Post RSNA 2003 Wrap up
JANUARY 2004
Rex Osborn
Sr Manager Digital
Imaging Practice
RIS Systems Overview
RIS/PACS Integrations
Topics of Discussion
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RIS Systems Are No
Longer Islands of
Information
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RIS Vendors Quick
Assessment
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Key Functionality
Overview

Integration Overview
3 Categories of RIS
Vendors

Why One vendor is
Chosen Over Another

New F&F Seen
Demonstrated at RSNA
RIS are no Longer Islands
of Data
They Must Integrate With
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Clinical Data
Repository
Electronic Health
Record
Clinical Information
Systems
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PACS
Voice Recognition
and Digital Dictation
Systems
Financial Systems
RIS Systems Fall in to 3 Categories
RIS products fall into three distinct camps:
“best of breed” vs.. “integrated” vs..
“RIS/PACS integrated single offering”.

The “best of breed” solution is a pure RIS
product that will interface and work with
numerous HIS products. Also referred to as a
Stand-alone

The “integrated” RIS products are bundled
with the vendors HIS and enjoy a significantly
larger market share than the “best of breed”
products.

And the newest creation is the “RIS/PACS
Only” a truly niche player, usually has
extensive capabilities in storage or PACS for
the OP and Imaging Clinic market Segment
Major Reasons Why One Vendor Won a
Deal over Another RIS
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Reputation
Historical performance
Recommendation
Client installations
Incumbent HIS
What we see performing system selections….
What Executives From Hospitals Say Are
Important Attributes of a RIS Vendor
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Features/Functionality (that address the
prospect organization’s specific business needs)
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Corporate Stability and Commitment
(both to customer support and RIS enhancements)
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Technology and Computing Platform
(that meet the prospect’s established or planned
Information Technology (IT) standards, is this system
part of our “strategic plan?”)
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Client Installations (number of sites, with
emphasis on those most similar to prospect)

Costs (Start-up and On-going Support) (Rule of
thumb is 10% of Hardware and 16% of Software for
maintenance fees)
New Features & Functions in RIS Systems
1 of 3 Slides

Virtual Master Jacket
Film Folder tracking allows multiple master film folder volumes and their subsequent sub folders
be it digital films and images or from outside sources CD, DVD, or Foreign Hard Copy Images.
Some images are not digitized and need as place to be tracked and managed. Easy to place
auditable image access reports here. Can also work for scanned images and tracking of those
images to archiving source.

Web functionality for remote access to RIS functions
Allows access to the web via URL and or through an ISP port i.e. Internet Explore and or
Netscape. Security is LDAP, SSL and Kerberos. Including Remote access to Scheduling for
referring physicians

Web distribution of reference images and related data
Image Management allowing access to ASP based Image Management Systems and or PACS
option. Allows URL, embedded sites i.e. Links to Mallinckrodt
CME site, and or affiliated Hospital, Healthcare System or University Health Consortium satellite
for education for Radiologists or Technologists

Utilization review management reporting
Utilization and Review allows reporting on resources used for Radiology to indicate cost and
investment of time and technical expertise to provide executives with a more comprehensive
view of what Radiology is doing and can do.
New F&F RIS Systems
2 of 3 Slides
Additional

Integration with the CDR on enterprise-wide basis
Allows computerized data record to have radiology information integrated and
available via HL7 interface.

Seamless integration with PACS and Image Management Systems
HL7 and DICOM standard interface(s) with Image Management and PAC systems.
Allowing image distribution with an integrated demographic and clinical relational data
available i.e. Diagnostic Report, patient history and Image Information to include AE
title and modality work list interface/countering off of the Scheduled procedures
(outpatient only)

End user configuration tools to include Export and Import functions for Implementation
(simplification of conversion)
Allows client(s) the option to provide simple data sets for their existing system to be
loaded on to a pre-set and or designated spreadsheet (CSV, .xls etc..). This
spreadsheet can be downloaded into existing dictionaries. Thereby requiring a
limited access build for clients with existing history, patient and diagnostic report files.
Simplification of any implementation step is deemed as positive for the overall costs
associated with supporting an install.
New F&F RIS Systems
3 of 3 Slides
Additional

Patient Tracking (an Airport Terminal effect for Pt Tracking)
Patient Tracking will allow a Radiology manager and or interested parties within Radiology to peruse
real time tracking of patients from the time the patient arrives has the procedure/exam and to the
time the patient is discharged from Radiology. The technologists as well as supporting
administration will update the system as they interact with the patient at key points during their visit.
An up to date interactive screen will update at selected times to show the status of all exams and
patients.

