A Good RIS – They Are Now A Requirement For Survival
In years past, radiology departments purchased a radiology information system (RIS) to help them increase productivity, to become more efficient and to better manage their department. In more recent years, facilities have purchased RIS products in order to better utilize PACS systems. Today, we are seeing an increasing number of radiology departments who are purchasing a RIS not as a management tool and not as a supplement to their PACS, but rather to survive as a business.
It is an unfortunate fact that we live in a world where lawsuits (frivolous or not) are all too common. One key element to survival is the ability to protect your facility and defend it from potential inspections, audits and lawsuits. Here is a potential scenario that could easily be a reality. A hospital has a manual system in place and keeps thousands of patient index cards in a group of filing cabinets. The hospital has a Hospital Information System (HIS) but the radiology department uses a radiology patient number for filing and not the medical record number that the HIS uses. An Alzheimer’s patient comes in for a CT exam with contrast. Moments after the contrast is injected, the patient experiences a major reaction and dies. The patient’s family sues the facility because just one year ago the same patient had a near death experience from the same exam. Unfortunately, the patient’s index card had since been misfiled. If the radiology department used the medical record number for filing, the tragedy may have been avoided. But, with the original filing number lost, there was no way to locate the patient’s records without the radiology patient number. Therefore, the hospital personnel, who scheduled the exam, did not have access to that crucial information. This scenario could have been avoided with the use of a RIS. With a RIS, patients are stored in a database which can be cross indexed by patient name, medical record number, date of birth, social security number, etc. The likelihood of losing a patient record in a RIS database is extremely remote. Even, if the radiology department uses a radiology patient number instead of medical record number, the patient can easily be located in the database.
The bottom line is that patient index cards can too easily be lost or misfiled. In fact, it is very common to find large numbers of patients duplicated in a manual system. Each of these patients is a lawsuit waiting to happen because their patient data is fragmented throughout the file cabinets. Another example of a common card file problem is when a woman gets married and changes her last name. The next time she visits the radiology department, there is a very high probability that she will have a new index card created and be treated as a new patient since they won’t find her using her new name. Suppose she had a strong allergic reaction to Latex a few years ago. Now that data is lost and without that information, the same mistake could be made twice.
HIPAA went in full effect on April 20, 2005. What many manual radiology departments don’t realize is that manual departments are just as liable as computerized departments when it comes to ensuring the confidentiality of patient data. The problem lies in the fact that manual departments are not nearly as secure as their computerized counterparts. For example, you can’t password protect a patient’s record in a manual system but you can in a RIS. In addition, HIPAA requires that radiology departments track the dissemination of patient information to parties outside the facility such as mammography letters, film jackets and faxed and/or emailed transcribed results. In a manual system, there is no easy way to determine who viewed or changed a patient’s record, much less to be able to create an audit trail of such activities. If a patient walks into a manual radiology department and demands to be given a report of where all of their patient information has been distributed in the past six months, how could such a report possibly be created in a timely manner? If the patient reports the hospital, a HIPAA audit could be forthcoming not to mention a possible lawsuit. These threats can be completely avoided with a RIS that can track who views and/or changes patient data and also tracks where patient data goes.
If you have ever been audited for anything, including JCAHO inspections, you know how time consuming and distracting that process can be. Hundreds, if not thousands of staff hours can be consumed by these black holes of staff time. What’s worse, if you are found to have violations caused by inaccurate or incomplete records, you could be subject to fines and/or loss of licenses. In today’s highly competitive marketplace, few facilities can afford such penalties or drain on their resources. Being audited by JCAHO, ACR or HIPAA without a RIS is like being audited by the IRS without having receipts and comprehensive records of your expenses. A RIS not only facilitates the creation and the storing of patient data, it should also put that information at your fingertips in a variety of helpful ways. A RIS should be able to provide you a wide variety of management, statistical and productivity reports. In the event of an audit, inspection or even a lawsuit, the information that a RIS can provide can be invaluable in helping you to defend your facility.
