RIS: Backbone of the multispecialty practice

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 - Nick Arledge, RTR

For some healthcare providers, a RIS is simply nice to have. But for large, multispecialty practices with an imaging component, it is an imperative. Changes effected by such technology at The Austin Diagnostic Clinic (ADC), Texas, are proof positive that a best-of-breed RIS can make a big difference on many levels, operational and otherwise.

Nicholas I. Arledge is ADC’s administrative director. He explains that the multispecialty practice has seven clinic locations in and around Austin, facilities that are staffed by a collective 130 to 140 physicians. Imaging services are offered at the provider’s primary imaging center in North Austin, as well as at one women’s imaging center; three to four clinics have X-ray capabilities. These facilities conduct a total of 70,000 to 80,000 imaging studies annually; imaging domains encompass nuclear medicine, ultrasound, women’s imaging, echocardiography, CT and MRI.

Not long ago, ADC recognized a need to better manage heavy volumes of studies ordered by physicians from disparate facilities within and beyond its network.  At the time, the practice had what Arledge describes as a “hybridized” EMR system that “functioned as a RIS would, but for the front office rather than for radiology.”  The system’s generic nature, coupled with the fact that it did nothing to streamline the capture of orders from referring physicians or manage the exam authorization process, rendered it inadequate for the practice’s requirements. This was especially so given the number of facilities at which ADC serves patients and the breadth of medical disciplines (22) in which its physicians specialize.

Administrators decided to replace the technology with a best-of-breed RIS that would, most importantly, handle rules-based scheduling at the CPT level. Other criteria encompassed the ability for orders from referring clinicians to be captured without manually re-entering patient and ancillary data into the system, as well as to easily identify situations in which critical information was missing prior to scheduled appointments. Robust reporting capabilities were also on the “must-have” roster.

“It was really important for us to improve the authorization process by using a RIS to determine, for example, that by the appointment time, we had to have x and y information for a particular patient, or that a certain (diagnostic) procedure wasn’t going to be covered by Medicare, necessitating a signed Advance Beneficiary Notice (ABN),” Arledge explains. “Having everything in hand ahead of time, rather than after the fact, is becoming more of a requirement today.”

ADC has since implemented Synapse RIS, from FUJIFILM Medical Systems U.S.A.  Although the practice does not have radiologists on staff, and studies conducted at its facilities are read by an affiliated partner, the RIS is used in conjunction with a FUJFILM Synapse PACS.

Tangible benefits

ADC is still in the “honeymoon phase” of the implementation. Nonetheless, Arledge says, it has already begun to reap the benefits of migrating to the RIS. Notably, the system’s rule-based scheduling capability and seamless integration with the practice’s EMR component has significantly streamlined order entry. In 99 percent of cases, requisitions for imaging studies written by referring clinicians automatically “flow” from the EMR to the RIS, enhancing schedule accuracy and speed.

“Before we deployed the RIS, the necessary codes for each order were manually entered into the EMR,” Arledge explains. “We would run the EMR three to four times a day, and it typically took a half-day to an entire day to get each order in and generate the form. Then there was extra time needed for the scheduling. With everything now happening automatically and often simultaneously, we are saving at least a day and sometimes more. Including the time needed to obtain authorization to perform studies, we are now at one to one-and-a-half days from order to (study conclusion), versus three to five days pre-deployment.

“In addition to eliminating data transmission errors and achieving workflow efficiencies, we are improving the patient experience because they do not have to wait as long as they otherwise would to undergo the procedure and find out what the problem is—no matter the specialty of the referring physician. 

Another bonus on this front: The system’s scheduling function is so straightforward and user-friendly that technologists can be assured that patient information is in the proper place and the correct modality has been selected.

Meanwhile, the authorization process has, as desired, become far more manageable with the RIS in place. The system’s configuration is such that staff can, when reviewing schedules for upcoming procedures, see exactly which information and documentation is missing and flag it with an icon for future reference. “It’s much less of an administrative burden than in the past; it eliminates a lot of scrambling and headaches later on,” Arledge states.

A better handle

Moreover, the system’s robust reporting feature is enabling ADC to maintain a better handle on overall operations, workflow, and productivity. For example, administrators can compare the number of procedures performed by one technician with the number of procedures performed by one technologist on a given day.

They also can determine the difference between the number of appointments for studies booked on a particular day and the number of unfilled appointment slots for that same day.  Other data brought to light by the reporting capability includes, but is not limited to, the utilization of a certain CPT code over a set period of time or by time of day; similar breakdowns by technologist and modality are accessible as well.

Arledge says ADC will utilize this data in making future decisions about operational changes and the like. “With a practice that is as large as ours, things cannot be done in a vacuum,” he asserts.

Some insights gleaned from the reports already are allowing problems to be addressed in a more effective manner. “Everything we do within the system is time-stamped, so we know who handled what function, and when,” Arledge explains.

“For example, we had an instance in which a patient did not have authorization for a study at the time of service. Someone was supposed to have noticed that and informed the patient it had been denied, but that did not happen, and we received a complaint about it. Because we had the time-stamp, we were able to tell who dropped the ball, and to learn from it. Transitioning to the RIS has been a big change for us, and it has required an effort—but it is proving to be worthwhile and is a must for large multi-specialty practices.”

Julie Ritzer Ross is a contributing writer for Radinformatics.com.