Multi media links for web as well as for images
Allows the user to link to appropriate URL’s for education, additional clinical information as well as
B2C services, and future applications. Image Management Systems can also be added and or
embedded to allow easy integrated access.

A more detailed technologist completion screen that will allow assessments etc…
This should allow the technologists to enter all relative information to the procedure, this is where
the additional views can be added, as well as additional relative charges can be added on the fly,
and where the exam becomes complete, thereby allowing technical charges to take place.
Remember a Radiology procedure is an intervention, think charting!!!

Mammography Module
Allows support of a mammography centric application that meets regional regulations for
reporting and statistic gathering. Meets BIRAD requirements.
RIS Vendors Assessed at RSNA 2003
RIS Vendors Quick Review - RSNA 2004
Agfa HealthCare - Agfa highlights included a bi-directional interfaced RIS system with embedded VR technology (Talk
Technology) at the Diagnostic Workstation. The US version of RIS is truly a work-in-progress version, probably
not going to be fully functional until the release of Agfa’s second generation PACS solution Q4 2004.
Avreo - Avreo demonstrated its OP and Imaging centric RIS system version 2.8, InterWorks RIS application (available
Q1 2004). Avreo offers an integrated Imaging product that is web based.
Brit Systems - Brit demonstrated Roentgen RIS (available today), single DB PACS and RIS solution. The RIS has
limited functionality and is used primarily with imaging clinics and OP facilities. Brit Systems is known for their
government contract work for the military Hospitals DIN-PACS, and are used as a primary storage/archive manage
with the IBM solution.
Cerner - Cerner showed RadNet its RIS system complete with an “Envoi” styled Radiologist worklist and protocol list
complete with PowerChart access for the EHR (Electronic Health Record “CHIME”). The RIS side of this offering
is very competitive and has been successful in sites with over 50K exams.
CPU Medical Management Systems - Web MED/FM the professional and technical billing feature functionality was
demonstrated at the RSNA 2004, with a focus on billing this system is capable of managing billing for OP and IP
environments, the system reminded us more of a Practice Patient Management system than a RIS. Web based
and able to offer a wide variety of management reports complete with trend analysis reporting.
Merge eFilm - Merge eFilm adds RIS functionality via the RISLogic acquisition, the RISLogic product has competed
well in the Imaging Clinic and small Hospital market segment and has worked hard to identify better ways to
integrate with existing PACS solutions.
RIS Vendors Quick Review - RSNA 2003
DR Systems – The PACS Dominator’s data driver the RIS offers a nice segue of clinical data from a PPM or a HIS
system. The RIS product is due out Q2 2004, internet based with the ability to scan in clinical documentation and
link those files with the DICOM Images is deemed as a positive step towards eliminating paper in the department.
The RIS supports the PACS solutions quest to benefit imaging clinics and community Hospitals, the new RIS will
offer scheduling of procedure access to clinicians (very innovative) as well as management reports.
Eastman Kodak Health Imaging - Kodak introduced its new RIS 2010 to the U.S. market, along with newly acquired
Algotech’s PACS solution. A lot is missing at the desktop (integration PACS.RIS) but will be linked in the future.
Scheduling and Patient Tracking seemed to be the focus of the demonstrations. With the emergence of VR and
digital dictation integrations a\]the transcription module will go away and leave the electronic signature and audit
trail for dx report distribution. Deeper functionality is required to be competitive in a number of market segments in
the US.
Eclipsys – Eclipsys demonstrated the XA Sunrise (EHR) integration and a newly developed Radiologist worklist with
their strategic PACS partner Sectra of Sweden (sole provider of PACS for Philips as well). The Knowledge-Based
Diagnostic Imaging (KBDI) module is a combination Clinical IS and PACS, no real RIS feature functionality exists
today within the Eclipsys portfolio. The focus is on the episode of care rather than the standard RIS features used
to drive a PACS. This is where Radiology Informatics is headed but in the mean time departmental management
is still a requirement from a competitive RIS.
Epic Systems – With a new strategic relationship with Philips, this RIS/PACS combination will be interesting. EPIC
uses cache as its DB, and Philips uses Oracle. The EPIC approach is refreshing as the navigation and UI are
more reminiscent of an EHR than the standard dogma RIS approach as is seen with the top RIS vendors. Patient
centric data clearly indicated clinical relevance at the Dx Workstation and will require more work to really make the
desktop integration as navigation friendly as will be required by Radiologist. Deeper functionality is required but
with EPIC’s history, more is soon to come.
RIS Vendors Quick Review - RSNA 2003
IDX Systems - IDX brings Imagecast RIS version 10+ to RSNA 2003, the demonstrations were complete with
Stentor playing the part of PACS and archive. The RIS centric approach allows MPPS information to be
validated between the RIS and Modality allowing better source data to flow to the PACS system. Be it Stentor or
a third party PACS solution, IDX has positioned themselves as an innovative integrator using the Imaging Suite
as the conduit for any integration using DICOM and or HL7. The Imaging Suite enables version 9 and 10 to
integrate well and manage the worklist responsibilities of a RIS/PACS. IDX competes in the complex world of
IDN’s and has a split client base with over half of the clients using the older version 9 and all new clients being
relegated to version 10. IDX has been successful working with clients to develop dynamic integrations once their
RIS is stable and ready to be integrated to a PACS solution.
Inphact (Now Evolved) - Version 4.0 of RadWeb was demonstrated as was the integrated PACS solution, single
