5.van Herk M, Remeijer P, Lebesque JV. Inclusion of geometric uncertainties in treatment plan evaluation. Int J Radiation Biol Phys 2002;52:1407–1422.

6.van Herk M, et al. The probability of correct target dosage: Dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiation Biol Phys 2000;47:1121–1135.

7.Rosenthal SA, et al. Immobilization improves the reproducibility of patient positioning during six-field conformal radiation therapy for prostate carcinoma. Int J Radiation Biol Phys 1993;27:921–926.

8.Catton C, et al. Improvement in total positioning error for lateral prostatic fields using a soft immobilization device. Radiother Oncol 1997;44:265–270.

9.Kneebone A, et al. A randomized trial evaluating rigid immobilization for pelvic irradiation. Int J Radiation Biol Phys 2003;56:1105–1111.

10.Bayley AJ, et al. A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Radiother Oncol 2004;70:37–44.

11.Nagar YS, et al. Conventional 4 field box radiotherapy technique for cancer cervix: Potential for geographic miss without CECT scan based planning. Int J Gyn Ca 2004;14:865–870.

12.Reinstein LE. Patient positioning and immobilization. In: Kahn FM, Potish RA, editors. Treatment Planning in Radiation Therapy. Baltimore, MD: Williams and Wilkins Publishing; 1998. p 55–88.

13.McGee KP, Das IJ. Commissioning acceptance testing and quality assurance of a CT simulator. In: Coia LR, Schultheiss TE, Hanks GE, editors. A Practical Guide to CT Simulation. Madison, WI: Advanced Medical Publishing; 1995.p 5–23.

14.Fraass B, et al. American association of physicists in medicine radiation therapy committee task group 53: Quality assurance for clinical radiotherapy treatment planning. Med Phys 1998; 25:1773–1829.

15.Low DA. Quality assurance of intensity modulated radiotherapy. Semin Radiat Oncol 2002;12:219–228.

16.ICRU Report 50 Prescribing, recording, and reporting photon beam therapy. Bethesda, MD: International Commission on Radiation Units and Measurements; 1993.

17.Rasch C, Steenbakkers R, van Herk M. Target definition in prostate, head and neck. Semin Radiat Oncol 2005;15:136– 145.

18.ICRU Report 62. Prescribing, recording, and reporting photon beam therapy (Supplement to ICRU Report 50). Bethesda, MD: International Commission on Radiation Units and Measurements; 1999.

19.Roach M, et al. Penile bulb dose and impotence after three dimensional conformal radiotherapy for prostate cancer on RTOG 9406: Findings from a prospective multi-institutional phase I/II dose escalation study. Int J Radiation Biol Phys 2004;60:1351–1356.

20.Gagne IM, Robinson DM. The impact of tumor motion upon CT image integrity and target delineation. Med Phys 2004;31: 3378–3392.

21.Schmuecking M, et al. Image fusion of F-18 FDG pet and CTis there a role in 3D radiation treatment planning of non small cell lung cancer? Int J Radiation Biol Phys 2000;48(Suppl): 130.

22.Kiffer JD, et al. The contribution of 18F fluoro-2-deoxy-glucose positron emission tomographic imaging to radiotherapy planning in lung cancer. Lung CA 1998;19:167–177.

23.Fox JL, et al. Does registration of PET and planning CT images decrease interobserver and intraobserver variation in delineating tumor volumes for non-small cell lung cancer? IJROBP 2005;62:70–75.

24.Leunens G, et al. Quality assessment of medical decision making in radiation oncology: Variability in target volume

delineation for brain tumors. Radiother Oncol 1993;29:169– 175.

25.Roach M, et al. Prostate volumes defined by magnetic resonance imaging and computerized tomographic scans for threedimensional conformal radiotherapy. Int J Radiation Biol Phys 1996;35:1011–1018.

26.De Crevoisier R, et al. Increased risk of biochemical and local failure in patients with distended rectum on the planning CT for prostate cancer radiotherapy. Int J Radiation Biol Phys 2005;62:965–973.

27.Kapulsky A, Gejerman G, Hanley J. A clinical application of an automated phantom film QA procedure for validation of IMRT treatment planning and delivery. Med Dosim 2004;29: 279–284.

28.Herman M. Clinical use of electronic portal imaging. Semin Radiat Oncol 2005;15:157–167.

See also CODES AND REGULATIONS: RADIATION; RADIOTHERAPY TREATMENT PLANNING, OPTIMIZATION OF; X-RAY QUALITY CONTROL PROGRAM.

