1

Delivering On The Promise of Integrated RIS/PACS

Sunny Sanyal

PACS Provides A Platform For Digital Workflow Solution For Radiology

Short Term Storage Archive

Web

CT or MR

PACDatabase

Diagnostic and Clinical

WorkstationsRIS

CR

RIS Orders, Scheduling Film Library Management Charge Capture and Billing Reporting

Modalities Image capture QA and Image Processing

PACS Acquisition Diagnostic reading stations Clinical review and Web

distribution Archiving

Advanced Applications Clinical Applications 3D Volume Rendering

Advanced Clinical Apps

FunctionsTechnology Components

Radiology IT Environment

Ultrasound

Standalone Workstation Enterprise Image Management

PACS Evolution

1980s

1990s

Current Generation

Modality archiving – simple storage systems

Individual modality based systems

No workflow

Modality archiving – simple storage systems

Individual modality based systems

No workflow

Multi-modality systems

Focus on workflow Simple RIS integration

using interfaces/brokers

Limited enterprise workflow

No IT integration

Multi-modality systems

Focus on workflow Simple RIS integration

using interfaces/brokers

Limited enterprise workflow

No IT integration

Modality Archive

Department Workflow Enterprise solution –

hospitals, clinics Integrated RIS/PACS

workstation Web based

connectivity with referring physicians

Standalone advanced clinical apps

Enterprise solution – hospitals, clinics

Integrated RIS/PACS workstation

Web based connectivity with referring physicians

Standalone advanced clinical apps

Enterprise Workflow

RISDB

CR

MR/CT, etc.

Diagnostic WS

Web

Integrated RIS/PACS WS

Advanced Apps

Historical exams

prefetched automatically

Historical exams

prefetched automatically

Physician orders exam using RIS via web interface

Physician orders exam using RIS via web interface

Technician performs scans and

previews on screen

Technician performs scans and

previews on screen

Radiologist uses worklist

and voice recognition

tools

Radiologist uses worklist

and voice recognition

tools

Reports and images via Internet

Streamlined radiology and hospital workflow

Electronic linkage with referring community

Reduced material and labor costs

Increased equipment utilization

“After RIS/PACS”

“Before RIS/PACS”

Manual processes for handling film and paper reports

Repetitive data entry

Bottlenecks due to manual report dictation and transcription

Long lead time for results reporting

Reduced FTEs

Reduced Material Costs

Increased Throughput

PACS Drives Digitization of Radiology Workflow

Patient data (film & paper)

handled manually

Patient data (film & paper)

handled manually

Physician faxes or mails a referral to hospital and

patient

Physician faxes or mails a referral to hospital and

patient

Technician performs

diagnostic scans

Technician performs

diagnostic scans

Radiologist generates

and verifies report

Radiologist generates

and verifies report

Reports transcribed and verified manually

Prints image on film, reviews, repeats tests

Avoidable Costs

Bottleneck

Report and films sent by mail

Week

Hours

Filmless Radiology Department

Tremendous Benefits From Workflow Optimization

All Recent Exams Are Pre-Fetched Automatically When Exam is Scheduled

Referring Physician Receives Results Via Web Within Hours

Seconds Later, A Remote Specialist Can Read Study

Productivity (Exams/Day)

216

Before After

248

30%

4323

Report Turnaround Time (Hrs)

45.2

18

66%

Before After

15.5

3

Chaotic… Previous Exam Is Somewhere In Here

All Information, Anywhere, Any Time

Mean

Std. Dev

Results Of PACS Implementations 66%+ reduction in reporting time 80%+ reduction in film usage 30%+ reduction in FTEs

Information Management Using PACS

Filmless… How About Paperless?

DICOM Gateway

ArchivePACS Broker HL7 Engine

RIS Database

Referring Physician

HL-7DICOM

Hospital Medical Records Room

Limited Access To Patient’s Medical Record

Manual Updates Needed To Maintain Tables in RIS

Modality Work lists Not Always Available,

Depends Legacy RIS

PACS Database Paper Requisitions and Referrals

Complex Ordering and Scheduling

Process

Web

Other Hospital Departments

Clinics

Several Interfaces… Paper Based Processes With Other Hospital

Departments

Integrated Radiology Workflow

Desktop Integration Platform

RIS DatabaseArchive PACS Database

Tighter End-To-End Digital Integration In Radiology

Department

Voice Recognition

Web

DICOM Gateway

Other Hospital Departments

Clinics

Direct Connect

Improved Order Entry process

Physician O/E Order verification Rules for selecting

modality protocols

Direct database integration between RIS and PACS

Simpler systems – eliminates the Broker

Automated table updates IHE compliant workflow Fewer points of failure

Component based architecture -- Enables integration with other Windows applications

Direct Order Entry Into RIS

Apps Integration

PACS Worklist

Integrated RIS-PACS

Patient EMR

On-line requisition

Patient Reports

Access to Powerpoint, Email, Netscape, etc.

Detailed patient demographics

To… An Integrated Radiologists’ Cockpit

Next Generation

From… Islands of Information and

Applications

Double-digit growth in multi-slice procedures (CT: 10%, MR: 15%);

Growth in functional imaging

Shortage of Radiologists: 8% decline in radiologists in residency since early 90’s

APCs impacting reimbursement

RIS WSRIS WS

Mammo WS

Mammo WS

PACS Workstatio

n

PACS Workstatio

nEMREMR

Legacy HISLegacy HIS

Advantage WS

Advantage WS

QA WSQA WS

– Clinical Content– Teaching Files– Medical Knowledge

Databases Voice Recognition

Integrated RIS/PACS and EMR

Internet Intranet

Legacy HIS

Computer Aided Detection and Image Matching

Specialized Post Processing Clinical Apps

– Clinical Content– Teaching Files– Medical Knowledge

Databases Voice Recognition

Integrated RIS/PACS and EMR

Internet IntranetInternet Intranet

Legacy HIS

Computer Aided Detection and Image Matching

Specialized Post Processing Clinical Apps

Single workstation for diagnostic reading, advanced clinical apps, and specialty apps

Integration with Computer Aided Detection

Access to patient information

Environment

Tremendous Pressure To Increase Radiologists’

Productivity