit a company’s PACS/RIS. Cloud may be a technology that smaller practices might want to look into, while larger practices may not. Knowing the benefits and set backs of these technologies will help radiologists make informed decisions regarding what technologies would best suit their practices. itn