RADIATION, ULTRAVIOLET. See ULTRAVIOLET

RADIATION IN MEDICINE.

RADIOACTIVE DECAY. See RADIONUCLIDE

PRODUCTION AND RADIOACTIVE DECAY.

RADIOACTIVE SEED IMPLANTATION. See

PROSTATE SEED IMPLANTS.

RADIOIMMUNODETECTION. See MONOCLONAL

ANTIBODIES.

RADIOISOTOPE IMAGING EQUIPMENT. See

NUCLEAR MEDICINE INSTRUMENTATION.

RADIOLOGY INFORMATION SYSTEMS

JANICE C. HONEYMAN-BUCK

University of Florida

Gainesville, Florida

INTRODUCTION

If asked to define the functionality of a radiology information systems (RIS) 5–10 years ago, one may have listed order entry, film management, charge capture, billing, patient and examination tracking, and possibly inventory management. These systems were in place long before Picture Archiving and Communication Systems (PACS) and the Electronic Medical Record (EMR) were in widespread use. Although PACS, and especially the EMR, are not globally implemented, it is an accepted premise that they will be globally implemented sometime in the future. Now, people often refer to radiology information systems as a suite of computers serving the myriad of functions required for an electronic radiology practice that might include the classic RIS, PACS, speech recognition, modality workflow, and the radiology portion of the EMR and the Hospital Information System (HIS). Generally, in this article RIS will be defined in the more classic sense, it is the computer that manages all

550 RADIOLOGY INFORMATION SYSTEMS

aspects of radiology orders. The RIS must now additionally perform the functions required to automate the workflow in a radiology department including examination ordering and management, modality scheduling, examination tracking, capturing charges, inventory management, electronic signatures, report distribution, and management reporting. Every transaction and interaction with the system must be recorded for auditing purposes and must help maintain the privacy and security of Protected Heath Information (PHI) for a patient. Furthermore, the RIS must interface seamlessly with a PACS, a speech recognition system, an HIS and an EMR. This is a nontrivial task in a multivendor installation.

This article focuses on the RIS as the center of the radiology department workflow management with the interfaces to other systems. Interface standards are introduced with examples and some developing concepts in healthcare as they pertain to radiology are discussed.

INFORMATION SYSTEMS IN RADIOLOGY

Figure 1 shows the typical workflow associated with a radiology study. The referring physician orders the study, typically through the HIS, but often in smaller institutions, through the RIS. The order is then sent to PACS and to the speech recognition system. It is available for the technologists as a virtual worklist and on PACS modalities through DICOM modality worklist. In this case, the modality worklist is supplied by a broker or translation system that creates the correct format from the order. After the examination is completed, it is sent to archives and PACS displays where it is interpreted by the radiologist. The radiologist is working from their own worklist of studies that are available according to their role in the department and which have not been dictated. A role may be defined as a radiologist who interprets chest studies or perhaps a radiologist who interprets

Ordering

Physician

CT studies. The radiologist dictates into a speech recognition system that appends the report to the data about the examination that exists in the system. The reports are sent to the RIS, closing the loop, and then are sent to the EMR. The dashed line from the PACS Archive to the EMR indicates that the images may be stored in the PACS archive with links to them in the EMR, so it is unnecessary to store the images in both systems. The PACS displays and databases and the speech recognition system are frequently from different vendors, so an interface between the two must be accomplished to be certain that the radiologist is dictating the report on the study they are viewing. This loose coupling of the report and imaging exam must be carefully developed and tested to be sure the reports are permanently attached to the correct exam. Of course when all the systems are purchased from a single vendor, a tighter coupling of data and images may be easier to accomplish. The magic number in a radiology system that ties all the information, images and reports for a specific study together is the accession number. This number should be unique for a study and should identify the patient, exam, date, time, report, images, contrast used and anything else that goes with that study. An accession number query should only get one accurate result.

THE RIS AND ITS ROLE IN RADIOLOGY WORKFLOW

Although the RIS appears to be a very small actor in radiology workflow, this is far from the truth. Note the number of interfaces, indicated by arrows, with the RIS as opposed to the other systems in Fig. 1. The RIS is the integral part of the total electronic radiology practice and without it there would be no connection with the rest of the healthcare enterprise (1,2).

