By Michael J. Cannavo

For the past few decades, radiology information systems (RIS) have lived in PACS’ shadow.

In the early days of PACS, the 1990s and early 2000s, RIS was PACS’ partner. You almost never heard of someone buying a PACS without a RIS. Then, for a host of reasons, RIS growth slowed (despite what companies that sell market reports stated to the contrary). The reasons were many and ranged from cost justification to the use of standards-based integration that allowed facilities to obtain best-of-breed solutions versus an all-in-one solution.



Today, RIS and electronic health record (EHR) systems with embedded RIS functionality are making a comeback. Lower prices for an integrated RIS and the high price that vendors often quote to integrate disparate systems is one reason, while having “one throat to choke” is often cited as a primary driver for choosing an integrated RIS. The use of cloud-based solutions that employ VM (virtual machine) hosting the hardware and software both in the cloud is yet another, especially since most IT (information technology) departments are overcommitted to supporting the existing clinical information systems they have now. Most importantly, though, is MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and its paths for participation that involve quality improvement programs that RIS can address. The Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs) pathways require participants to use certified EHR technology to develop programs that involve quality (50 percent), outcomes (25 percent) and cost containment (10 percent). Under MIPS, a provider’s base rate of Medicare Part B payments would be adjusted based on a composite performance score. Providers would receive positive, negative or neutral adjustments. In 2019, the maximum payment adjustment amount starts at 4 percent upward or downward. It then incrementally increases to 9 percent in 2022 and onward .That said, the financial incentive to use RIS and EHR technology is probably the biggest single factor for RIS’ resurgence. While a RIS alone cannot meet all of the MACRA requirements like electronic prescribing and creating a patient portal, although some do have this feature, it can help with many of the needs of a facility to improve quality, especially if the facility has an electronic medical record (EMR) in place already.

A RIS typically addresses the multiple functional areas, although there can be fewer or more modules than discussed. These include patient registration and scheduling; patient list management; modality interface using worklists (typically to a PACS via an HL-7 interface); document scanning; dictation and transcription, including custom report creation and speech recognition (although this typically is done using a third-party vendor like Nuance or MModal); auto-routing of results to the primary care physicians and others via email or fax; patient tracking; and many others. Some RIS providers also offer billing and ICD-10 verification as well as data dashboards, real-time data analytics, integrated mammography tracking and reporting and more.

It’s interesting to see how RIS is being used, not just for MACRA-related reimbursement, but also to improve overall quality and functionality at an imaging center or radiology department. The more automated a department can become, the less dependence it has on people to determine what is and is not going on within the site. This is especially true when dealing with things that improve patient satisfaction. Patient tracking, which keeps track of the patients from the time they are checked in until they are checked out, can be key to insuring that patients are processed in a timely fashion. So often, staff members misjudge how long a patient has actually been waiting to get in to the exam room and have their procedure done, A RIS takes the guesswork out of that by using pre-defined color changes based on the time the patient has been waiting. Patient wait times may be shown in green if 10 minutes or less, in yellow if between 10 and 25 minutes and red for anything over 25 minutes. This insures the patients will be taken back for their study in a timely fashion, or at least notified if there is a delay that will impact the timeliness of the study. Insurance verification also lets the patients know exactly how much financial responsibility they will have for a study and avoids surprises weeks or months down the road.

Having information that can be transferred to the patients’ primary care physicians quickly and electronically, as well as having it available to them in secure patient portals, is yet another benefit, as is a scheduling and registration module that allows them to choose their appointments by time and date that is most convenient to them.

To the clinicians using the system the benefits shown are numerous. Reports that show no abnormalities (also called normals) can be dictated and signed off on in a matter of seconds, saving the clinician several minutes per case. This can translate to hours of time savings daily and allow them to complete more studies in the same time allotment.

Data dashboards and data analytics are invaluable to the facility determining not just resource utilization, but also referral patterns, payer profiles, accounts receivable and so much more. This can make the difference between a facility that is making money and one that is losing it, often through no fault of its own. It’s a simple question of knowing versus not knowing that makes the difference here.

PACS and RIS are often tied together because a PACS only deals with the images, not the reports or the historical patient data. If the prior reports and images are both available, as well as other pertinent patient information (patient history, lab results, etc.), then technically a radiologist is only required to be on-site for interventional procedures like biopsies and catheterizations. This allows a facility to use remote reading services from teleradiology service providers (TSPs) to either augment a site’s reading capacity, or just provide coverage for vacations and other events where a radiologist may not be present.

The use of RIS goes back to the late 1970s when Massachusetts General Hospital’s MUMPS programming language was the standard for many clinical systems. It has since evolved to become an invaluable tool in radiology’s armament. A RIS is often the key to providing the highest quality service to patients, valuable information to clinicians and others, and most importantly, generating revenue in a system where value-based care has become the name of the game.

About the author: Michael J. Cannavo has 30 years of experience in the evaluation, design and implementation of PACS and associated clinical systems including RIS.