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The radiology information system (RIS) marketplace has experienced significant activity within the last 24 months. New RIS vendors have entered the marketplace and existing modality and picture archiving and communications system (PACS) vendors have acquired or developed an RIS. Some vendors claim they have an RIS as part of their offering but in reality provide only a few components. RIS solutions have been developed to handle the full life cycle of the imaging order, as opposed to PACS, which has been focused on handling image acquisition, display, and storage.
This article illustrates the common misconceptions about what a fully featured RIS offers.
Radiology information systems have been developed that provide multiple components of functionality with the goal of? expediting the delivery of result to the ordering physician as soon as possible and capturing the correct charges. All components play a roll in results turnaround. Components consist of patient registration,? scheduling, and tracking; order entry; film tracking; technologist completion; technical charge capture; dictation; transcription; breast imaging; electronic signature; professional charge capture; results distribution; billing; and management report.
The Role of RIS
A review of the functional features make it clear that RIS have been developed to manage the radiology work flow.
A fully featured RIS does the following:
? automates repetitive, manual tasks
? reduces the amount of paperwork associated with ordering, scheduling, reporting, and billing
? stores information for future reference and makes retrieval easier
? facilitates accurate billing
? automatically communicates results to other systems
? provides more reliable and easier access to information about the radiology business.
RIS helps to ensure that sufficient information is collected during the diagnosis process so that the radiologist can interpret the images and payors can appropriately reimburse for them.
Patient Registration. Patient registration is a feature that assigns patient identifiers, and collects patient demographics, financial information, and clinical history. The RIS manages patient information generated throughout the patient history. Patient information can be entered directly into the system or electronically transmitted from an outside source, such as a hospital information system (HIS). This feature provides billing systems with the correct data necessary to generate statements and reimbursement for services.
In the hospital environment, patient information is typically passed from the HIS to the RIS with an ADT (Admit, Discharge, and Transfer) interface. In a freestanding imaging center environment, the radiology personnel use the patient registration component to collect patient demographics. In either environment, the patient registration component needs to be evaluated to confirm that patient name, date of birth, age, sex, clinical indication, and admitting physician data elements are passed and displayed to the radiologist during interpretation. At its most complete, RIS data elements could include:
? patient name, address, contact information (telephone, fax, email)
? clinical information
? patient account data
? patient diagnosis
? attending/referring physician
? insurance data
? alerts and allergies
Patient registration provides a comprehensive, cumulative online patient profile with multiple means to look up and access patients. For multiple radiology facilities, this feature provides a central data repository in an ever-changing health care industry.
Scheduling. Technologists must often process a continuous stream of patients on a tight schedule, as well as fit in ad hoc patient arrivals and emergencies. This component provides the ability to schedule multiple procedures across multiple facilities by automatically checking conflicts, segmented procedures, repeat procedures, resources, rooms, and duplicate checking through automatic (first available) and manual scheduling. It includes preparation instructions, appointment letters, and workload analysis, as well as assists users in scheduling the right appointment at the right time with the right resources.
Scheduling decreases the amount of time radiology and referring physician FTEs spend scheduling procedures, and increases patient satisfaction. Utilizing resources effectively and meeting patient and physician scheduling requirements can generate an increase in revenue.
Order Entry. Order entry collects what procedures are to be performed and the reason for the examination. If a procedure has been scheduled, the information should automatically pass over to the order entry component. Order entry provides the ability to generate new orders, modify orders, add procedures to existing orders, cancel a procedure from an order, and cancel an entire order. Order information includes:
? procedure name
? CPT-4 code
? reason for the procedure/clinical indication
? ICD-9
? date of procedure
? ordering physician.
Click here for a table Illustrating typical RIS interface work flow for a hospital-based RIS.
In the hospital environment, orders may be passed from the HIS to the RIS with an OE (order entry) interface. In an imaging center environment, the radiology personnel use the order entry component to generate orders.
