RIS Migration at Cheyenne Regional Medical Center
It’s as extreme a transition as any IT professional could imagine: moving from a remotely hosted RIS to a fully integrated RIS/PACS over the course of just a few short months. Bill Cummins and his team, however, had ample motivation to make the switch. The director of medical imaging at Cheyenne Regional Medical Center (CRMC) in Wyoming had seen both customer service and turnaround times suffer at the hands of the facility’s legacy RIS. 
Bill Cummins “We weren’t in control of our own destiny, so to speak, with the database servers,” Cummins recalls. “We were working via two modems, and on the technical side, that was difficult. We couldn’t access the database the way we needed to; it always took a phone call or a service request to get something done. A hosted solution should have made our lives easier, but once we identified the right solution, we knew it would be easier to run our own RIS/PACS.” CRMC implemented the remotely hosted RIS about six years ago, but it would be another three years before the facility would bring in its first PACS. The process of coaxing the two systems into working together highlighted some of the RIS solution’s inefficiencies, Cummins says. “We ran into complications in trying to interface between the two systems,” he explains. “The long-distance remote hosting didn’t give us enough control over our own timelines when we went to connect the PACS, and the technology wasn’t conducive to what I wanted for my department in the future.” In addition, CRMC’s radiologists, technologists, and referring physicians had all expressed problems with the hosted RIS. “End-user dissatisfaction was the biggest factor that drove our decision to transition to a new RIS,” Cummins says. Shopping for an Integrated Solution What Cummins wanted was a fully integrated RIS/PACS platform with the cutting-edge features that his department needed to optimize workflow and improve service to referring physicians, as well as the technical support necessary to tweak the system as the department’s needs changed over time. The savings associated with an integrated platform were also a deciding factor. “My ultimate goal was a fully integrated RIS/PACS,” he says. “Other systems just weren’t there. They always got proprietary, and the cost of interfacing, duplicating any changes back and forth across the two systems, was difficult at times. With a fully integrated system, we wouldn’t have to worry about the interface cost.” Cummins hoped to trim hardware and software support costs as well. “With our previous RIS, we were paying $18,000 a month just for support,” he notes. “It didn’t logically make sense.” CRMC had implemented the Synapse PACS from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut, in 2006; when the company acquired the Encompass RIS (now known as the Synapse RIS) from Empiric Systems in November 2008, Cummins saw all the pieces in his RIS/PACS puzzle begin to slide into place. “I had seen how the Encompass product worked in the past, and it met all of our criteria,” Cummins says. “Coincidentally, FUJIFILM wound up purchasing it last fall. The product is very robust, but affordable, and we knew it would work well with the Synapse PACS we already have.” Flipping the Switch In transitioning to the Synapse RIS, Cummins was surprised and pleased to achieve additional cost savings. “Because it’s an integrated system, our additional hardware expenses were limited,” he says. “All we had to purchase were two more servers, because the RIS could already leverage the infrastructure we had set up for the PACS, with redundancy and long-term archiving.” The migration process has enabled CRMC to leverage its PACS test server, which allows the facility to test any changes to the system before flipping the switch. “That was a capability we were lacking before,” Cummins says. “It was always a total rebuild every time we wanted to make a change. Now, with a test server and a production server, we can test changes before implementation.” On August 26, the full system is scheduled to go live, and CRMC is currently in the midst of deep tests of the integration, with the help of FUJIFILM support staff. “They’ve been wonderful in working with our clinical systems to make sure the flow of information between the two systems is as smooth as possible,” Cummins says, “and RIS support is included within FUJIFILM’s Synapse support shop, so you’re not working between two different technical-support groups.” End-user training began in early August with radiology-department staff; as the month went on, ancillary staff and the center’s radiologists were trained on the system, giving all users the opportunity to preview the features and benefits of the integrated platform. Faster, Better, and Stronger With full implementation on the horizon, Cummins and his team are looking forward to the efficiencies that the integrated Synapse RIS/PACS will provide. “A big selling point was that the Synapse RIS is Web based,” he says. “That offers outside entities, like referring physicians, the ability to tap into the system without any additional work. It also makes things easier for the radiologists, who can access the RIS remotely for reading. It will be linked into our physician portal, giving physicians within our facility direct access to a patient’s medical imaging history.” Referring physicians will be able to take advantage of Web-based scheduling. “We define the criteria they have to meet in order to schedule an exam,” Cummins explains, “and they schedule their own patients, without ever having to call us. We’re excited because some of our larger practices in town that send us a lot of volume currently have to spend a lot of time on the phone. Now, they have the ability to do their own scheduling, and all we do is send back a confirmation.” Key referrers will also enjoy improved access to the medical center’s patient records. “The system can be set up so that if particular physicians are sending me all their radiography patients, we can give them referrer access, where the system will filter out all the patients they’ve sent,” Cummins notes. “They can see if their exams have been scheduled, and if the exams are final, the physicians can see all the information through the Web.” For the medical center’s technologists, the open exchange of information between the two systems will permit more efficient workflow. “Everything can be captured on the front end with an integrated RIS/PACS. Orders, questionnaires, and consent forms—they all flow all the way across the system automatically. You don’t have to duplicate what you put in,” Cummins says. Most important, CRMC’s radiologists will benefit from the two systems’ integrated worklist feature, which will enable them to view information from both the RIS and the PACS without switching back and forth between the two. “It’s very user friendly,” Cummins says. “They can go through and pick out whatever they’re looking for; all the information they need will be at their fingertips.”Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.