database java based RIS system. Competitive for the OP and Imaging Clinic and starting to compete in the
community hospital market segment. The OP billing component is one of the best we have seen in the
marketplace.
Insight Healthcare Information Systems - IHIS is the offering from Insight. This RIS is designed for small to midsize hospitals but appears to be fully functional rich, but will continue to work to become more competitive in a
marketplace where you compete head to head against the monolithic behemoth Meditech.
McKesson Information Solutions – Via acquisition McKesson has brought in a RIS system to drive the McKesson
PACS solution acquired from ALI Technologies. The all new Horizon Radiology Manager is available now.
McKesson is working on deeper functionality and better desktop integration driving the McKesson PACS to better
clinical connectivity. Links currently to the Horizon EHR look great and the clinical data is rich and readily
available via a patient centric encounter based approach towards viewing clinically relevant data. The MS
Outlook styled menu driven navigation will certainly need some revisions and new feature functionality will come
as clients start providing invaluable input to McKesson.
RIS Vendors Quick Review - RSNA 2003
Misys Healthcare Systems – MISYS Radiology is a fully functional RIS system available now for environments beyond
50K exams a year. A PACS relationship exists today with eRad to offer a strategic integrated RIS/PACS offering,
although several PACS systems have found it easy to integrate with MISYS as a RIS. Using Cache as the DB,
MISYS competes well with other major vendors in the RIS marketplace. The latest development effort has been to
offer the PACS Integration Module (PIM) to be used as a conduit for HL7 and DICOM bi-directional data transfers,
easing the ability for MISYS to interface with any PACS solutions in the marketplace.
RadInfo Systems – Using Chinese development teams the PowerPACS/RIS has been developed in unison, allowing RIS
data to be intertwined with PACS workflow. This international product has a niche in small to mid-size Hospitals
overseas and Imaging clinics in the US, the core RIS functions mirror a stand alone provider of data to a PACS to
allow scheduling and creation of an accession number.
Siemens Medical Solutions - The vendor's Novius RIS has an updated look and feel and has added integration to
Siemens MagicWeb, a clinical distribution mechanism for images to the enterprise. The RIS is very competitive for
large complex IDN’s and has been a willing integrator using HL7, Siemens has not been as aggressive in the IHE
profiles for RIS systems, but has developed a nice desktop integration and bi-directional integration with its Sienet
PACS solution. The new Soarian (EHR) product line offers clinical connectivity at the clinician desktop, and allows
easy views of encounter based visits and results as well as all interventions.
GE Medical Systems – The Centricity RIS PACS product was demonstrated and the functionality has improved and is
still being used as the primary driver of data to the PACS system, with the GE PACS solution carrying the bulk of the
management of workflow responsibilities. The RIS system uses and Oracle gateway to communicate to the Sybase
based PACS solution and has been slow to grow a large user base as was expected by the industry. The RIS
development has gone through several phases and is being offered as a single solution but has not been as
successful since being acquired by GE as it was as an independent product in Per’se’s solution suite.
RIS Vendors Quick Review - RSNA 2003
SoftMed – A Canadian company using a Java based front end and MS Outlook styled navigation is an icon driven
functional RIS system designed for stand alone imaging clinics and OP clinical environments. The product works
closely to stay within the framework of IHE providing all necessary links to offer connectivity to a practice patient
management as easily as a HIS. Market segment efforts will start to move more towards small community
hospitals with future releases.
VitalWorks - Java-based RadConnect RIS is the primary RIS offered by VitalWorks and has proven successful in the
Imaging Clinic and small Hospital niche. Deeper functionality is required and work will need to be done to
integrate the web based Archive solution Amicas.
XIMIS - XIRIS 5.0, eXtended Internet Radiology Information System is a stand alone RIS system that is slowly building
a large user base in the small to mid size Hospital market segment. Platform and Database independent this open
system offers folks a software version that is both reliable and affordable. Integration efforts have been effective
but more work is necessary to make desktop integrations a reality for sites using XIRIS.
Ferrania – LifeWeb RIS is an Italian based RIS system, a web based RIS system developed in unison with a web
based PACS solution, recently named as a finalist for a large IDN in the UK Health System . The RIS as well as
the PACS system will be made commercially available in the US in 2004. Usually deemed as a ECR (European
Congress of Radiology) Capital equipment giant, the latest innovative RIS solution is heavily vested in to the IHE
framework and is looking to be an aggressive player in the US marketplace in the coming year.
Creative Computer Applications - CCA written in Cobol and available today offers Imaging clinics and community
Hospitals the RIS CyberRad version 4.1. CyberRad, compliments the Laboratory and Pharmacy systems offered
by this clinical informatics company.
Key Functionality
Within RIS Systems
** Patient Registration (OP) (BDI)
** Scheduling (SU Messages to PACS)
** Order/Exam Requisitioning
** Charge Capture/Exam Billing
** Patient Tracking
** Virtual Master Jacket
** Standard Management Rpts
** Inventory Control (Supplies)
** Equipment Maintenance
** Mammography/Patient FU/MQSA
** Quality Control/Quality Assurance
** Interfaces (e.g., PACS, Digital Dictation,
Report Transcription/Electronic
Sign/Security, Transcription, Billing,
Scheduling, Voice Recognition, Results
Report & Distribution)
Key Points to Considering a RIS Solutions
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Scheduling (Enterprise vs.

