Maximizing RIS Potential

The IT needs of today’s radiology practices are ever evolving, and investing in the latest information solutions can be vital to the survival of a business in an increasingly cost-focused marketplace. For Raleigh Radiology Associates, a privately owned North Carolina practice offering a full range of imaging services across six locations throughout the Research Triangle region, that meant focusing on its RIS, as well as its PACS, in order to achieve optimal operational efficiency.

“Our marketing team started mining data from our RIS in 2004. It keeps up with the referrer database very well—how many procedures of each type we’ve done and what referrers ordered those procedures. You can pull which ZIP codes certain procedures are coming from, and we cross-reference that against the referrer database to find out what types of physicians are ordering what types of exams.” --Marsha Woods

Raleigh's current RIS is the Encompass.NET RIS solution from Empiric Systems LLC, Morrisville, NC, (now Synapse Information Systems from FUJIFILM Medical Systems USA Inc, Stamford, Conn). While Raleigh was initially impressed with the typical RIS features that would provide it with scheduling, ordering, and reporting, the team was pleasantly surprised to discover a host of other capabilities made possible by the Web-based design and robust tool set of the RIS. Soon after implementation of the RIS, Raleigh’s marketing team found a nonclinical use for the solution’s extensive database. “Our marketing team started mining data from our RIS in 2004,” Marsha Woods, IT director, says. “It keeps up with the referrer database very well—how many procedures of each type we’ve done and what referrers ordered those procedures. You can pull which ZIP codes certain procedures are coming from, and we cross-reference that against the referrer database to find out what types of physicians are ordering what types of exams.” The data contained a few helpful surprises; Woods emphasizes that when it comes to determining which physicians in your area are top referrers, the anecdotal evidence is not to be trusted. “You hear the same doctors on the phone all the time, but when you’re taking into account all the faxes and emails as well, you’re surprised at how much some of the doctors are actually sending to you,” she says. “It also surprises you when it comes to types of exams. Some exams that you would think would be more likely to come from specialists are actually being ordered by family physicians a lot of the time.” Armed with a robust range of referral data, Raleigh’s marketing team is better prepared to reach out to physicians in the community. “We can specifically target certain types of physicians, practices, and specialists by knowing exactly what types of exams they’re ordering,” Woods says. Scheduling information can also be mined, benefiting both the patient and the facility. “I can pull anything I need out of it, as far as which patients are scheduled, when they were scheduled, and how long they were scheduled for,” she says. “You can also figure out how much time patients are spending in various rooms, so you can better organize your schedule based on how much time you need for a specific procedure.” From an IT standpoint, the data aggregated by the RIS help Woods achieve efficiency in her day-to-day operations by allowing her to track when, where ,and for how long users have been accessing the system. “You know everyone who’s been there, where they were, and what they were doing,” she says, “which helps when you’re trying to track a patient’s specific account in the event of a delay or a problem.” It goes without saying that an audit trail for every exam is a necessity, but Raleigh Radiology also uses this function to improve patient service. “On some occasions, a patient may call in wanting to know whether his or her physician has seen the images or the report,” Woods says. “You can track that through the system and tell the caller everything: whether the physician has opened the images and whether someone in the office has seen the report. It’s a customer-service benefit.” Referring-physician service is also improved, thanks to the ability to log onto the system remotely and access exam data or schedule patients. “Giving access to the referring physicians is a big plus,” Woods says. “They can request their own orders, and they like that because it saves them time on the telephone.” There’s a cost savings associated with allowing referrers to access the system. “We have cut down on our film printing and on burning CDs because specialized physicians prefer to go into their offices, sit down at their computers, and have what they need when they want it. I even have some offices that have chosen to go on without printing the reports. They save the reports as PDFs and move them directly to the electronic medical record, instead of creating a paper pile that has to be scanned in,” Woods says. The practice’s first PACS was the RamSoft One from RamSoft Inc, Toronto; in 2003, the practice brought on the Encompass.NET RIS solution from Empiric and continued to use RamSoft’s PACS viewer. “We had been using a third-party RIS vendor, but it was too difficult when you needed something changed or another information solution integrated,” Woods recalls. “At the time we went on Empiric’s RIS, it did not have its own viewer, but was mostly integrated with the third-party RamSoft solution.” It would be a few years before Raleigh switched to the Encompass viewer, in 2007. In 2005, Raleigh converted to digital mammography, the last step necessary for the practice to be fully digital. “We do all of our film management and database storage in the RIS,” Woods says. Except for plain-film overreading for urgent care facilities, all viewing and reading now takes place in the digital environment. With the conversion to digital mammography and the need for more advanced interpretation tools, Raleigh found itself interested in a PACS that could provide advanced multimodality viewing capabilities. In November, FUJIFILM Medical Systems USA announced its acquisition of Empiric; the company is now offering full integration between its Synapse PACS and the RIS. Soon, Raleigh Radiology will switch from its legacy PACS to the Synapse system, and Woods is excited about what the integration has to offer. “It’s going to open up more capabilities as far as how the radiologists view and read the images,” she says. “We’ve actually already upgraded to the latest RIS version, which includes advanced communication functionality and has a lot of nice features in it, like instant messaging. We can now communicate instantly between any of our six locations. When we go live with the Synapse integration, the radiologists will be able to do their comparisons faster.” Referring physicians will get new tools as well, Woods says. “We have some physicians who are specialists, and they’d like to be able to go in and view the images as their patients come in,” she says. “Right now, we have to go in and specially arrange those accounts when the patient arrives. The Fuji system will allow us to designate specialists so we can automatically allow them to open specific kinds of images.” There will even be an added benefit for the urgent care facilities that send interpretations to Raleigh, and it will translate to higher efficiency on Woods’ end of the operation. “One big problem we’ve had is getting the overreadings into our system—getting the plain films and all the documentation into the RIS,” she says. “That’s takes a staff member, on its own. Now, the urgent care facilities can go into the system themselves and enter all the information so that it’s in the RIS when the films get here. That’s a nice benefit of the Web-based system: We can allocate the work back to them, where it can be done more efficiently.” Meanwhile, facilities using digital imaging will be able to send the images directly; the RIS features the ability to autogenerate an order based on the DICOM information. “That’s a big deal for us,” Woods says. “Now we can say, you put them into the system and we’ll read them. We’ll be much less limited in what we can offer the community.”