1. RIS (PACS) Workflow redesign
Nick Hollings
Consultant Radiologist
Royal Cornwall Hospital

2. RIS PACS Workflow redesign
An enormous task!
Do NOT underestimate if you wish your departments to function well afterwards…

3. 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

4. RIS PACS Workflow redesign
Choose your team with care
Every PACS Manager needs an assistant
Every Lead Radiologist needs an assistant

5. 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

6. 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

7. 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!

8. 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!

9. 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

10. 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?

11. 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

12. 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?

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. RIS PACS Workflow redesign
Give one person overall control of redesign and make sure they hold up to date versions of all documents

20. 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

21. 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.

22. 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.

23. VR 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

24. VR A simple COTS product (Dragon, Powerscribe etc) will NOT work
Need a specifically designed s/ware product that ‘drives’ reporting, as economically as possible

25. VR VR engine merely the transcriptionist
MUST have a good trainer and trouble shooter to help when it goes wrong – always!

26. 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 )

27. e-referrals Generic electronic request card
Fields mapped directly from GP system
Request ed 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