Departmental)
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Patient Identification (How many
vs. Voice Recognition)
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Patient
Profile/Demographics
Orders/Accessioning
Charges (Professional and Technical)
Work Lists (Via MPPS)
Patient Tracking
Result Reports and
Distribution (Via clinical Web
Application vs. HL7 Feed to EHR/Results
Reporting Module CIS/HIS)
Film Management (Virtual Master
Jacket to include CD’s, Foreign Film, Audit
Trails of access)
Patient ID Domains Exist within your IDN?)
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Dictation/Transcription (Digital
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Department Forms (Requisition vs.
Virtual Requisitions)
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Management Reports (ad Hoc as
well as Standard Stat Reporting)
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Mammography (MQSA Standards,
BiRADs)
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Exam Management
Integration (To the Dx Workstation, to
the Web Clinical Image Distribution System to
the HIS, CIS, EHR, EMPI and or CDR)
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Structured Reporting (DICOM SR)
Scheduling, Patient Information
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Scheduling
Enterprise-wide identifier
Central vs.. Departmental
Location codes
Physicians
Information from registration and scheduling processes should be
available
Access to allergy information, ability to add allergy information
Access to Lab Results
PT’S WILL SCHEDULE PROCEDURES VIA INTERNET, W/
PROCEDURE EDUCATION URL’S
Orders/Accessioning
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Orders
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Registration location
Timing
Who enters orders
Where are orders entered
Changes to existing orders
Order flow
Different patient types / order types
Cascading orders (CT of CAP, MR of Head + C-Spine)
PGP)
Order Splitting Logic
Bi-Directional Updates (Status)
Paperless Requisition
(IHE
Accessioning
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Unique accession number per exam
System or manually generated
Accession number suitability with PACS
CPOE WILL REDUCE ORDER ERRORS, AND SOME ORDERS WILL
BECOME AN INTERVENTION REQUIRING CHARTING AND
ASSESSING SIMILAR TO RESPIRATORY THERAPY AND CARDIOLOGY
Charges
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Technical & Professional
When charging occurs
How charging occurs
Relationship between procedures and charges
Credits
Billing system integration
RADIOLOGIST WILL CODE/CHARGE PROFESSIONAL VIA
STRUCTURED REPORTING MECHANISMS, LINKING A DIAGNOSTIC
REPORT AND THE DIAGNOSTIC WORKSTATION; CLICK ON THE
PATHOLOGY AND NARRATE THE FINDINGS CODED AS KEY IMAGE
ANNOTATIONS ADDED REAL TIME TO THE CDR AND EHR FOR CLINICIAN
PERUSAL
Patient Tracking & Exam Management

Transport Status – Patient retrieval Time, Patient Availability Status, Patient
Arrived in Department
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Track procedure times and exam status
Track film use
Reasons for Repeated Studies
Reprint labels, req’s, b/c’s
Technologist Notes
Technologist Completion Function
TECHNOLOGIST WILL CHART INTERVENTIONS AND COMPLETE ORDERS, AS
WELL AS PROVIDE NARRATION OF PROCEDURE/EXAM NOTES
(TECHNOLOGISTS CLIPS, PART OF THE EHR)
Work Lists
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Information Needed
Format – On-line or manual
Origination and organization
MPPS Bi-directional (Update and Standard
Patient Data Message)