Order entry decreases time for all FTEs writing up patient information by automatically generating requisitions, flashcards,?? and labels and bar codes for folders. It also? creates pull lists for prior films, daily logs, statistical information, and electronic charges, and tracks patient arrival time, order status, and worklist status for radiology personal. To enable a paperless environment, worklists are displayed for each group of radiology personal, including the technologist, radiologist, and transcriptionist. The worklists are updated as the order moves through the order process.
Patient Tracking. This function enables the administrator to track the patient through the department by monitoring the time the patient arrives for a procedure to the time the visit is completed. Patient status, examination status and departmental location, and alerts for patient delays can be displayed. The patient’s historical information and management reports are provided with tracking data. Patient tracking decreases patient wait times and increases patient satisfaction.
Technologist Completion. Technologist completion collects detailed information about what happened during the examination, such as film utilization, patient incidents, medications, contrast media, radiographic views, technical factors, and comments. It also provides the ability to allow the user to complete the procedure, capture charges, and supply charges. This feature allows the user to modify, cancel, or add procedures to the order. Technologist completion increases revenue by assuring that charges are correct because the requisite information is entered by the technologist. It also ensures that the collection procedure details are available for the interpretation.
Click here for a table Illustrating typical RIS interface work flow for an imaging center RIS.
Film Tracking. Film tracking is utilized to follow films within the department as well as outside of the department, ensuring that films are available when new procedures are ordered for comparison and available for the ordering physician. It provides the ability to create pull lists for prior examinations, and track folder movement within the radiology department and outside of radiology. This feature tracks and displays a patient’s folder, subfolders, and films, and provides information on their current location. When films are loaned, it monitors all folders that have not been returned and automatically generates overdue folder notice letters; it also has the ability to print bar code labels.
The function provides the ability to flag and track interesting cases, legal cases, and films from outside institutions, and to move groups of folders that have had no activity from short-term storage to long-term storage.
Film tracking reduces cycle time by eliminating manual recording of pull list, film movement, and loan information and improves patient care by facilitating availability of the prior films.
Patient History. Patient history is the component that displays all of the data collected throughout the life cycle of the order. So, if the radiologist is looking for a prior result or the technologist is looking for the technique used on the patient’s last portable, it can be found within patient history. It provides a view of a patient’s diagnostic imaging record that includes future and past procedure history. Specific information on each procedure is displayed including results, ordering information, and folder loan and tracking history. Detailed information includes result events and routing information; ACR, CPT-4, and ICD-9 coding; supplies used; technical factors; film usage; patient tracking; and procedure charging. When integrated with PACS, this feature ensures that image location and access to images should also be available.
Patient history reduces cycle time by providing easy access to the entire radiology record.
Charge Capture. This function offers enhanced speed and accuracy in providing necessary billing information through the automatic capture of technical and professional charges. Separate technical and professional charge capture events and outbound interface transactions can be preset and triggered automatically. Pricing can also be preset for each procedure code.
Charge capture provides comprehensive revenue data management reports and can increase revenue up to 7%.
Integrated Billing, A/R. The financial management component of RIS provides electronic medical claims, claims tracking, patient invoices, HCFA statements, electronic remittance, and patient eligibility and authorization.
Transcription. This component is used by transcriptionists to transcribe results. It provides the ability to create and modify results when listening to voice files from an external voice capture system. Today’s new breed of RIS solutions are providing integrated voice capture that has the voice file linked to the patient demographics, which provides the transcriptionist with a single point of entry.
Transcription decreases results turnaround time and increases transcriptionist productivity.
Breast Imaging/Mammography. This assists users in achieving compliance with the Mammography Quality Standards Act (MQSA) with the use of the Breast Imaging Reporting and Data System (BI-RADS) coding. Results can be generated through structured reporting. Breast imaging automatically generates patient normal and abnormal letters, physician letters, follow-up letters, and patient reminder letters. It also provides statistical reports, quality assurance, and outcome analysis.
