There is more to picking the right radiological information system (RIS) than just choosing a piece of software that comes highly recommended or fits the budget. Like so many tools in healthcare, the right RIS investment starts with looking in the mirror and figuring out what your unique needs are and how you plan to meet them.

“Most people do not seem to understand that to make it work takes a little bit of skill and a little bit of flexibility. You can pick a great tool but if you can't implement it to keep your business going, health systems are going to cut their volumes or spend hundreds of dollars on a consultant,” RadNet CIO Ranjan Jayanathan told HCB News. “You need a product that you can take from presentations to actual use and implementation without destroying your business."

And it’s easier said than done. According to Jayanathan, providers in the U.S. are replacing RIS solutions at a high rate because they are investing in tools that aren’t meeting their productivity demands.

Making the right purchase requires providers, both for radiology and now, the hospital enterprise, to understand the type of solution that RIS is today, and the functionalities it possesses. It commands experience and knowledge in how to integrate RIS within a workflow and enable it to operate in conjunction with, and in support of, other systems and tools.

RIS has evolved
Originally designed as stand-alone system, RIS has historically overseen the management of orders for imaging studies and related documentation as well as billing, administration and some workflow tasks. Although they remain largely a stand-alone in international markets, RIS solutions in the U.S. are increasingly becoming a set of functionalities embedded within other types of systems.

"You could say in many cases that departmental RIS solutions were essentially cannibalized by a broader EHR solution that covered all administration, billing and order management across the hospital, with RIS a module of the wider EHR solution,” said Steve Holloway, principal analyst for Signify Research.
Meanwhile, according to Holloway, PACS systems also became more sophisticated, offering radiologists more tools for workflow and different specialties.

The combination of these two changes reduced the role of RIS as a stand-alone system in the U.S., where today, manufacturers primarily develop RIS as a set of "best-of-breed" functionalities embedded within enterprise imaging systems, broader radiology platforms and a variety of other products.

"We’re starting to see broader platforms for radiology covering workflow, QA, operational tools, and business intelligence, all of which are embedded RIS capabilities," said Holloway. "It’s more of the best of breed functionality being spread and adopted into other products.”

Though steamrolled as a standalone by EHRs, RIS as a set of best-of-breed functionalities is growing as a competitor to EHR RIS modules, many of which are not as nuanced or sophisticated as the stand-alones they replaced in providing business intelligence and practice management.

As a result, the main use of RIS in hospitals has changed from that of a clinical workflow tool to one used mainly for administrative tasks, billing and scheduling. It also is used for preauthorization, ensuring that the process is completed seamlessly for all parties, from patients to payors to radiology business managers. “The purpose of the RIS, if nothing else, is to reduce as much friction as possible between various parties so they can be served,” said Jayanathan.

Assisting in these tasks is the incorporation of various forms of communication, such as texting and email. “There’s really been a push toward automation, whether that’s on the revenue management side or the patient check-in and the pre-visit workflow that needs to be accomplished for every imaging study,” said Tim Ninke, head of RIS implementation at MedInformatix.

What to look for in your vendor
For Christina Bronsky, the focus at her hospital was integration. The Advanced Patient-Centered Excellence (APeX) radiant manager and enterprise imaging program manager was searching for a RIS solution that could integrate with the EHR system at the University of California, San Francisco to allow its clinicians to access different forms of data throughout the entire facility.

"There are a lot of niche systems out there that are much, much better than some of these enterprise solutions because they have the focus and care on that specific specialty," she said. "Our focus was on integration because we wanted to see the same information across our entire organization and be able to easily flow patients through our system more quickly and in a way that enhanced their overall experience and satisfaction."

The need to connect with and share information across multiple sites has left providers with the challenge of connecting together different types of systems, such as RIS, EHRs, PACs and VNAs, all of which, in many cases, are designed by diverse manufacturers to meet diverse needs.

Based on this reality, choosing the best RIS solution for a practice requires an evaluation of the type of workflow and current technologies used there, as well as an understanding of what each vendor has to offer.

"You want RIS technology from vendor partners that have other compatible modules or solutions whether they are PACS, VNAs or other products," said Holloway. "You want the ability to integrate and interface with other systems, including legacy ones."

Another factor to consider is size. While very small clinics or providers that only perform a small number of imaging exams may be able to get away with a rudimentary system, larger ones may need a fully-featured RIS depending on their type of workflow and the ability of their systems to manage it.

“If the system isn’t able to manage the full workflow for a department, there’s a need for RIS as a component, because it can manage the radiology department and its resources, providing specialized workflow management,” Leigh Dyment, technical product manager for Carestream Vue RIS, told HCB News. “It really depends on the other systems at the hospital and their capability. If the EHR has RIS capabilities for enterprise-like scheduling, the site is less likely to purchase a RIS solution. However, if sites need to do resource management across multiple sites and manage prioritization of imaging studies based on resources, EHRs typically don’t provide that functionality, which ushers in the need for RIS.”

RIS solutions should offer flexibility for business models such as subscription-based pricing and the re-sharing of contracts, as well as architecture, in terms of hybrid approaches and the ability to use it with the public cloud.

“You need to verify that RIS is flexible enough to accommodate both your current needs today, as well as the potential growth in size and scale and the extension of other functionalities in the future,” said Tse’ela Mida, worldwide product line manager for RIS and Information Systems at Carestream Health. "Don’t just look at what you have or what you need today. Look at what you need five or ten years from now and make sure your RIS solution can address your growing needs.”

The RIS systems of tomorrow
Providers today are turning away from multi-vendor environments and are more and more looking for single vendor solutions, while developers and manufacturers are looking to capitalize on emerging technologies to expand the sharing of vital information for their customers.

Though considered still far off, one specific area of interest is adoption of the cloud, with many large providers currently operating on a private cloud model from their own center, or even their own cloud. “The primary copy of the image is still stored on-site. We do expect that to gradually transition to public cloud over time, but not for a while,” said Holloway. “Once you see the big EHR vendors shift toward public cloud, systems like RIS or broader radiology will follow suit.”

He foresees RIS continuing to transition away from stand-alone to embedded, best-of-breed functionalities that are part of a broader radiology platform or one central operational system.

“Worklist and scheduling will be the basis of that, but I think you’ll be seeing the addition of operational tools and business intelligence for radiology practice management being embedded,” said Holloway. “This will address many of the operational challenges facing radiology practices and help embed functions – regulatory, dose monitoring, staff quality and audit, utilization, dashboarding, service contracts – within one central operational system.”

Bronsky agrees, but sees RIS not just as a system for the radiology department five or ten years down the line but one for many parts of the hospital enterprise. “I think we’ll see it more commonly used in cardiology, ophthalmology, dermatology, pathology and other areas, providing the same functions that radiologists have been using for the past decade.”

In addition, the amount of information accessed and shared by RIS with other systems is anticipated to increase with the emergence of machine learning and artificial intelligence. Some influence of this technology has already taken effect over the past ten years, with new developments expected to build further on these promising inroads.

“With national initiatives, AI will help create a better overall picture of a larger number of studies and general population trends in health. RIS should be able to use that type of information with a decision support system that will help referring physicians make informed decisions about the types of studies that should be ordered for a patient,” said Dyment. “At the end of the day, it’s all about the health of the patient.”

Regardless of how RIS changes over time, one certainty is that it will continue to exist in some form that aids in the running of radiology departments.