RIS Centric vs. PACS Centric vs. EHR Centric
SCHEDULING AND PRE-REGISTRATION (ENTERPRISE) WILL
COMMUNICATE WITH EACH MODALITY AND UPDATE THEM REAL TIME
ALLOWING A VALIDATION OF PATIENT, PATIENT DATA, PROCEDURE
ORDER AND WILL PROVIDE THE PACS SYSTEM RELEVANT PRIOR QUERY
Dictation/Transcription
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VR vs. Digital Dictation
 Transcriptionist vs. Correctionist
PACS based Integration (Dx Workstation)
vs. RIS based Integration
Availability of Tech Notes
Viewing and access (images)
Integration with Dictation and Voice Recognition products
Data availability for Radiologist during dictation
Reading by Location vs.. Modality vs.. Subspecialty
Reading across facilities (Central vs. Dispersed)
RADIOLOGIST WILL CODE/CHARGE PROFESSIONAL VIA --- STRUCTURED REPORTING
MECHANISMS, LINKING A DIAGNOSTIC REPORT AND THE DIAGNOSTIC
WORKSTATION; CLICK ON THE PATHOLOGY AND NARRATE THE FINDINGS CODED
AS KEY IMAGE ANNOTATIONS ADDED REAL TIME TO THE CDR AND EHR FOR
CLINICIAN PERUSAL; RENDERING, NARRATION, CODING, BILLING, DISTRIBUTION
Result Reports
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Transcribed Report
Electronic Signature / Approved Report
(Part of a Dx Workstation)
OR Reports
ER Result Reporting (Nighthawk, Preliminary Reading)
Turnaround Time
Paper Distribution/Faxing to referring physician offices
Preliminary Results
Multiple tests – one report (CT of Chest, Abdomen, Pelvis)
See previous slide…..
Film Management (VMJ)
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Search process (patient name, MRN, date of service,
unit, etc.)
Pre-fetching (Schedule Application Messages to PACS
system)
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Less Film or Filmless?
Storage
Purging
Sign-out process
Bar-coding
VIRTUAL MASTER JACKETS THAT CAN STORE IMAGES FROM MULTIPLE
LOCATIONS (within the IDN) AS WELL AS THE ACKNOWLEDGEME
AND TRACK
FOREIGN FILMS WILL ALLOW THE RADIOLOGIST TO
SEE A TRUE PATEINT
HISTORY. EXAM HISTORY OF EACH
PROCEDURE WILL ALSO STORE DX
REPORTS & CLINICAL NOTES
WILL BE AVAILABLE FROM A STANDARD HL7
FEED TO THE RIS OR
PACS APPLICATION MANAGING THE VMJ
Department Forms
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Patient History
MRI Questionnaire
Wet Read Forms
Film Release Forms
Disclosure and Consent Forms
Diabetic Pre-Scheduling Forms
Management Reports
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Patient Wait Times
Exam Reports
Technologist Productivity
Radiologist Productivity
Turnaround Statistics
Mammography
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Mammogram Summaries by Radiologist
Mammography Outcomes by Radiologist,
BIRADS
Patient Due/Overdue for Follow-up Report
Exam Recommendation Summaries
MQSA Reports
Integration

