Which Radiology Application Drives Your Workflow? Which Should?

Abstract

Since their introduction in 1982, PACS have gradually gained the center stage of radiology operations [1]. PACS automated the storage, distribution, and display of digital medical images (thus eliminating the need for film) and helped optimize radiology workflow, particularly for practices that also eliminated paper from their workflows [2]. Initially, PACS only provided components required for the storage, distribution, and display of digital medical images, with very little flexibility to adjust to workflow idiosyncrasies. Gradually, by tighter integration with radiology information systems (RIS), PACS became more adaptable to radiology’s workflow. With time, other important electronic components have been integrated with PACS and RIS to facilitate advanced visualization needs (eg, virtual colonoscopy), to expedite report generation (eg, speech recognition and structured reporting applications), to optimize critical result communication, to enable electronic medical record (EMR) integration (eg, receive clinical indications for an imaging study from computerized provider order entry), and so on. At most academic institutions and radiology private practices, PACS and RIS have survived as the core modules to which all other systems relate. Indeed, “PACS-driven” or “RISdriven” workflow is the terminology most often used in radiology practices to refer to the automation of workflow and the creation of “work lists” used by radiologists to get through their daily work. More specifically, PACS-driven workflow involves radiologists’ work lists being created by the PACS (from orders received from the RIS and matched with digital imaging studies arriving in the PACS). Alternatively, RIS-driven workflow is created primarily by the RIS, which is presumably the source of truth for “examination status” in your practice. In this column, we describe the fundamental challenges for the traditional PACS and RIS model of workflow and identify automation opportunities to enhance a radiology practice’s performance.