Some RIS systems on the market will interface or integrate a third-party mammography package.
Radiologist Desktop. Patient registration, order entry, and technologist completion information collected during the order process is needed by the radiologist during interpretation. New RIS components have come into play with the introduction of PC voice applications, digital dictation, and voice recognition. The radiologist desktop offers a single point of entry for the radiologist that provides online review, editing, electronic signature for results, access to prior results as well as integrated speech recognition, digital dictation components, and access to compressed images.
By providing the radiologist with flexible voice capture options by either using voice recognition and editing the results at time of dictation or routing the voice file to transcription for corrections, dramatic decreases in results turnaround time can be accomplished.
Results Distribution. This provides the ability to distribute the results by batch printing, faxing, online access, or email. Faxing functionality includes auto faxing as well as on demand. When batch printing is selected, the system allows preset sorts to be created, such as sort by patient identification number and by ordering physician, which decreases cycle time. Results distribution should also include the ability to create custom result templates for each modality, patient, or procedure type.
By providing the ordering physician with their preference of result delivery, a decrease in results turnaround time and increase in physician satisfaction can be accomplished.
Inventory. This feature allows for the tracking of inventory and supplies that need to be reordered. Each inventory item includes quantity on hand, reorder point, reorder quantity, and overstock points.
Interfaces. Interfaces provide the ability to accept data from and transmit data to external information systems, based on the Health Level Seven (HL7) standard suite of functions, message types, and data elements. Typical message types include ADT, order entry, and results and billing. With PACS, outbound scheduling messages are also used.
Management Reports. The ability to generate management reports provides administrators with an efficient method for the collection of statistical data to support department planning, decision-making, and productivity evaluation. Standard reports include procedure turnaround, film utilization/retake rate, procedure stats, ordering physician stats, overdue folders, open orders, pending transcription, transcription workload, and unsigned results. This feature also enables the ability to access the database through an ad hoc reporting tool.
This function provides a management tool to make decisions based on real-time information.
Data Conversion. This involves taking data from an existing system and transferring it into the RIS database. Data should include patient demographics, patient history of procedures, and results.
Added Features
Additional components that are included in some RIS packages include the following features:
System Administration. This provides the ability to tailor the system to each institution’s needs through system configuration parameters. Users also can modify/edit/add information to prepopulated tables.
Security/Health Insurance Portability and Accountability Act (HIPAA). This provides the system administrator with the ability to assign, monitor, audit, and control user access. Each user may or may not need permission to perform every function.
Web Server. A Web server provides access to images and results for the referring physicians.
Multiple Facility. Some RIS packages provide the ability to track data across multiple facilities and regions. This feature supports multiple facilities with a master patient index, query access, and output reporting of patient information to various departments, clinics, facilities, and external entities, regardless of how the entities choose to identify patients.
Test/Training Database. The RIS should provide a production database as well as a test/training database.
Hospital-Based vs Freestanding
Freestanding imaging centers depend on the RIS to run their business and decrease cycle time, while a hospital’s primary reason to implement an RIS system is to decrease cycle time. RIS typically have been designed either with the hospital in mind or specifically for freestanding imaging centers. While both settings require much of the same functionality from a RIS, each has its own unique needs, as illustrated in figures 2, 3, and 4. Hospital-based radiology departments typically rely on interfaces from the HIS to collect patient demographics and order information, and to produce patient bills. An imaging center relies on the RIS for patient registration, order entry, and patient billing. Click here for a table comparing the RIS functionality needs of radiology in each setting.
Each component of the RIS provides valuable functionality throughout the life cycle of the order.
From the time the ordering physician requests a procedure to the delivery of the final signed result, all components of the RIS are utilized to expedite the delivery of the results to the ordering physician and ensure that the correct charges are collected.
Part II of this series will appear in the May/June issue.
Sherie D. Giles is an independent radiology information system work-flow consultant with more than 26 years of health care information experience, with a primary focus on radiology information systems, and voice and image management. [email protected].