Electronic Health Records: Both text and
image data combined with Radiology notes
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Clinical Data Repositories: Most often
textual result reports (lab, dictated history and
physical exam findings (H&P), anatomic pathology,
etc.).
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Clinical Information System: Order
communications, Nursing Assessments/Notes,
Protocols, Care Plans, etc.
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Hospital Information System:
Registration, Billing and Accounts Receivable, and
general accounting.
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& PACS: HL7, via Broker or Brokerless
approach; Registration, Order Management, Order
Status, Scheduling SU and Inbound Results
Reporting
Example of a Standard Integration Workflow
ADT
Scheduling
Enterprise
Or
Departmental
ADT
Order
Schedule (engine converts to order)
Schedule
ADT
Order
Voice
Recognition
Order
RIS
Result
Schedule
Result
PACS
Interface
Engine
Result
ADT
Order
Clinical
Info
System
Schedule
Result
Image (addr)
Image (addr)
RIS/PACS Integration; a MUST
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RIS systems must
provide clinically
relevant data
Without a RIS a PACS
system is merely a
Glorified Lightbox!
Eliminating the line
between a RIS and
a PACS; A Radiology Dream
Key Questions
Single vs. Multiple DB Approach
 RIS
systems this year showed a variety of DB schemes but most RIS
PACS offerings provided a gateway linking databases, but not
necessarily a single DB shared from the origination of development
 These integrations are not unlike disparate integrations with a few
desktop integration effects allowing the Radiologist at the desktop to
maintain patient focus and click on a RIS access key on the tool palette
Three examples of DB Integrations:
1.
Proof that separate DB
systems can be integrated
closely is GE’s Centricity, a
PACS system that uses
Sybase while the RIS
system uses Oracle
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The RIS system uses the Oracle
Gateway to communicate with
Sybase and emulates a single
entity DB
RIS & PACS were NOT built by the
same Development teams and yet
the integration has quality and
allows bi-directional navigation
Centricity offers the Radiologist a
nice “Physician Access” styled
EMR screen
2.
AGFA uses the Quadrat
RIS (a Belgian RIS
solution), and it integrates
in to their PACS product
IMPAX
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Quadrat and IMPAX are designed by
separate development teams and are
available in an International version and
a US version (set to be released this
year)
The integrations started with a general
RIS information screen with multiple
parts allowing easy access to RIS data
on the patient, and bi-directional
navigation
IMPAX uses script buttons on the Dx
Workstation to access a proprietary
conduit called the context server to
integrate with disparate third party
systems including desktop integration to
VR and digital dictations systems
3.
IDX Stentor tout a single
database using SQL 2000 as
the common DB between
their systems
•
•
•
The common denominator for
integration is the Imaging Suite
offering from IDX, allowing HL7 and
DICOM messaging to be managed
by IDX
The worklist from Stentor is replaced
with multiple styled worklists from
IDX (using MPPS allows the RIS
system and the modality to do a prePACS validation of data prior to
offering the Radiologist a view of
their daily workload)
IDX allows script buttons on Dx
Workstations to access key
applications within IDX’s RIS
What strategic relationships exist between third
party integration engines and S/W development
companies?
Key Questions

When asked about third party tools, most vendors basically have
worked to develop their own tools for desktop integration, or have
simply not addressed the issue of desktop integration.
Examples of Approaches:
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Philips – EPIC (New strategic Partner): Historically
Philips did NOT believe that desktop integration, but the
latest agreement with EPIC is pro-desktop patient
synchronization allowing a script button access to
EPICS powerful EMR and newly developed RIS
system.
Cerner PACS (Cedara) – RadNet RIS (Strategic
Partners): Disparate systems, separate development
approaches “Desktop integration can only be achieved
when both RIS and PACS are working together.”
Cerner does not own their PACS partner and have not
moved forward with desktop integrations with any
disparate PACS system. “If you want desktop
integration you have to buy all Cerner ‘Net’
components.”
DR Systems RIS/PACS (single development
approach): The focus here is on innovative integration
offerings built in to a common framework allowing
workflow to provide Radiologist with the right data at the
right time. Most sites using DR Systems needed an RIS
solution to provide accession numbers, the RIS system
is the latest part of the Dominators quest to become a
single source solution for radiology beyond the Imaging
clinics where they compete well.
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Evolved RIS/PACS: Developed to
generate accession numbers and to
manage simple scheduling for the
ASP PACS solution the RIS system
has since expanded functionality to
be a fully functional OP Imaging Clinic
RIS solution. Inphact has worked
extensively to make the “little RIS that
could” be more accommodating for
imaging clinics and small community
hospitals that could not afford a PACS
RIS combination. This ASP based
model offers a wide variety of
integration points within Inphacts
solution. But unlike many vendors
Inphact is more than willing to
integrate at the desktop with
disparate RIS systems. This
company supports desktop integration
using DCOM, Active x and or socket
level integration and is developing
xml tools for internet based disparate
systems.

McKesson PACS/RIS: Disparate system
acquired, new emphasis is to stabilize
functionality and upgrade current features
and functions to allow the RIS system to be
both competitive and embedded in to
McKesson's PACS solution. Desktop
integration prior to the McKesson acquisition
allowed customized integrations using a
variety of methods mostly proprietary
approaches. A new standard has been put
in to place to make all integrations
supportable but they limit desktop
integration for third party RIS solutions
working in consort with McKesson's PACS.
Currently no standard approach is in place
for a tight integration beyond HL7 with
disparate RIS systems and McKesson's
PACS solution, and no interest has been
shown to work towards that end.
Differentiators
PACs/RIS combinations; What differentiates your integration schema from what
you do with other RIS systems or other PACS systems?

By and large PACS and RIS combinations be it strategic or in-house developed seem to
be better integrated because they have an incentive to offer tight integration beyond HL7.
Therefore they share DB mapping and the integrations appear more complete and
sometimes are just as unstable as a third party if the work is not QC validated!

