After visiting with the vendors at the RSNA in November, it is clear that this year’s buzzword is “integration.” To reference a common quip in the industry, “The good news is that you are integrated; the bad news is that you are integrated.” “Integration” is becoming the most abused word in informatics. So what does it mean, and what can it mean to your facility? Additionally, and maybe more importantly, what does it not mean?

Integration comes in many colors and flavors; its impact on radiologists, technologists, clinicians, and referring physicians also varies. This reality is exactly why every facility or enterprise needs to completely understand each category of “integration” and its implication. The next steps are to weigh, prioritize, and align the category implication with a facility’s strategic technology vision.

Integrating PACS to the Modalities

Today, the technologist enters patient demographics at the modality. If this information is entered incorrectly, it isn’t a huge issue as long as the data archived belongs to the film in the film jacket. However, if the images are going to be sent electronically to an archive that requires the data to match the existing data from the RIS or PACS, then any data that doesn’t match exactly will create an exception and require an additional resource to correct the mismatch. This happenstance is why people refer to the integration of PACS to the modalities; however, this is not a “true” integration.

We are actually interfacing the modalities to PACS through each modality’s DICOM Modality Worklist (DMWL) output. Therefore, to maximize the efficiency of the PACS, all modalities that are capable of being DMWL must be upgraded so that they are DMWL ready. The seamless communication of patient demographic data directly to the modalities streamlines patient imaging and, by removing the need for additional human intervention, raises the quality of services.

Integrating PACS to a Dictation System

The dictation system is another area that doesn’t have “true” integration with a PACS. A current workflow typically consists of the radiologist using a bar-code requisition that, when scanned, automatically launches the dictation session for the exam to be interpreted. In a PACS environment, depending on the vendor, the workflow can remain the same and a requisition is still required to launch digital dictation, provide patient demographics to digital dictation, and enable microphone-for-voice entry. Many PACS vendors also allow the ability to directly launch digital dictation for the diagnostic review station via the user interface for the radiologist.

Obviously, this issue is less critical in smaller radiology departments; however, in a multi-site environment or for a large number of radiologists with read stations geographically dispersed, this situation presents a major impediment to streamlining workflow and creating a virtual reading capability. Certainly, if the ability for any radiologist to access and read any exam is a high priority, the capability to launch without the paper requisition becomes a key requirement in vendor selection. Be warned: During vendor evaluations and site visits, it is common to ask about “integration” to digital dictation and receive answers about the PACS’ capability to connect to voice recognition, not the digital dictation.

Along the same lines is integrating PACS to a voice-recognition system. As mentioned previously, this topic relates to how you are launching voice recognition currently and how it would be “integrated” into your voice-recognition environment. This integration is common, and most, if not all, PACS vendors have this capability either with their software or a third party’s software.

Integrating PACS to EHR, CPOE, Physician Portal…

In performing due diligence of vendors’ PACS solutions, it is important to understand their capability to “integrate” to a facility’s current referring physician access solution. Ideally, the referring community will enter a facility’s system via the current method to access and view all patient data-as opposed to launching the PACS Web viewer to look at images and reports. Several differentiators can provide the ability to launch and view images directly from the various applications.

Integrating PACS to RIS

Undoubtedly, this area is the most significant movement forward over the past several years to the “true” integration of the radiology systems. Bidirectional communication between a RIS and a PACS is becoming more commonplace as RIS vendors have either developed their own PACS, PACS vendors have developed their own RIS, or acquisitions and mergers have combined PACS and RIS vendors. When selling a PACS, some PACS vendors work hard at also selling a RIS solution. Other PACS vendors will sell their PACS system anywhere, often with the goal to compete for the RIS business down the road. With a “true” RIS/PACS integration, PACS is driven by the RIS worklist, and all radiology functionality is delivered to end-users in a single user interface, eliminating the need to alternate between systems to manage a patient exam-from scheduling to final radiologist sign-off and billing.

When researching the PACS offerings for a facility, the incumbent RIS vendor will play the integration card as the key strategic reason to be selected as a PACS vendor. A fully integrated RIS/PACS is valuable; however, the competing PACS vendors will obviously downplay this integration, focusing on the key functionality and benefits of their systems. It is always entertaining to observe how the same vendor plays the integration card in one facility and then downplays the same benefits when they are competing for the business of a facility where they do not have the RIS. One is not inherently better than the other.

Also, don’t forget that RIS and PACS solutions are available as stand-alone products that can achieve various levels of integration and should not be overlooked. The complexity of this issue is why it is critical that facilities understand the value of an integrated RIS/PACS versus the value of what the PACS offers for their facility.

Ultimately, the key stakeholders in their evaluations will weigh the importance of each vendor’s product offering. The PACS committee should focus on the vendors’ ability to meet their essential criteria, functionality, vendor support, and strategic business partners. With proper due diligence and carefully defined criteria in vendor selection, a committee will be able to understand, evaluate, and select a PACS that properly supports a diverse balance of hospital stakeholder requirements. Integration is just one component of these requirements.

Michael Mack is VP of business development at the Thomas Group Ltd (Anaheim, Calif). Having more than 20 years of experience in the medical imaging industry, Mack now specializes in PACS planning and implementation.