Bill Cummins “We weren’t in control of our own destiny, so to speak, with the database servers,” Cummins recalls. “We were working via two modems, and on the technical side, that was difficult. We couldn’t access the database the way we needed to; it always took a phone call or a service request to get something done. A hosted solution should have made our lives easier, but once we identified the right solution, we knew it would be easier to run our own RIS/PACS.” CRMC implemented the remotely hosted RIS about six years ago, but it would be another three years before the facility would bring in its first PACS. The process of coaxing the two systems into working together highlighted some of the RIS solution’s inefficiencies, Cummins says. “We ran into complications in trying to interface between the two systems,” he explains. “The long-distance remote hosting didn’t give us enough control over our own timelines when we went to connect the PACS, and the technology wasn’t conducive to what I wanted for my department in the future.” In addition, CRMC’s radiologists, technologists, and referring physicians had all expressed problems with the hosted RIS. “End-user dissatisfaction was the biggest factor that drove our decision to transition to a new RIS,” Cummins says. Shopping for an Integrated Solution What Cummins wanted was a fully integrated RIS/PACS platform with the cutting-edge features that his department needed to optimize workflow and improve service to referring physicians, as well as the technical support necessary to tweak the system as the department’s needs changed over time. The savings associated with an integrated platform were also a deciding factor. “My ultimate goal was a fully integrated RIS/PACS,” he says. “Other systems just weren’t there. They always got proprietary, and the cost of interfacing, duplicating any changes back and forth across the two systems, was difficult at times. With a fully integrated system, we wouldn’t have to worry about the interface cost.” Cummins hoped to trim hardware and software support costs as well. “With our previous RIS, we were paying $18,000 a month just for support,” he notes. “It didn’t logically make sense.” CRMC had implemented the Synapse PACS from FUJIFILM Medical Systems USA Inc, Stamford, Connecticut, in 2006; when the company acquired the Encompass RIS (now known as the Synapse RIS) from Empiric Systems in November 2008, Cummins saw all the pieces in his RIS/PACS puzzle begin to slide into place. “I had seen how the Encompass product worked in the past, and it met all of our criteria,” Cummins says. “Coincidentally, FUJIFILM wound up purchasing it last fall. The product is very robust, but affordable, and we knew it would work well with the Synapse PACS we already have.” Flipping the Switch In transitioning to the Synapse RIS, Cummins was surprised and pleased to achieve additional cost savings. “Because it’s an integrated system, our additional hardware expenses were limited,” he says. “All we had to purchase were two more servers, because the RIS could already leverage the infrastructure we had set up for the PACS, with redundancy and long-term archiving.” The migration process has enabled CRMC to leverage its PACS test server, which allows the facility to test any changes to the system before flipping the switch. “That was a capability we were lacking before,” Cummins says. “It was always a total rebuild every time we wanted to make a change. Now, with a test server and a production server, we can test changes before implementation.” On August 26, the full system is scheduled to go live, and CRMC is currently in the midst of deep tests of the integration, with the help of FUJIFILM support staff. “They’ve been wonderful in working with our clinical systems to make sure the flow of information between the two systems is as smooth as possible,” Cummins says, “and RIS support is included within FUJIFILM’s Synapse support shop, so you’re not working between two different technical-support groups.” End-user training began in early August with radiology-department staff; as the month went on, ancillary staff and the center’s radiologists were trained on the system, giving all users the opportunity to preview the features and benefits of the integrated platform. Faster, Better, and Stronger With full implementation on the horizon, Cummins and his team are looking forward to the efficiencies that the integrated Synapse RIS/PACS will provide. “A big selling point was that the Synapse RIS is Web based,” he says. “That offers outside entities, like referring physicians, the ability to tap into the system without any additional work. It also makes things easier for the radiologists, who can access the RIS remotely for reading. It will be linked into our physician portal, giving physicians within our facility direct access to a patient’s medical imaging history.” Referring physicians will be able to take advantage of Web-based scheduling. “We define the criteria they have to meet in order to schedule an exam,” Cummins explains, “and they schedule their own patients, without ever having to call us. We’re excited because some of our larger practices in town that send us a lot of volume currently have to spend a lot of time on the phone. Now, they have the ability to do their own scheduling, and all we do is send back a confirmation.” Key referrers will also enjoy improved access to the medical center’s patient records. “The system can be set up so that if particular physicians are sending me all their radiography patients, we can give them referrer access, where the system will filter out all the patients they’ve sent,” Cummins notes. “They can see if their exams have been scheduled, and if the exams are final, the physicians can see all the information through the Web.” For the medical center’s technologists, the open exchange of information between the two systems will permit more efficient workflow. “Everything can be captured on the front end with an integrated RIS/PACS. Orders, questionnaires, and consent forms—they all flow all the way across the system automatically. You don’t have to duplicate what you put in,” Cummins says. Most important, CRMC’s radiologists will benefit from the two systems’ integrated worklist feature, which will enable them to view information from both the RIS and the PACS without switching back and forth between the two. “It’s very user friendly,” Cummins says. “They can go through and pick out whatever they’re looking for; all the information they need will be at their fingertips.”Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.