Cammisa M et al. 2004 "Design and implementation of an integrated HIS-RIS-PACS system: our experience."

Cammisa M, Guglielmi G, Zarrelli N, et al. Design and implementation of an integrated HIS-RIS-PACS system: our experience. Radiological Medicine 2004;107(1-2):102-112.
"Purpose: To develop an integrated information system to support the administrative and healthcare work processes in a highly specialised research-oriented healthcare institution composed of one hospital and a separate outpatient centre. The project, developed within the context of an ongoing process of technological innovation, aimed to improve the efficacy and efficiency of the services provided. In particular, over the past year our efforts focused on developing and implementing a RIS-PACS system to support the management of clinical data and radiological reports and images.
Materials and methods: The RIS-PACS system was implemented in four phases to meet the technical-functional needs of the Units of the Department of Diagnostic Imaging. The plan was developed considering the work flow between the Department, the outpatient centre and the hospital wards with the aim of creating a filmless and paperless organisational model for the Radiology Units. The four implementation phases were characterised by defining and developing protocols that would integrate the systems (HIS, RIS, PACS, and modalities) to guarantee correct and complete management of the work flow.
Results: Phases I and II have already been completed and have led to efficient, safe and complete interaction between the hospital wards, the outpatient centre and the Radiology Units. Overall performance of the hospital has improved and the outpatient centre is now completely managed in digital mode. Phases III and IV will extend these positive results by enabling the routine distribution of radiological reports and images to all hospital wards and clinics and associated facilities. As a result, the use of film and printing and developing materials will gradually be reduced, enabling all the required clinical and diagnostic information to be immediately and securely shared.
Discussion and conclusions: This project is one of the first examples in Italy of the routine implementation of a single virtual radiology department distributed across physically remote locations. In particular, the project was successfully completed thanks to the approach used in planning and defining the clinical and functional specifications, and in the implementation phase. We conclude that setting up an information system truly capable of supporting the routine clinical activity of a Diagnostic Imaging Department requires a detailed operational project and careful planning of each implementation phase."
To outline the plan for implementation of the integrated radiology information and picture archiving and communication (RIS-PACS) system and describe its effects on the institution.
Type Clinic
Primary care and specialty care
Other Information
The study was conducted at Casa Sollievo della Sofferenza (CSS), a "highly specialized research-oriented healthcare institution." The institution has 1,028 beds.
Type of Health IT
Picture archiving and communication system (PACS)
Radiology information system (RIS)
Type of Health IT Functions
The system created a radiological record which could be shared across all radiology departments. The system was designed to be integrated with the hospital's electronic medical record (EMR) system.
Context or other IT in place
The facility contains an enterprise-wide integrated electronic medical record (EMR) system. This study described how the digital imaging system would integrate into the existing system.
Workflow-Related Findings
By allowing all processes to be digitized, the overall performance of the institution increased.
Radiology room occupancy was optimized.
Waiting times for radiological services decreased.
"Increased appropriateness of requests, as a consequence of the new organisational model based on centralised planning of requests and the obligation to explicitly state the clinical query for each imaging service requested."
Data entry errors relating to "diagnostic modalities" resulted from replacing manual processes with electronic ones.
"Repetitive activities or activities with poor added value in the management of work flows" were eliminated.
Study Design
Study Participants
Study participants included staff implementing and using the RIS-PACS system.