The other systems in Fig. 1 are also important and must be interfaced carefully. Although at times the lines between the functionality of the various systems blur, each

Patient-Centric Electronic Medical Record

EHR

Report

Exam order

HIS

system has its purpose in the overall electronic health system. The HIS is generally a system used to capture information about a patient, including but not limited to, their demographics, address, and insurance information (very important). The HIS captures charge information, alerts users when communications with a third-party payer is necessary, and generates bills. Frequently, the HIS is the centralized location for ordering various studies including radiology, lab, speech pathology, physical therapy, and so on. In addition, the HIS can be the center for reporting hospital issues, such as maintenance needs, network failures, and so on. The HIS usually provides extensive administrative reporting tools. The EMR is a patientcentric system containing the electronic record of all a patient’s encounters at the institution. The HIS can be used to generate numbers of radiology orders generated in a certain time frame, but when a physician needs to see the total record for his patient with all associated orders, reports, and images to form a diagnosis and treatment plan, the EMR is a better model. The EMR will be discussed with more detail later in the article. The main purpose of PACS is to manage radiology images efficiently. These very large datasets have special needs when it comes to archiving, display, and networks and it makes sense to keep the PACS functionality a little apart from the rest of the usually text-based information systems. Speech recognition is generally developed for specific specialties, such as radiology. The radiology lexicon known by the recognition engine is unique to radiology. Of course, parallel systems exist in other specialties, but the focus here is on radiology. In general the radiologist dictates a report; the speech recognition transforms the voice file into a text file and displays it for confirmation of correctness or for editing.

Table 1. Core Feature Set for the Typical Current RIS

RIS BASIC FUNCTIONALITY

Most RIS vendors offer a core feature set that captures the information items regarding a patient study in radiology and provides tools for those involved to manage the study. Table 1 is based on the list generated by Aunt Minnie (3) in the section on Radiology Information Systems in their buyer’s guide. These functions are probably the minimum required for an RIS purchase. Anyone seeking to purchase an RIS should be aware of the resources available to help them with their decision and should follow a structured Request for Proposal (RFP) or bid format. Buyers should specify how these functions should work in their institution. For example, if the feature ‘‘interaction checking between exams’’ is included, the buyer should write a requirement that matches their workflow. An example of part of the requirement might be, ‘‘automatically check patient history for previous exam and warn user at the time of order’’. If you go back to Fig. 1, it is quite common for the physician or their agent to enter the order on the HIS, then this is transmitted electronically to the RIS, so the RIS would need to alert the HIS, which in turn would alert the physician or their agent. A requirement specification document tells vendors what the buyer expects and forces them to respond to the buyer with respect to their specific workflow. Buyers should be sure to include any special requirements for the institution. Some examples include the length and format of the medical record number or accession number or the requirement that it must be possible to enter a report directly on the RIS in the case of an HIS downtime. The buyer may want to specify their requirements for performance; ‘‘a query for a patient record should return results in < 2 s’’.

552 RADIOLOGY INFORMATION SYSTEMS

Although an institution may have an HIS and/or an EMR, the RIS will probably also keep an archive of diagnostic reports. From an information sciences storage perspective, a single data repository for specific information is more desirable that multiple, different repositories that have to be synchronized and managed. Since the RIS is rarely the system that is used by the ordering or referring physicians, it serves as an additional archive of diagnostic reports and can be used to track trends, search for diagnoses and impressions, and is used as a backup should other archives fail.

Table 2 contains a (noncomprehensive) list of advanced features for an RIS. Many of these features have become more important since hospitals have added PACS and required integration of all their systems. Bar code support may not be as important in a paperless world, but most of us are not there yet. Bar codes offer a quick and painless way to choose accurate information from a database. One or two bar code entries can locate the right information without the frustration most people experience trying to enter a long string of numbers and letters.

More institutions have merged into one larger entity or have splintered out clinics and imaging centers to locations with easier access. Since it is frequently the case that patients can be seen in various locations in a healthcare system, the RIS needs to support multifacility scheduling, as well as patient tracking. If a group of institutions form an enterprise and each institution can create individual medical record numbers (MRN) identifying patients, it is possible that more than one person will have the same medical record number: from different institutions. The RIS, as well as the EMR and HIS and PACS, must be able to differentiate individuals and track them throughout all the institutions in an enterprise. This can be a difficult and frustrating problem and should be managed carefully. All the interfaces need to be specified in detail. A more comprehensive discussion on the required interfaces is included later in this article. Electronic signatures and addenda need to match the workflow for an institution. In a large teaching hospital, it is common for a resident to

Table 2. Advanced Feature Set for the Typical Current RIS

dictate a report and for a faculty member to approve and verify it. At this point, two signatures are required. Then, if an addendum is entered on the report, which could happen when comparison studies are received from an outside source, a different resident–faculty member combination could dictate it, resulting in up to four signatures on a report. If multiple addenda are allowed, multiple signatures must also be allowed.

