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RIS (PACS) Workflow redesign. Nick Hollings Consultant Radiologist Royal Cornwall Hospital. RIS PACS Workflow redesign. An enormous task! Do NOT underestimate if you wish your departments to function well afterwards…. RIS PACS Workflow redesign.

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RIS (PACS) Workflow redesign

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Ris pacs workflow redesign

RIS (PACS) Workflow redesign

Nick Hollings

Consultant Radiologist

Royal Cornwall Hospital

Ris pacs workflow redesign1

RIS PACS Workflow redesign

  • An enormous task!

  • Do NOT underestimate if you wish your departments to function well afterwards…

Ris pacs workflow redesign2

RIS PACS Workflow redesign

  • Based on redesign for agfa CR, GE PACS, GHG VR and HSS CRIS RIS in Cornwall.

    • 2 acute Trusts & 1 elective hospital (c.1000 beds)

    • 7 community hospitals

    • 93 mile distance

Ris pacs workflow redesign3

RIS PACS Workflow redesign

  • Choose your team with care

  • Every PACS Manager needs an assistant

  • Every Lead Radiologist needs an assistant

Ris pacs workflow redesign4

RIS PACS Workflow redesign

  • You need:

    • Radiologist +1

    • RIS/PACS Manager +1 (or more)

    • IT project Manager

    • (Imaging business manager)

    • Radiographer leads

      • Acute Trust

      • Community

    • A&C lead +1 (or more)

    • Supplier

    • Others

Ris pacs workflow redesign5

RIS PACS Workflow redesign

  • How much do you want to change?

  • Don’t re-invent the wheel

  • Visit local trusts with identical hardware & software design

Ris pacs workflow redesign6

RIS PACS Workflow redesign

  • Planning Away Day

  • All interested parties present

    • RIS/PACS Team

    • Super Rads from all modalities

    • GP/primary care medical representative

    • Don’t forget e.g. breast care centre

    • Medical secretaries/p.a.s

    • Health records

    • Make sure you extend invitation to ‘problem’ areas

  • Takes all day!

Ris pacs workflow redesign7

RIS PACS Workflow redesign

  • Need RIS running on p.c. with projector

  • Need supplier conversant with system

  • Need sec. filling in patient journey proforma, in real time, on p.c with projector

  • Keep audience sweet with regular breaks, coffee & biscuits!

Ris pacs workflow redesign8

RIS PACS Workflow redesign

  • Map an imaginary patient through the department for a chest xray

  • Start with the GP referral, before it arrives in the department

  • End with the GP receiving the report, in the surgery

Ris pacs workflow redesign9

RIS PACS Workflow redesign

  • How do you receive your referrals?

  • Do patients walk in or do requests arrive in the post?

  • Do they phone you or do you phone them?

  • Each scenario needs thinking about

  • Will it be the same for all your departments?

  • Should you centralise your booking office?

Ris pacs workflow redesign10

RIS PACS Workflow redesign

  • Try to remove all steps with inherent delays

    • Post (external and internal)

    • Med secs typing up letters

    • Radiologist vetting

  • Work with your GP rep to facilitate e-referrals if possible (unless order comms already!)

  • Ditto for in-hospital referrals

Ris pacs workflow redesign11

RIS PACS Workflow redesign

  • Decide if you want to dispense with request cards

  • Do you have RIS terminals in every room?

  • If no, you may still need cards to check patient details

  • Labels

    • Do you really still need them (possible exceptions mammo & N/Med for syringes)?

    • Will your old printers be able to print them?

Ris pacs workflow redesign12

RIS PACS Workflow redesign

  • Intended radiologist field very important for work-list driven reporting

    • Hot, MSK, Neuro, GI etc., as well as individual consultants

    • Allows for a/l etc

Ris pacs workflow redesign13

RIS PACS Workflow redesign

  • How do you avoid double reporting?

    • Message on PACS

    • Text in VR transcription box

  • Batch printing or individual reports?

  • How do you disseminate reports?

    • White copy

    • Third party electronic dispersal system

    • webPACS

Ris pacs workflow redesign14

RIS PACS Workflow redesign

  • This will take at least 3 hours!

  • Have lunch

  • Extend scenario to other modalities

  • Extend scenario to IPs as well as Ops

  • Don’t forget ‘special’ areas such as A&E and # clinic

Ris pacs workflow redesign15

RIS PACS Workflow redesign

  • During the day various issue will arise that cannot be worked through. If an issue take >5 mins, document it, park it and move on

  • Beware luddites and ‘the good old days’ ~ change is necessary. A good chairman is vital to keep discussion moving

  • Try to harmonise working practices across entire HC community. Avoid units doing their own thing

Ris pacs workflow redesign16

RIS PACS Workflow redesign

  • Charge Super Rads with responsibility for completing the proforma for their particular area

  • That is why they need to be at the away day!

  • Arrange small group meetings to work through issues parked from away day

Ris pacs workflow redesign17

RIS PACS Workflow redesign

  • The result?

    • Easy to read flow charts/algorithms of how a patient proceeds through EVERY dept, beginning to end

  • Walk imaginary patient through each scenario on training system to make sure it works

Ris pacs workflow redesign18

RIS PACS Workflow redesign

  • Give one person overall control of redesign and make sure they hold up to date versions of all documents

Ris pacs workflow redesign cut over plan

RIS PACS Workflow redesign ~ Cut-over plan

  • Cut-over plan – supplementary plan for week leading up to change over

    • One manager

    • 2 radiologists (inc. CD)

    • 2 senior radiographers from different areas

    • Clerical officer

    • PACS Team

    • RIS trainer

Ris pacs workflow redesign19

RIS PACS Workflow redesign

  • Decide on priorities, i.e. which modalities (CT, MR etc) have to be reported. Free up radiologists to get reporting up to date.

  • Work through each modality, day-by-day, up to changeover, and decide how they will be processed.

  • Decide when each modality moves over to new system and how long they are temporarily paper based.

Ris pacs workflow redesign20

RIS PACS Workflow redesign

  • Cancel lists in preceding days if poss of staff will get overwhelmed

  • Try to change at w/end to avoid busy clinics

  • Allocate resource to transfer paper records onto new system once live

  • Ensure support from supplier is available at changeover, at least by phone, inc. e.g.VR & CR as well.

Ris pacs workflow redesign


  • Not going to discuss merits of DD vs. VR-based reporting

  • Huge increase in reporting efficiency

    • In report turnaround time

    • NOT radiologist productivity ( 28%)

    • Cost neutral

    • Transcription errors

Ris pacs workflow redesign


  • A simple COTS product (Dragon, Powerscribe etc) will NOT work

  • Need a specifically designed s/ware product that ‘drives’ reporting, as economically as possible

Ris pacs workflow redesign


  • VR engine merely the transcriptionist

  • MUST have a good trainer and trouble shooter to help when it goes wrong – always!

E referrals


  • Don’t wait for EPR!

  • Discuss with your GP IT lead

  • GPs don’t like having to enter text twice

    • Once onto GP system

    • Again on request card (or email)

E referrals1


  • Generic electronic request card

  • Fields mapped directly from GP system

  • Request emailed to central address in X-ray booking office for whole of county

  • e-request card imported into RIS

  • No more hard to read faxes with tiny GP labels

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