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EHI Industry view: Chris Yeowart

6th February 2015


What is the future of the radiology information system? In the second of two pieces debating the future of the RIS, Chris Yeowart from HSS / Wellbeing makes the case for using a specialist system in today’s NHS.

Radiology IT was one of the success stories of the National Programme for IT, benefitting from investment and focus, enabling a fully digital service across the NHS.

As scans get more complex and activity volumes continue to increase, radiology departments and the NHS as a whole are seeking more efficient ways of working.

As a result, the foundation components – namely an integrated picture archiving and communications system and radiology information system  – are beginning to evolve; with some questions being asked about their purpose going forward.

Early issues and learned lessons

The Royal College of Radiologists’ 2009 document ‘National Strategy for Radiology Image and Report Sharing’ noted various weaknesses in the National Programme, including “a failure to realise the importance of radiology information systems, and the importance of file sharing that integrated both reports and images.”

Since then, many lessons have been learned. Shared RIS is now much more widely available, supporting shared reporting and access to reports. This is vitally important, with patients now being seen in a variety of care settings, where imaging data is required at each stage.

Workflow benefits are also often cited, such as structured reporting, rapid messaging and interfaces with the local electronic patient record. For many trusts, a RIS is now a core and valued system.

Why is RIS so important?

Dr Tony Newman-Sanders, Croydon Health Services and Clinical Lead, CFH National PACS Programme, says: “The experience that RIS manufacturers have developed in meeting the needs of diagnostic imaging services in the NHS cannot be underestimated.

“As more trusts adopt electronic medical record systems, it is hoped that this experience will inform and benchmark the development of effective and user-friendly workflows (requesting, decision support, vetting, scheduling, administration and reporting) not just for imaging but for all diagnostic and support systems that are increasingly being integrated with EMRs.

“In addition, there is an emerging requirement for systems that enable reporting workflow to be balanced across organisations working collaboratively. RIS systems are ideally placed to develop this combination of enterprise image sharing and reporting with workflow and financial management.

“Systems like this will be essential if the Royal College of Radiologists’ recently published vision of wide area reporting networks is to be achieved.”

Eric Hughes, diagnostics divisional manager, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust explains: “In my role, I am firmly of the belief that that a trust’s RIS is vitally important. My RIS enables me to really understand what is happening within the radiology department at any given time.

“I have a weekly “dashboard” of key information which enables me to pick up potential problem areas before they develop.  Information from my RIS also enables me to keep my chief executive appraised with accurate statistics via the division’s key performance indicators, and to an equal extent, to protect my staff. RIS information is now key to enabling a trust to obtain its imaging funding.”

What next?

However, PACS and RIS suppliers are now competing for the next generation of contracts, as local service provider installations are replaced or upgraded.  This is good news, because it ensures prices remain competitive and innovation is back on the agenda – suppliers are keen to differentiate their offerings.

In some situations, this has led to some radical suggestions which warrant careful consideration.  Such as whether there is still a requirement in the NHS for an independent RIS.

Some trusts are deploying wholesale EPR solutions, and replacing long-standing systems such as RIS, only to find that the functionality is dilute, or not necessarily geared up to support UK centric work-flow.  This could be an unnecessary backwards step, when integration would be an obvious alternative.  A number of trusts are now in the process of reversing this decision.

Others trusts are being advised that PACS reporting is the future, and that scheduling should be driven from within the EPR, at the expense of the RIS.

However, this is largely driven by PACS companies, who possibly sense a very real threat from vendor neutral archive suppliers.  They see the value in RIS, and believe it is PACS that can be easily and cost effectively replaced by coupling VNA and a high quality image viewer and diagnostic toolset.

Taking out a RIS is like trying to remove the spark plugs while the engine is running, so why risk it, especially when there’s little evidence to suggest this has ever gone well?

There are also safety benefits to patients and to clinicians, including the granularity of the data and how easy it is to export data using stats.

Dr Mark Griffiths, Paediatric Radiologist University Hospital Southampton NHS Foundation Trust says: “Most trusts use RIS for workflow and it is a well-developed product, with which trusts are happy.

“Our trusts need a discreet RIS for their integration and workflows. Statistics and the reporting ability of a RIS are vital to produce data requirements for the running of a safe and effective department, as well as diagnostic imaging dataset returns.

“The workflow for supporting the patient pathway through the department to reporting is well organised utilising national codes. Our RIS works across multiple sites within the trust and multiple separate trusts. This enables us to use it across region to enable network reporting.

“Most use RIS as a central hub and scheduler rather than using their PAS for these functions. My RIS is well developed and enables safe documentation feed to multiple downstream systems. I think it would be difficult for a department to operate without a RIS.”

Integrate, don’t replace?

As with the EPR debate, there’s an argument for better integration rather than replacement.  We don’t need to change what already works.  We should be driven by market demands, not supplier whims.

There’s a danger the NHS and its suppliers will become distracted with complex procurements, and even more complex deployment projects when the result is to replace an apple with another apple, just with a different sticker – that’s not innovation.

A consistent approach on a national basis, or at least in geographical clusters, would add benefit and support the drive to share radiology images and reports.  This is about enabling efficiency through greater collaboration and utilising increasingly scarce resource to the optimum.

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