It is important for report distribution, and especially in the case where critical results have been found, that referring physician information is stored somewhere. When an RIS is in a stand-alone installation or the RIS is the distribution entity for reports, then each ordering physician and ordering service must have a unique profile and protocol rules for the communication of reports and especially for critical results. When the RIS is part of a larger enterprise system, the HIS or EMR will distribute the reports, but some triggering mechanism must alert the physician if a critical result or unusual finding is present. This will usually be a function of the RIS. The system must keep an audit of the successful communication with the ordering physician or service as part of the Joint Commission on the Accreditation of Health Care Organizations (JCAHO) recommendations for taking specific steps to improve communications among caregivers (4). This organization requires that each accredited institution have a method for rapid communication of results for both critical results and critical tests in place. In addition, each institution must have a way to monitor and report the efficiency and effectiveness of the communication for a subset of the results considered critical. For radiology, this will most likely be a function of the RIS.

The RIS should be able to generate administrative reports on the numbers of studies performed by date, the modalities used for studies, performance figures for technologists, costs of examinations, and reimbursement trends. In addition, the system should have a query interface so custom reports can be generated. It is very common for this query interface to use the Structured Query Language (SQL) that may have a steep learning curve. Some

vendors offer a graphical user interface for custom queries that may make queries and reports easier to generate. Many of the RIS systems on the market today have a web-based interface that seems to be intuitive to the current internet-literate generation.

It is increasingly common to find RIS vendors storing images and providing PACS services, such as study display. For some users, this may be a good solution to an electronic radiology practice, for others, the RIS vendors may not have the sophisticated tools for image manipulation that PACS vendors have traditionally supplied. In addition, to complicate matters, PACS vendors are now offering more RIS functionality and once again the borders between the two systems are becoming blurred. It will be up to the institution to decide whether to use one of these hybrid systems or to interface two dedicated systems.

INTERFACING SYSTEMS

In radiology, there are two main interface standards, Health Level 7 (HL7) (5) and Digital Imaging Communications in Medicine (DICOM) (6). The HL7 is a formatted text-based standard that typically specifies the content of messages that are communicated among information systems in a healthcare institution, such as admission information, radiology results, and operating room notes. An RIS typically contains information about radiology schedules, orders, billing and reports, mostly text values. A complete EMR needs reports and images from radiology. Reports can be sent using HL7, but there is no way to encode image data in the current versions of HL7. Because of this limitation, DICOM was developed as the standard to handle transfer of images between systems that acquire, store, and display them.

Figure 2 illustrates the usual standards used for communication in the electronic medical practice first introduced in Fig. 1. Following the information flow,

Figure 2. Current standards used as interfaces among information systems associated with a radiology study.

the attending physician places their order for a radiology study on the HIS, which is sent to the RIS via HL7. The order information is sent to PACS and the study is scheduled. The HL7 information is converted to DICOM in PACS using a translation program or broker and the patient demographics are attached to a study produced by PACS acquisition units (CT scanners, MRIs, computed radiology units, etc.). The radiologist using the DICOM viewer views the images and a report is generated using speech recognition. Note that the speech recognition system also receives the ordering information from the RIS, so at this point, there should be a single pointer or index to match the images with the report. The output from speech recognition could be in an HL7 format or a DICOM structured report. The report is usually sent to the RIS and then to the EMR.

The HL7 offers a rich data definition and is widely used to communicate information about the status of the patient in the form of an Admission Discharge Transfer (ADT) packet that informs all relevant systems about the location and identity of a patient, an order packet (ORU), and a report packet (ORP). There are of course many other types of packets that are part of normal transactions of an institution, but these are the ones most often used in the transfer of information between the RIS, PACS, and the speech recognition system. An example of an HL7 message is shown in Table 3. The field entries have been created for this example and this does not reflect an actual patient, referring physician, or radiologist. However, if this were an actual patient, the medical record number would be 0000123456, and the patient’s name would Robert Richards, who wasbornon September1,1991 (19910901).Thepatient’s ordering and attending physician is Forest Wood whose phone number is listed in the order. The accession number for this patient is 4445555 and the examination ordered is a bone age radiograph. The reason for the study is included in the text. For this institution, the procedure number for the routine bone age is 3000 and the location where the study will

vendors. The DICOM can be interpreted in different ways: HL7 fields may be required by one vendor and ignored by another, and problems will arise. Buyers have several options to consider. The easiest way to assure that integration will be successful is to purchase all information systems from the same vendor. Of course, that will not completely assure success because not all vendors can supply all the required systems. Most noticeably, they may not all supply the imaging modalities needed. As soon as another vendor’s modality is introduced, an integration project is needed.

