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RIS replacements: hard to do, easy to get wrong (reported on EHI)

27th August 2013

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Some trusts that have chosen to implement new radiology information systems on exiting their National PACS Programme contracts have reported problems. Imaging informatics editor Kim Thomas asks why implementing a RIS is so challenging.

RIS implementations are major infrastructure upgrades. And when upgrades go wrong, they hit users.

Earlier this summer, reports that patients in Kent and Medway were experiencing delays in getting scan appointments and results hit the headlines. The delays were blamed by hospital trusts on a new radiology information system from GE Healthcare, implemented in June. Annette Schreiner, the medical director of Dartford and Gravesham NHS Trust, which was one of four in a consortium formed to buy a new picture archiving and communication system and RIS ahead of the end of their National PACS Programme contract, told EHI the RIS element had not gone well. “A planned downtime of three days extended to 17 days. During that time, the department had to resort to paper-based systems” she said, adding that it had proved difficult to catch up because the system was slow. After several weeks, GE had not resolved the problems.

A last-minute pile through the door

Implementing a new RIS is not easy. Indeed, when analysts from EHI’s research arm, EHI Intelligence, interviewed IT managers and clinicians for its annual report on PACS/RIS, a number emphasised that a RIS is such a complex, business critical system that upgrades and replacements should be approached with great care. Yet, for several months, trusts across England have been racing against the clock to implement new PACS and RIS, before contracts negotiated under NPfIT expired on 30 June.

Yet, for several months, trusts across England have been racing against the clock to implement new PACS and RIS, before contracts negotiated under NPfIT expired on 30 June.

Most trusts have opted to stay with HSS, but some, including those in the Kent and Medway consortium, opted to switch.

Chris Bull, a healthcare informatics professional and director of Purple Fish consultancy, says that problems with RIS often have a greater impact than problems with other systems, such as PACS.

“RIS is really the driver behind patient workflow and patient care. So when you walk through a patient through a trust, everything subsists around how you manage that patient and, of course, everything is managed around the RIS system.”

Migrating data isn’t easy

Bull says that there are three inter-related areas that are often handled badly in RIS implementations: data migration, integration and workflow management.

Stuart Bain, chief executive of East Kent Hospitals University NHS Foundation Trust, which was another member of the Kent and Medway consortium, has said that problems with data migration are partially responsible for causing the backlog in patient scan results.

Migrating data from one software system to another is a perennial problem, but vendors and trusts often underestimate the scale of the challenge. “Slight differences in data format and storage can become large barriers to an easy migration,” says Neil Twist, HSS development manager.

The Cheshire and Merseyside consortium, which consisted of 11 trusts, minimised some of the potential problems by migrating from an HSS RIS to another HSS RIS.

When Taunton and Somerset NHS Trust and Yeovil District Hospital NHS Trust joined forces to implement a Carestream RIS, they both had to migrate from existing (but separate) HSS RIS systems.

Senior says that problems were caused by the fact that the Carestream RIS and the HSS RIS handled the unique patient identifier differently.

Further difficulties were caused by the need to bring the two MPIs together, he says. “Both MPIs were fed through our patient administration systems.

“In Taunton, we have a Spine-compliant Cerner Millennium PAS, which is fed from the Personal Demographics Service, and always had the latest NHS Number.

“Yeovil have a PAS but it isn’t Spine-compliant, and it doesn’t take a feed from the PDS. It had a number of duplicates.” Merging the two together proved harder than the trust and companies hoped.

Getting integration right, dealing with workflow

Data migration is tied up with another issue: integration with other systems, such as a trust’s patient administration system, as well as its PACS.

Bull says that many trusts fail to do their background research on vendors. “We still see many vendor systems using proprietary formats that do not enable easy communication of information. This can make integration difficult.”

Trusts need to be confident that a RIS will allow them to cross-track patient information from one site to another when expert opinion is required or a patient is moved for specialist treatment.

They should always, says Bull, ask for test scripts from the supplier to make sure that systems can cross-talk.

A lack of integration causes serious problems for both staff and patients, says Twist. “Improper or no integration with trust systems can cause a huge workload for radiology staff and also introduces risks of human error, such as mistyping patient information.”

The third challenge for trusts and vendors is getting the workflow right. “The real key with radiology is moving through the patient experience from start to finish,” says Bull.

It’s important to choose a RIS vendor who understands the workflow arrangements in radiology departments and can configure their product accordingly. “A lot of RIS systems can’t support particular ways of working,” he says.

Planning ahead

Some of the problems that have been seen in the first wave of post National PACS Programme changes might be averted by better planning.

Procuring trusts should involve clinicians in the procurement process, and make sure that they are clear and precise about their requirements.

Rather than take what vendors say on trust, they should ask for test scripts to make sure that data can flow between different systems.

Choosing the same vendor to deliver a PACS and RIS, rather than opting for a best-of-breed vendor for each, can be a mistake, says Bull: “With a RIS system, you should go with a vendor that knows how to deliver patient information.”

For the full story please visit the EHI website.