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The RIS is dead, long live the RWFMS?

March 15, 2013
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Have we reached the age where a RIS is superfluous? The lines of functionality are blurring.

In working with a client that is evaluating acquisition of a new PACS (Picture Archive and Communications System) and the addition of a RIS (Radiology Information System), discussions with Philips confirmed that they have discontinued their RIS!  One of the premises for this is that so much of the RIS functionality has been taken over by the Electronic Medical Record (EMR) that there is no longer a need for a RIS!  Also, some of the functionality of the RIS has been encompassed in the PACS, and again displaces the need for a dedicated RIS.  Since then I have spoken with other vendors that are now reevaluating their position relative to their RIS offerings.

So, what is going on?  Is the RIS dead?  If the vendors follow this logic, then, yes it is dead.  There are legitimate reasons for suggesting this in light of certain RIS functionality.  Since many RIS were created in the age of film, many of these systems had capability built in to handle film management, such as film folder tracking.  Given the high penetration of PACS and digital radiography these days, folder tracking is on the decline.  How many places might still check out a film folder as opposed to burning a few relevant studies on a CD? 

In addition, many of these products are getting long in the tooth in terms of user interface.  Quite a few years ago before IDX was acquired by GE, IDX bit the bullet and went through the painful process of rewriting the user interface of their RIS to make it web-based (Version 10).  This was revolutionary at the time, and stood out in its simplicity in using the concept of forward and backward web pages in lieu of multiple Microsoft Windows “windows.”  The dilemma vendors now face is the investment they would need to make to update these products to more modern and likely web-based user interfaces.  This is particularly true for vendors that also have EMR product offerings that clearly have a higher priority in terms of investment.

On top of this, there are startup companies such as Medicalis ( that define themselves as the “Next Generation Radiology Workflow” that interact with the EMR and other enterprise systems to provide the necessary radiology workflow.  In other words, they address the modern-day PACS environment RIS functions and ignore old-school film-based functionality. 

And what are RIS-PACS vendors who don’t offer an EMR to do?  I would expect the lines between a RIS and a PACS will further blur to the point that they will be described as a singular product.  For example, several vendors attempted to create a “RIS-Driven” PACS workflow by providing a 3rd screen on a PACS workstation that was essentially the RIS workstation.  The intent was to have the physician interact with the RIS workstation to select a patient from the RIS work list, and have it launch the PACS application.  Over time, and the realization that the RIS user interface was not ideal for a physician, these systems are evolving such that the 3rd screen is really more of a dedicated “portal” to the information contained in a RIS, presenting their own work list and launching image display from their own dedicated application. 

Hence, one could argue that RIS and PACS have evolved into a “Radiology Work Flow Management System,” or RWFMS, and that the RIS as an entity is essentially dead.  Regardless of what you call it, the fact is that there is a fair amount of functional overlap between systems these days.  The net result is that one needs to wisely consider the functionality requirements of one’s environment and figure out what best fits your needs.  In the case of my client, which happens to be a large imaging center based practice, their EMR is not strong enough to address what they need, and their existing PACS lacks sufficient integration with the EMR.  Their primary need is the addition of RIS-like functionality.  They also happen to be in an area where film-based studies still exist, so they could use film folder tracking.  In their (and I believe many others) case, a RIS is probably the right answer.  Contrast this with a large medical center with multiple locations and a full EMR implementation, and the likelihood is they could implement an alternative workflow solution such as that offered by Medicalis. 

So, is the RIS dead?  I think in either instance it will come down to functionality and how it is packaged, and more than likely, the terminology will change to address workflow.  So, in that sense, yes the RIS is dead, and long live the RWFMS!