Can the NHS manage without a RIS?

Is the end of RIS already in sight?

Technology companies don’t often ask their customers to stop buying a product they supply. But could the radiology information system (RIS), as a standalone solution, be a limitation that the NHS no longer needs? Other technologies used throughout the health service can now deliver RIS functions. And as the NHS seeks to do more with less, attitudes and approaches to NHS IT, healthcare analytics and business intelligence are changing, as too are requirements for a more enterprise wide view of healthcare, meaning that RIS may very well have had its day in its current form.

When two become one: Newer technologies can absorb RIS functions

At its core RIS supports the intelligence behind the workflow. It has played an important role and has enabled important functions to be carried out, such as appointment scheduling, delivery of operating metrics and radiology reporting.

RIS was an entirely necessary and important step forward when it was first introduced. It became a way to manage the specific workflow within radiology.

However, commonplace features of the NHS IT landscape can now absorb the central functions RIS has offered, especially with the widespread adoption of technologies like the picture archiving communication system (PACS) and the ever growing introduction of electronic patient records (EPRs).

Slow to move—complication and cost

The reality is that RIS would never have been developed if PACS had been there first. Yet, despite the advent of PACS, RIS has continued to be deployed as a distinct solution.

This apparent desire to hold on to something historic makes no logical sense for some insofar as IT infrastructure and strategy is concerned.

The result is that it is now still the norm for a hospital to have a separate RIS and a PACS, a costly and cumbersome arrangement, highly dependent on integrations and collaboration between often competitive organisations. NHS IT leaders may in the near future choose to resolve these issues by embracing the functionality of the RIS within their hospital’s PACS and EPR solutions.

Whatever your view, a separate RIS and likely a separate RIS database does add a level of complication and cost. It means a trust is required to have products that are distinct, potentially from different suppliers, with different roadmaps that then need to be integrated at the server level.

However, there is now a growing recognition that other systems could simply absorb standard functionality that historically would be seen in the RIS. For example, the clinical reporting workflow could be absorbed into the PACS and logically trusts should look to EPRs to handle enterprisewide appointment scheduling.

Increasingly hospitals do not want unnecessary levels of integration within their IT infrastructure.

If the trusts choose to remove that complication and simplify their IT environment, then they can further drive down cost and utilise existing solutions to deliver the functionality needed.

Changing markets, simpler infrastructure

Things are starting to change. A growing number of NHS leaders, radiologists and IT champions, are now questioning the current expensive way of sharing radiology information. More and more people believe they should no longer continue to pay for unnecessary levels of IT infrastructure that cause needless complexity and expense. Are they right? I certainly believe that there are some strong arguments to justify that they are.

In fact, discussion has already become a reality for some countries, where RIS is already being confined to history. The RIS market in the US, for example, has already died, as large EPR companies acquired or have enveloped RIS functionality.

Questions over the need for RIS are now increasingly being asked by healthcare organisations in other parts of the world, including Scandinavia, where Sectra has a strong market share in RIS. Are other world markets starting to tell suppliers that they do not need a separate RIS?

And as the discussion now firmly moves onto UK shores, it is even set to be a central topic for debate at the next meeting of the UK Imaging Informatics Group. I certainly welcome this as an important opportunity to really understand what customers are thinking.

Responsibilities: Suppliers must help change

Suppliers have until now had a role to play in holding back this change; after all it can be expensive and risky to become a trailblazer. But companies now have a responsibility to make this change a reality for their customers if and when healthcare providers decide such change is needed.

Technology suppliers must be flexible and have an open architecture that allows different customers to plug in different components as and when they need to. If the NHS comes to decide that RIS is no longer required and RIS markets disappear, it will be those companies that can provide a transitional, cost effective alternative solution able to meet the requirement and deliver the best workflow that will come out on top.

For the market, it is a difficult decision to know when to ‘abandon’ something as widespread as RIS. But I believe
the time to engage with the NHS on this is now. There is a need to make products more cost effective, easier to rollout and support and simpler for the customer to manage and integrate into their infrastructure.

Should the NHS be heading towards a simplification of infrastructure and a simplification of IT strategy, holding on to a historic beliefs about what you need may no longer be an option.