Another decision that must be made is the actual storage of the images from PACS and the diagnostic reports associated with these images. The RIS or EMR can supply the storage for both, or the PACS can supply the storage for both, or some combination of storage options can be designed. Neither the RIS nor the PACS would be the preferred method for storing and delivering studies and reports to referring and ordering physicians because the information is all radiography-centric and it is far more desirable to see a total picture of the patient with laboratory results, history and physical notes, nursing documentation, and all other information regarding the health record for a patient.

The Health Insurance Portability and Accountability Act (HIPAA), a landmark law that was passed in 1996, specifies mandates in the transactions between healthcare companies, providers, and carriers (8). This act was

originally designed to make the healthcare records for a patient available to healthcare institutions and physicians and to insurance companies using standards. Individuals should be able to give a physician permission to access their healthcare record at any location, quickly and efficiently. The law also protects the privacy of the patient and provides security guidelines to assure the information could not be accessed inappropriately. Only an EMR system build on well-accepted standards can meet these requirements (9–12). The radiology information should be either stored in an EMR or the EMR should have pointers to the information and should be able to communicate that information in a standard format.

The Radiological Society of North America (RSNA), the Healthcare Information and Management Systems Society (HIMSS), and the American College of Cardiology (ACC) are working together to coordinate the use of established standards, such as DICOM and HL7, to improve the way computer systems in healthcare share information. The initiative is called ‘‘Integrating the Healthcare Enterprise’’ or IHE (13). Integrating the Healthcare Enterprises promotes the coordinated use of established standards, such as DICOM and HL7, to address specific clinical needs in support of patient care. Healthcare providers envision a day when vital information can be passed seamlessly from system to system within and across departments (10,11,14). In addition, with IHE, the EMR

556 RADIOLOGY INFORMATION SYSTEMS

Figure 3. An image associated with the simulated order shown in Table 3. Note the inclusion of the accession number on this image that is required to associate the image with the report.

will be a standard and will facilitate information communication among healthcare venues. Recent research suggests that the United States could realize a savings potential of $78 billion annually if a seamless, fully interoperable healthcare information exchange could be established among key stakeholders in the healthcare delivery system (9).

SELECTING AN RIS

The KLAS company, founded in 1996, is a research and consulting firm specializing in monitoring and reporting the performance of Healthcare’s Information Technology’s (HIT) vendors. The comprehensive reports they produced are valuable for comparing the vendors they review. Buyers should be aware that not all vendors are included in the reports, but the major ones are represented. The Comprehensive Radiology Information Systems Report, Serving Large, Community, and Ambulatory Facilities was released in January, 2005 by KLAS (15). In the report, eight RIS vendor products were represented and were reviewed by interviewing users of the systems. In an addendum, seven other vendors were presented whose products did not yet meet the KLAS standards for statistical confidence in order to be compared with other ven-

dors in the main body of the report. Vendors were all allowed to prepare overviews and their perceptions of their products. Of course, these overviews stress the strengths of a vendor’s product. Performance measurements of the KLAS traditional 40 indicators (Table 6), technology overviews, client win/loss and pricing provide the bases of the provider experience. The KLAS report should be part of an institution’s decision-making process when a report is available, and in this case the report is available and very timely.

This report focused on large (> 200 bed) and ambulatory (free standing clinics and imaging centers) facilities. The large facilities were asked additional questions. The larger institutions were asked why a vendor was selected and why a vendor was NOT selected based on the following six criteria: Functionality, Cost, Relationship with Vendor, References/Site Visits/Technology, and Integration/Interfacing. The most cited reason as to why a vendor was selected was their ability to integrate or interface. The most cited reason as to why a vendor was not selected was their perceived limited functionality.