Few vendors will explore desktop integration with third party (disparate) systems except
for the rare effort by IDX’s (via its Imaging Suite) integrations with the major PACS vendor
(offered via IFID documents created due to demand of IDX clients) the only real
differentiator with its RIS centric approach towards integration is sharing a single DB with
its strategic partner Stentor. 3rd parties as well as Stentor have to use Imaging Suite!

Stand alone RIS systems that do not have a strategic relationship with a PACS vendor are
more than willing to use a third party conduit, or self developed integration tools to
integrate and bring better quality data to the PACS solution investment made by its clients

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CCA
VitalWorks
Ximis
Merge
SoftMedical
Vendors willing to customize integrations if necessary to meet the needs of clients
PACS/RIS (Major vendors)
Strategic
Integrations
RIS to PACS
PACS to RIS
HIS to PACS
Single Vendor
Development
IDX – Stentor
DR Systems
Misys – eRad
Ferrania
Acquired PACS to
Integrate
RIS Solution
Acquired RIS to
Integrate with
PACS Solution
VitalWorks –
Amicas
Agfa – Quadrat
Kodak - Algotech
CCA – eMed
McKesson –
WebMedx
RadInfo Systems
Siemens – SMS
Philips – Epic
Inphact (Evolved)
Eclipsys – Sectra
Avreo
GE – Per’Se
(Consort)
Cerner – Cedara
Brit Systems
Merge - RISLogic
eMed – Cedara
WebMD
INTEGRATIONS SUPPORTED
RIS VENDORS
RIS Centric
PACS Centric
HIS EHR Centric
Custom Integrations
N/A
N/A
N/A
N/A
Agfa HealthCare
Avreo
Brit Systems
Cerner
CPU Systems
CCA
DR Systems
Eastman Kodak Health
Eclipsys
Epic Systems
Ferrania Imaging
GE
IDX
Inphact
Insight Healthcare
McKesson
Merge eFilm
MISYS
Ferrania
RadInfo Systems
Siemens
SoftMed
VitalWorks
XIMIS
Innovative RIS Integrations
HL7 & XML
 URL Calls and links to Multi
Media Files (a few do not support
this but by and large the RIS
vendors have embraced this)
 Digital Dictation Integration
(allows transcribed reports to
reside within the RIS, where
Electronic Signature will be
available for the Radiologist)
 Protocol List (ordering modifiers

can be edited here via protocol for
procedure(s))
OP and Imaging clinics need
ability to have on-line adjudication
via PPM to update status in RIS
 Bi-directional HIS Order
Management and Update
Registration capabilities

Scheduling to the Enterprise
 Pre-fetching HL7 SU messages
 Order Management and Update
messages
 MPPS data send and update
via command from modalities
 Results Reporting (PRN)
Diagnostic Report availability
depending upon pre-set rules
based logic (i.e. View Preliminary
Y/N, View Resident or ER Initial
Review Y/N)
 Decrement for interventional
and special procedures linked to
logistics system enterprise
 Cost Accounting Reports

HIS/RIS
HL7
Workflow
Manager
DICOM
Orders
Exam Updates
Reports
Report Updates
ADT
Patient Updates
Exam Details
Exam Details
Reports
Reports
Worklist Query
Patient Query
Report Query
PACS/Modalities
Worklist Query
HIS Verification
Report Query
When MPPS is more readily available a connection will occur between
RIS and Modalities (Worklist, Patient Data & Patient Update Status)
PACS/Modalities
HIS/RIS
Admissions, Discharge
and Transfer Data
Data validation, patient
information updates
(w/ MPPS Validation can also
be done via RIS/Modality)
Orders and Scheduling
Information
Enable worklist management and pre-fetching of
prior studies from long
term archive to online
storage
Radiology Reports
Allows physicians to
view images and reports
simultaneously
PACS Integration Requirements
Modality
PACS Data Flow







Patient data
Order
Information
MPPS
Validation
Patient Data
Scheduling Data
Orders
Reports

HIS/RIS



Patient Data
Scheduling Data
Orders
Reports
RIS-PACS
Interface
To achieve the workflow and automatic data validation
benefits of PACS, organizations must have tight
integration between their HIS/RIS, modalities and
PACS.