Disaster recovery is also a major concern in a manual radiology department. How devastating would it be for there to be a fire, or flood in your radiology department? Years of patient films, reports and histories would be permanently lost. Could your facility survive such a disaster? With a RIS, all the patient results and histories are electronically stored. If you also had a PACS, all of the films would also be electronically stored. The fact that everything is electronically stored means that backups can easily be created. If backups are stored on-site and off-site, you are well prepared to recover from virtually any disaster.
It is an industry accepted fact that the average radiology facility loses 3-5% of their charges in a manual system. Paperwork gets lost. A doctor orders an additional view but the requisition is not updated accordingly by the tech. A number gets transposed from the billing document to the billing system. All of these possibilities can result in lost or inaccurate charge, resulting in lost revenue for your facility. A good RIS will virtually eliminate the chance of lost charges because there are multiple checkpoints at which data is verified. By the time a charge is automatically dropped to the billing system, it has been checked and rechecked in the RIS by various personnel. Imagine what 3-5% can mean to a department that does $3,000,000 in exams annually. That’s $90,000 – $150,000 per year that can be recouped that is currently falling between the cracks.
Patient & Physician Goodwill
Physician goodwill can also be in jeopardy with a manual radiology system. If a very important referring physician calls a radiology department and complains about excessive patient wait times, how can you defend yourself with a manual system? With a RIS, you should be able to run a report of all the patients referred by that physician, for a given period. The report should show the individual patient wait times along with the average patient wait time. Such information can quickly and easily diffuse an otherwise volatile situation.
A good RIS can also increase physician referrals. Imagine a referring physician who has multiple facilities to which he can refer patients to. The physician will most likely refer patients to the facility that can get the patient results back to him the quickest. Faster results mean better patient care. Better patient care means happier patients. Happier patients mean happier referring physicians. Happier referring physicians refer more patients which, in turn, translate into more revenue for your facility.
Information is Power
The bottom line is that information is power and information is money. Radiology departments who have harnessed the information within their department and who utilize that information to keep their finger on the pulse of their department are well prepared for all the uncertainties of today’s world. Therefore, you could say that a good RIS can do many great things for a radiology department but the lack of a good RIS can actually be hazardous to the health of your department.
Selecting a RIS
When searching for the right RIS for your facility, it is important to note that not all RIS systems are created equally. Some RIS products are simple add-ons to existing PACS or HIS products and therefore contain few, if any, management reports and are very limited in their functionality. Selecting a RIS will be a major step for your facility that will impact your operations for years to come. Selecting the wrong RIS can result in significant loss of manpower and dollars. Therefore, proper due diligence during the selection phase is critical.
With so much on the line, it is highly recommended that you request as many references as possible from each RIS vendor under consideration. If a vendor only provides a few references, that should raise a red flag. If you take the time to call all of the references, you should get a very good perception of which RIS is best for your facility which will insure the maximum return on your RIS dollar. After all, a RIS should not be looked at as an expense; it is an investment from which your department should reap benefits for years to come.
Top 10 Perils of Not Having A Good RIS
- Losing patient data. Between lost index cards, duplicate cards, and misfiled cards, important data is easily lost. This can result in costly medical errors, misdiagnosis as well as other problems.
- Inability to recognize and recoup lost charges. Not to mention the inability to monitor and analyze inappropriate reasons for exams in order to maximize reimbursement.
- Inability to get transcribed results in the hands of the referring physicians in a timely manner. Risk of damaging physician goodwill and losing physician referrals to other service providers.
- Inability to comply with regulating bodies such as HIPAA, JCAHO and ACR.
- Inability to secure and control access to private patient files.
- Inability to produce required monthly statistics for administration in an accurate and timely manner.
- Inaccurate scheduling of procedures and required preps. Errors in scheduling waste time of patients, techs and radiologists. Overbooked rooms and procedure conflicts are also very common.
- Inability to prepare for disaster recovery.
- Inability to take advantage of current technology such as PACS, Voice Recognition, Biometric Devices (Fingerprint readers), bar code readers, etc.
- Inability to minimize patient wait times.