Survey participants from the large institutions were asked questions regarding their RIS and its; (1) benefits; (2) functional strength of the reporting module; and (3) the RIS–PACS integration. The top benefit, reported by > 50% of the survey respondents, was that of More Efficient/ Better Workflow. The number two and three benefits identified were Interface–Integration and Manage Department Better. The functional strength of the reporting module on a scale of 1–5 (1 þ weak and 5 ¼ strong) was rated with an average of 3.5, with the highest score of 4, which indicates that there are a lot of users who are not totally satisfied with their reporting module. Forty-seven percent of the survey respondents indicated that they have plans to move to an integrated RIS/PACS solution and 81% of these reported that Radiologists and Clinicians were mostly driving this integration. This indicates that there are a large number of institutions without an integrated solution.

THE RIS OF THE FUTURE

In the future, it is likely that speech recognition systems will be incorporated into an RIS solution. Throughout this article, the two systems have been shown as separate entities and indeed, that is the most common incarnation at this time. Speech recognition has become a more important part of the radiology workflow as researchers demonstrate the potential for improving report turnaround time and decreasing costs when compared to systems with manual transcriptionists (16–19). Unfortunately, the increase in report turnaround time does not guarantee efficient personnel utilization. Although the report can be available for the physician immediately after the radiologist verified the dictation, the responsibility for editing the report falls on the radiologist and may make the time required for the process longer than with a transcriptionist performing the typing and editing. Because of this, speech recognition is not eagerly embraced by many radiologists, and therefore

acceptance has been slower than with other information systems used in radiology.

As speech recognition gains more widespread acceptance, researchers are looking into improving the diagnostic reporting methodology by structuring the format of the report. The DICOM Structured Report is a definition for the transmission and storage of clinical documents. A DICOM Structured Report can contain the traditional text report in addition to structured informa-

tion and links to key images. If you return to Fig. 2, you will notice that the RIS and HIS typically communicate using HL7, not DICOM, so either HL7 will have to change to support these reports or the RIS will have to support DICOM. There is an evolving standard for the HL7 Clinical Document Architecture (CDA) that supports text, images, sounds, and other multimedia content. The DICOM working group 20 (the Integration of Imaging and Information systems Group) and the HL7

558 RADIOLOGY INFORMATION SYSTEMS

Table 6. The 40 Success Indicators Used by KLAS in Their Information Systems Reports

10 Product/Technology Indicatorsa

Enterprise Commitment to Technology Product Works as Promoted

Product Quality Rating

Quality of Releases and Updates Quality of Interface Services Interfaces Met Deadlines Quality of Custom Work

Technology Easy to Implement and Support Response Times

Third-Party Product Works with Vendor Product

10 Service Indicatorsa

Proactive Service

Real Problem Resolution Quality of Training Quality of Implementation Implementation on Time

Implementation within Budget/Cost Quality of Implementation Staff Quality of Documentation

Quality of Telephone/Web Support

Product Errors Corrected Quickly

8 Success Indicatorsa

Worth the Effort

Lived Up to Expectations Vendor is Improving Money’s Worth&&

Vendor Executives Interested in You Good Job Selling

Contracting Experience Helps Your Job Performance

12 Business Indicatorsb

Implemented in the Last 3 Years) Core Part of IS Plan

Would You Buy It Again

Avoids Nickel-and-Diming Keeps All Promises

A Fair Contract

Contract is Complete (No Omissions Timely Enhancement Releases Support Costs as Expected

Would You Recommended to a Friend/Peer Ranked Client’s Best Vendor

Ranked Client’s Best or Second Best Vendor

aRating 1–9, where 1¼poor and 9¼excellent. bRating is a yes or no.

Imaging Integration Special Interest Group (IISIG) are working on harmonizing the existing standards (20,21). Future RIS implementations will most certainly support the DICOM structured report or its HL7 CDA translation.

In addition to supporting the traditional terminal or remote computer, the RIS of the future will be required to support a web interface as well as supporting handheld devices. A radiologist with a handheld Personal Digital Assistant (PDA) can currently access e-mail, the internet, digital media, and documents. With wireless networking available in many hospitals, these devices can support the exchange of information between ordering physician and radiologist including results, they can

support exchange of information between radiologist and technologist including protocol selection, they can access history and lab reports for the patient, they can provide a worklist of current studies, and can even display low resolution images. The ability of the PDA to support these functions is only limited by the ability of the RIS to provide PDA support (22).

The RIS of the future may store PACS images, must be able to interface with the EMR, and should provide structured reporting and support for PDAs. As institutions plan for purchasing new systems or updating the old ones, future functionality of the systems must be considered and be part of the request for proposal or bid process. In the past, institutions were able to select an RIS based on individual preferences without consideration of interface issues. As the national health records structure evolves, all institutions must be in a position to interface to an EMR using well developed standards.

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