As one of top issues facing healthcare facilities today, satisfying meaningful use (MU) criteria is driving replacement of existing information management systems, including radiology information systems (RIS). The challenge is to find an affordable RIS system that meets MU requirements while delivering the feature set your facility’s workflow requires.
A key issue facing many radiology directors is whether they should employ a powerful certified RIS or use a RIS module that’s part of a certified electronic health record/electronic medical record (EHR/EMR). There is often cost-based pressure to use the EMR’s RIS module, but these modules often deliver limited functionality.
Fully featured reporting and embedded voice recognition are usually not included. Built-in rules and triggers for complex exams (including angiography, contrast exams, positron emission tomography [PET], computed tomography [CT] and magnetic resonance [MR] exams) may not be offered. If patient preparation rules are not completed during scheduling, exams may have to be canceled when the patient presents. All of these deficits impede efficiency — and ultimately create higher costs.
Mammography imaging is another area of concern. A modern RIS should support additional breast imaging modalities for screening and diagnostic exams, including MR, ultrasound and nuclear medicine. Patient communications, reporting and other functionality required by Mammography Quality Standards Act (MQSA) guidelines must also be met. If the EHR’s RIS module doesn’t deliver this functionality, facilities will need to integrate a fully featured RIS or a mammography information system.
Managers also need to find a RIS that can accommodate ICD-10 in time to meet the October 2013 deadline. That’s no small feat, since ICD-10 involves 68,000 codes as compared to 14,000+ codes for ICD-9.
It’s important to understand that RIS suppliers can opt for either complete EHR certification or modular certification. With complete certification, the RIS adheres to all 33 criteria, which include 25 functional criteria and eight privacy and security requirements. A RIS with modular certification means it can meet any number of specific criteria, plus the eight required security measures. A facility can combine certified modular products to meet MU requirements.
The U.S. Department of Health and Human Services has two divisions that oversee meaningful use. The Centers for Medicare and Medicaid Services (CMS) oversees providers (physicians and hospitals). The ONC (Office of the National Coordinator for Health Information Technology) works with the certification bodies and regulates healthcare IT vendors and products.
New Features Influence Decision-Making
Meaningful use issues are just one part of the RIS selection process. Compelling next-generation features promise to influence RIS decision-making in 2012. They offer benefits today, and some of the tools could be added to meaningful use requirements in the future. These include:
• Data mining/business intelligence tools – Imaging providers are using business intelligence tools provided by their RIS to help improve productivity and workflow, a necessity in an environment of declining reimbursements and a sour economy. Facilities are tracking room utilization, staff productivity, radiology report turnaround and other key factors that can help drive gains in revenue and referrals.
• Support for structured data – This enables a certified RIS to share data with a certified EMR to ensure imaging data is appropriately stored and shared and meets MU requirements. MU rules dictate that data in an uncertified system cannot be exported directly to CMS, but can be sent to a certified system for reporting, as long as the data is in the required format.
• Order entry decision support – The American College of Radiology (ACR) has been working to create a decision support database for several years. The objective is to outline which imaging exams are medically appropriate for a patient’s symptoms or diagnosis. The ACR’s decision support database is currently being tested in several hospitals. Certified RIS platforms are available that support user-defined rules so each facility can set its own standards for the “appropriateness” of an imaging exam. These platforms can be adapted to support the ACR criteria when they are finalized.
• Exam protocols – Radiologists already use established protocols for ordering complex imaging exams at large teaching facilities and specialty hospitals. Protocol variations involve scan thickness, scan sequences, reconstructions, gantry tilt and other characteristics. The specific protocol is determined by a patient’s diagnosis, stage of disease, type of treatment level and other data. In the future, hospitals of all sizes and other imaging providers may adopt a list of protocols to ensure optimal imaging results based on a patient’s disease state.
• Quality Outcomes – There is a movement toward establishing guidelines for capturing, maintaining and reporting radiation dose, speed of reports and other factors that can enhance diagnosis and treatment. The RIS is the likely platform to collect and store patient imaging data as part of this effort to help improve patient outcomes.
• Structured Reporting – Conversion to structured reporting is driven by results from studies that show that up to 80 percent of physicians do not fully understand the radiologist’s diagnosis as presented in the report. Use of paragraph-style reporting based on dictation by a radiologist will likely be replaced with structured reporting that involves the selection of clear, standardized wording to convey a diagnosis. Standardized wording not only will make a diagnosis easier to understand, but it also will enhance the ability for data mining by research facilities nationwide.
A Flexible RIS Can Support Current, Future Needs
The bottom line is that most providers of imaging services — hospitals, outpatient imaging centers, women’s health facilities and others — have developed a specialized workflow that meets the needs of their physicians, radiologists and patients. Each provider needs a RIS that supports the existing workflow and allows flexibility for future adjustments, while simultaneously meeting MU requirements. It’s a tall order, but can be done.
An important note is that suppliers of standalone RIS systems may choose to have their RIS certified as a module. This offers users a flexible RIS that captures MU data and shares that information with other health IT and EHR systems. These RIS platforms can easily accommodate changes in MU standards.
Ultimately, today’s RIS solutions will need to satisfy specific workflow challenges while evolving to address changes in healthcare regulations. Choosing a Stage 1 certified modular RIS solution will satisfy short-term needs, but it’s important to select a vendor that has plans to move to full certification within the next year. This commitment to full certification can equip a facility to support new regulations today and Stage 2 and 3 initiatives in the future.
One of the bright spots for administrators and managers charged with evaluating certified products from multiple suppliers is that all the information on every certified healthcare IT system is presented on one website: http://onc-chpl.force.com/ehrcert. This website is managed by the ONC and is continuously updated as new systems are certified.
Doug Rufer is director of operations and business strategy for healthcare information solutions for Carestream Health.