Study Data
PACS



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Data Validation
Image Routing
Pre-fetching
On-Demand
Query
Clinical Systems Integration
a “Trinity”
Data Integration



Share ADT, orders and
reports
HL-7/DICOM
Broker/Integration
Conduit
Mostly unidirectional
interface
Database Integration

Desktop Integration


Today


Vendor
Partnerships
&
Proprietary
Approaches
Clinical Systems and
Ancillary Systems
able to operate on
single Dx workstation
Able to share data
between applications
Common user
interface
Single Point Login


Both systems use the
same database to
define worklists and
routing rules
Ability to see reports
completed prior to EIMS
Common administration
H7-Clinical
Context
Object Standard
and/or IHE
Approach
Integration Confirmation Part 1 of 2
HIS – RIS - PACS

Clinical Results; Multi-Disciplinary (HIS/CIS), Diagnostic Reports
available to the PACS (as needed, RIS Responsibility to PACS)

Radiology History of Procedures & Order Entry (RIS or HIS/CIS)

Bi-directional Order Management and Registration (RIS HIS/CIS)

Clinical Data; Primary Diagnosis, Medications, Allergies, Nurse Notes
(HIS/CIS)

Modality Work List (MWL), Protocol List and Clinical Exam Note (RIS)
Integration Confirmation Part 2 of 2
HIS – RIS - PACS
Client Responsibility to manage integrations with vendors:




Test the Integration of (RIS, CIS, HIS) Product with the
Diagnostic Display Workstation
Request a Tech. Spec. document for the Configuration
of the integration from each vendor
Create a Test Plan / Report for the integrations
Create a document to be used for supporting the
integration and who to call if any component fails or is in
need of analysis
Integration capabilities that add the most
clinical © and or economic value $.

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Share common data / indexes with RIS / HIS and enterprise data repository: $ ©
Share common communications protocol, e.g., HL/7, DICOM, etc ©
Pre-fetching of historical comparison exam images according to user-defined rules: $
© (not necessary with on-demand, but rules for relevant priors will have to be
considered)
Support for DICOM Structured Reporting: $ ©
Distribution of multimedia patient related information across the enterprise: $ © - via
web based clinical image systems
Common user interface, i.e., Web browser to standardize presentation and reduce
training and support requirements (IE Explore 5.0 and higher, Netscape 4.5 and
higher, version 6.0 at present has many problems with encryption): © - via web based
clinical image systems
Indexing and catalog capabilities according to ACR codes to facilitate clinician
education, training and service levels: ©
Use of industry standard compression algorithms to insure compatibility across wide
range of hardware and software platforms (Wavelit image viewing through URL or
portal from main application): $ © - via web based clinical image systems
Work flow capabilities to increase personnel productivity and organizational service
levels: $ ©
Controlled access to RIS via remote Web access, e.g., intranet and/or internet: ©
Enterprise Defined
CMPI: A system used to track patients across the IDN. The solution accommodates patient movement throughout the
health care network, greatly reducing the chances for misidentification and duplication of records, provides accurate
data integration into clinical data repositories, and supports heterogeneous application system environments. The
CMPI resides one level above each individual institution and or clinic's) MPI.
ES: An enterprise-wide patient scheduling system allows healthcare organizations to easily and cost-effectively schedule
patients throughout the enterprise; Inpatient, Outpatient, and Surgical environments. The system allows scheduling
to be performed centrally or in a distributed fashion for any facility in the organization.
EHR: The EHR serves two primary purposes: 1. It provides a current summary of the patient's status and it offers direct
access to frequently consulted parts of the record, such as: previous visits, diagnoses, sensitivities, past history,
current medication, and latest test results. The EHR can provide a view of the status of the patient at any date
between the patient's first visit and today. Patient data can also be accessed at a more detailed level than a patient
visit or a set of lab results. 2. The EHR supports browsing through all past clinical data via visit and or encounter
based timeframes. Information can be viewed such as: patient complaints, medications, allergies, discharge
summaries, clinical notes, H&P’s, VSIO, charting notes/annotations, graphs of normal/abnormal ranges, lab test
results, radiology diagnostic reports and diagnoses both past and present.
CDR: Clinical Data Repository (CDR) allows institutions to store patient data permanently. The CDR is a data dictionary
driven, relational database that manages relevant patient information such as demographics, insurance coverage,
patient medications, medical documents, laboratory results and radiology results. In addition, the CDR allows images
and other data formats such as voice and video to be embedded into the CDR database.
If you don’t understand the Enterprise you won’t understand RIS and PACS technology and where it fits….
Rex_Osborn@yahoo.com
Rex Randall Osborn

Over 17+ Years Healthcare IT Background;
Extensive Clinical IT, PACS & RIS experience

Over 64 Projects from Implementation, System
Selections, Project Management, Project Planning,
Product Management to General DI Consulting

Available to present in detail with IHE Requirements
for RIS and or PACS. Will Provide detailed RFP
questions for new RIS or PACS System Selections
as well as Product Management Strategy or Product
Review and Analysis for Market Segment(s)