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Delivering On The Promise of Integrated RIS/PACS Sunny Sanyal

Delivering On The Promise of Integrated RIS/PACS Sunny Sanyal. Technology Components. Web. Radiology IT Environment. Functions. RIS Orders, Scheduling Film Library Management Charge Capture and Billing Reporting. Short Term Storage. Archive. Diagnostic and Clinical Workstations. PAC

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Delivering On The Promise of Integrated RIS/PACS Sunny Sanyal

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  1. Delivering On The Promise of Integrated RIS/PACS Sunny Sanyal

  2. Technology Components Web Radiology IT Environment Functions RIS • Orders, Scheduling • Film Library Management • Charge Capture and Billing • Reporting Short Term Storage Archive Diagnostic and Clinical Workstations PAC Database RIS Modalities • Image capture • QA and Image Processing PACS • Acquisition • Diagnostic reading stations • Clinical review and Web distribution • Archiving Advanced Clinical Apps CR CT or MR Ultrasound Advanced Applications • Clinical Applications • 3D Volume Rendering PACS Provides A Platform For Digital Workflow Solution For Radiology

  3. PACS Evolution Current Generation 1990s Web MR/CT, etc. RIS DB Advanced Apps 1980s Integrated RIS/PACS WS CR Diagnostic WS Enterprise Workflow • Enterprise solution – hospitals, clinics • Integrated RIS/PACS workstation • Web based connectivity with referring physicians • Standalone advanced clinical apps Department Workflow • Multi-modality systems • Focus on workflow • Simple RIS integration using interfaces/brokers • Limited enterprise workflow • No IT integration Modality Archive • Modality archiving – simple storage systems • Individual modality based systems • No workflow Standalone Workstation  Enterprise Image Management

  4. Filmless Radiology Department “Before RIS/PACS” Report and films sent by mail • Manual processes for handling film and paper reports • Repetitive data entry • Bottlenecks due to manual report dictation and transcription • Long lead time for results reporting Avoidable Costs Physician faxes or mails a referral to hospital and patient Patient data (film & paper) handled manually Technician performs diagnostic scans Radiologist generates and verifies report Reports transcribed and verified manually Prints image on film, reviews, repeats tests Bottleneck Week “After RIS/PACS” Reports and images via Internet • Streamlined radiology and hospital workflow • Electronic linkage with referring community • Reduced material and labor costs • Increased equipment utilization Physician orders exam using RIS via web interface Historical exams prefetched automatically Technician performs scans and previews on screen Radiologist uses worklist and voice recognition tools Reduced FTEs Reduced Material Costs Increased Throughput Hours PACS Drives Digitization of Radiology Workflow

  5. Information Management Using PACS All Recent Exams Are Pre-Fetched Automatically When Exam is Scheduled Seconds Later, A Remote Specialist Can Read Study Referring Physician Receives Results Via Web Within Hours Chaotic… Previous Exam Is Somewhere In Here All Information, Anywhere, Any Time Productivity (Exams/Day) Report Turnaround Time (Hrs) 248 45.2 30% Results Of PACS Implementations • 66%+ reduction in reporting time • 80%+ reduction in film usage • 30%+ reduction in FTEs 66% 216 Mean Std. Dev 18 15.5 43 3 23 After Before Before After Tremendous Benefits From Workflow Optimization

  6. Web Filmless… How About Paperless? Referring Physician Other Hospital Departments Clinics Hospital Medical Records Room Complex Ordering and Scheduling Process Limited Access To Patient’s Medical Record PACS Database Paper Requisitions and Referrals RIS Database Archive PACS Broker HL7 Engine DICOM HL-7 DICOM Gateway Manual Updates Needed To Maintain Tables in RIS Modality Work lists Not Always Available, Depends Legacy RIS Several Interfaces… Paper Based Processes With Other Hospital Departments

  7. Web Integrated Radiology Workflow • Improved Order Entry process • Physician O/E • Order verification • Rules for selecting modality protocols • Direct database integration between RIS and PACS • Simpler systems – eliminates the Broker • Automated table updates • IHE compliant workflow • Fewer points of failure • Component based architecture -- Enables integration with other Windows applications Other Hospital Departments Clinics Apps Integration Voice Recognition Desktop Integration Platform PACS Database RIS Database Archive Direct Connect Direct Order Entry Into RIS DICOM Gateway Tighter End-To-End Digital Integration In Radiology Department

  8. Integrated RIS-PACS Access to Powerpoint, Email, Netscape, etc. PACS Worklist Detailed patient demographics Patient EMR Patient Reports On-line requisition

  9. Next Generation Environment • Double-digit growth in multi-slice procedures (CT: 10%, MR: 15%); • Growth in functional imaging • Shortage of Radiologists: 8% decline in radiologists in residency since early 90’s • APCs impacting reimbursement Tremendous Pressure To Increase Radiologists’ Productivity PACS Workstation EMR Advantage WS Mammo WS • Single workstation for diagnostic reading, advanced clinical apps, and specialty apps • Integration with Computer Aided Detection • Access to patient information Legacy HIS QA WS RIS WS From… Islands of Information and Applications To… An Integrated Radiologists’ Cockpit

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