This content is part of the Essential Guide: Conference coverage: RSNA 2013 annual radiology meeting
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New RIS workflows making EHRs look low-tech

At the RSNA annual meeting, speakers explain why EHRs are the weakest link in advanced RIS-based workflow integrations.

CHICAGO -- Radiology information systems (RIS) started out as basic data storage systems in the 1990s, were overshadowed by picture archiving and communications systems, and appeared to be dying on the vine in the early 2000s. But they've rebounded, becoming central data repository and practice management systems.

In fact, RIS workflows have evolved into the proxy EHR for radiologists, with more advanced features than many EHRs offer primary care physicians, according to IT-oriented speakers at the Radiological Society of North America's 99th Scientific Assembly and Annual Meeting.

I'm a big fan of EHRs. The problem is, we're ahead of them in radiology.

Paul Nagy,
director of quality, Johns Hopkins University Department of Radiology

Part of the reason is because of the proliferation of picture archiving and communications systems (PACS) that aren't necessarily interoperable with each other, said presenter Paul Nagy, director of quality at Johns Hopkins University's Department of Radiology and Radiological Sciences. RIS-based workflows demand a single system to keep a health system's radiology data and images linked in a centralized place on the network.

Another reason: Meaningful use is driving radiology practices to integrate with referrers' EHR systems, which has attracted more software vendors to the RIS market. Competition is driving innovation, and deep features such as search and natural language analytics enable radiologists to spot trends in their practices and caseloads.

The RIS at Johns Hopkins also has another driver behind it: peer review of radiology imaging diagnoses for second opinions, group consults or just to see what important cases came in over the last day. IT staff there has customized the health system's RIS with radiologist input to accomplish things that "can't be done with a commercial RIS," Nagy said.

Opening up radiology imaging and the text reports that go with them has not only been a method for improving quality of diagnostics, Nagy said, but also has empowered primary care and inpatient physicians to collaborate more with radiology. Previously, that might have happened on an ad hoc basis, but this new system paves the way for it to happen more frequently. It also gets patients involved when radiology images can be pushed through to the EHR and its associated patient portal, which helps build patient engagement and help satisfy meaningful use requirements.

RIS better prepare radiologists before the patient visit

He also noted that next-generation RIS-driven workflows at facilities such as the MD Anderson Cancer Center at the University of Texas are pulling information from EHRs via HL7 data exchange. The process offers much more up-front context for patients that allow practitioners to better prepare for their visits.

Alex Towbin, M.D., director of radiology informatics for Cincinnati Children's Hospital Medical Center, said EHR integration allows for the hospital's radiologists to learn critical information entered upstream about the patients they are about to run tests on. Instead of getting a vague order that might say, "Patient complains of back pain, perform [this test]," access to EHR data yields a full clinical history.

His efforts to standardize terminology and use EHR data to prep radiologists for patients, he believes, has paid off in creating more customized patient care and the potential byproduct of normalized, analytics-ready data streams.

EHR-RIS interoperability still a work in progress

Two other tools fostering collaboration are HTML5 browser-based PACS viewers, which open access to images to more machines, and tablets such as the iPad. The ability to pass video and audio pertaining to a patient case along with images and text fosters communication and clarification on diagnoses, which Nagy called "more rich consulting" among practitioners.

But there's still more integration work to do. Nagy, an admitted proponent of integrating EHRs with RIS workflows, sees EHRs as basic tools. He hopes, someday, they will catch up to where the RIS market is quickly evolving.

For now, many RIS offerings -- some of them are ONC-certified for meaningful use for radiology -- are proxy EHRs, and in fact are ahead of EHRs in their capabilities for handling data and performing advanced logic operations on it.

"I'm a big fan of EHRs," Nagy told SearchHealthIT. "The problem is, we're ahead of them in radiology. EHRs are still moving nurses and physicians from paper electronic systems. We're trying to go from 2.0 to 3.0. They're trying to solve much more basic problems."

Let us know what you think about the story; email Don Fluckinger, news director, or contact @DonFluckinger on Twitter.

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