A Careful RIS Replacement Emerges as a Key Business-Builder

If you’ve seen one data center, you’ve seen them all. That’s what Charles Rivers believed, at least. Today he’s the CIO of 30-plus site, 100-plus radiologist Southwest Diagnostic Imaging (SDI) in Arizona. Just two years ago he was new to healthcare IT, joining SDI after spending close to 20 years as an IT professional in the world of real estate and home construction. 

“Medical is very different from other industries I’ve worked in,” Rivers says. “We’ve got HL7 formatting, HIPAA rules and ransomware as a front-of-mind concern. Then there’s interoperability between systems to allow for much more data transfer than I’d seen before, plus so many transformation engines to get what you want, where and how you want it.” 

Fortunately, Rivers also found more than enough cross-industry commonalities by which he could adapt and expand his IT leadership skillset. One crucial step in the process came in August 2017, right around his one-year anniversary with SDI. That’s when the practice went live with Fujifilm’s Synapse RIS, vaulting end-users out of a long, increasingly frustrating run with another vendor’s RIS.  

The legacy system, to which SDI was tethered for around a decade and a half, had been falling short on key qualities. First among these: flexibility. “Our former RIS had a lot of proprietary storage formats that prevented us from expanding and continuing to grow our business,” Rivers says. “When we wanted to pull documents and do different things with them, we couldn’t proceed without engaging the vendor on data conversion.”

Equally challenging was the fact that SDI’s legacy RIS wouldn’t integrate with application programming interface (API) tools and resources for building software. Simply put, the IT team couldn’t get data in and out of the system. Last but not least among the legacy RIS’s shortcomings was its lack of capacity for supporting initiatives around business intelligence (BI).  

“When SDI started with the old RIS, there wasn’t a BI department anywhere. BI wasn’t even considered in the early 2000s,” Rivers says, suggesting the times have changed quite dramatically. Today SDI maintains a dynamic BI department of its own—and looks to its Synapse RIS, as well as its growing technology partnership with Fujifilm, as a robust source of data integration and analytics.  

“It’s important to us to be able to utilize that data to grow the business,” he says. 

Selected, installed and supported 

Fujifilm’s Synapse RIS first appeared on SDI’s figurative radar screen in 2014. Ann Welker, SDI’s clinical application manager, remembers surveying the field at RSNA and SIIM. Next came demonstrations from several finalists and, finally, site visits with peers who had hands-on experience with Synapse RIS and one other contender.  

“The other system behaved more like an EMR with a radiology component,” Welker says. By comparison, Synapse RIS “looked like a radiology product, and it behaved like one. It had a lot of nice visual features on the work lists, including a way to easily add questions, do scheduling, flag tasks and set alerts, all in a way that was very visual. I thought that would be very helpful in our environment.” 

The road from careful preparation to daily use wasn’t without its growing pains. Anticipating substantial upheaval, Rivers, Welker and colleagues spent time creating scheduling templates, replicating features in the outgoing system and getting various department heads within SDI to help customize Synapse RIS to everyone’s satisfaction.  

“The product install itself actually went pretty smoothly,” Welker says. “We did a lot of training. People really responded to that, and we did really well.” 

The groundwork-laying period included two additional factors. One was the IT team’s desire to create scheduling templates that replicated but improved upon interfaces with which end-users were familiar. The other was SDI’s decision to take on IT projects simultaneously with the runup to the RIS changeover. These included changing exam codes as well as installing a new enterprise master patient index (EMPI), a new billing system and a new PACS.  

“We were literally changing everything at the same time,” Rivers says. “We had a go-live date set for the RIS, and we decided to delay it not once but twice to make sure that the RIS go-live would be as smooth as we could get it. All of that contributed to a smoother RIS implementation.”

So too did the close involvement of Fujifilm’s technical support staff. “We held multiple Webex meetings with Fujifilm people,” Welker says. “Our Fujifilm product manager helped us with a lot of questions and helped us drive the workflow.”

“Fujifilm devoted resources to help us make this successful,” Rivers adds. “And they were onsite en masse during the go-live to help us get through the go-live successfully.”

Spotlight on stakeholders 

SDI continues tuning and improving its adaptation of Synapse RIS. The team is learning to leverage the product’s full set of business- and financial-management tools, and end-users as well as patients are benefiting by its anywhere-anytime access.  

Asked about feedback the team has received from specific stakeholder groups, Rivers responded as follows: 

  • While radiologists don’t spend a lot of time in the RIS, “there are some changes from Fujifilm that allowed us to give them access to lab results and clinical notes with fewer clicks than they had to make previously. We know this will make their lives much better because, for rads, it’s all about minimizing clicks.”

  • Attentive referring physicians are likely noticing a workflow change SDI has put in place to electronically deliver specialized reports. “In the past, we had to physically mail those reports.”

  • Registration staff can’t miss the replacement of paper forms with digital-kiosk interfaces via iPads at all of SDI’s imaging centers. The practice has partnered with Fujifilm to bring this vision to fruition, incorporating history sheets as well as intake and check-in forms. “This has really changed the patient check-in process, reduced the amount of paper floating around the office and automated data entry into the RIS. It’s made a big difference in data entry.”

  • Prior to Synapse RIS, many of SDI’s patients were already using an online scheduling system to choose their preferred appointment times. The upgrade to Synapse RIS required some tweaking to carry over this component. “We needed a lot of help from Fujifilm to get that integrated. They worked with us and made sure the process was seamless.”

ROI, realized and anticipated 

When asked about its precise return on investment relating to its Synapse RIS install, Rivers says, already the practice is “definitely seeing some softer returns, just from using less paper and spending less time trying to get to data.”  

Looking ahead, the IT team’s RIS functionality to-do list includes a patient portal offering not only scheduling options but also exam results, as well as capabilities for front-desk collections and payment estimations (via a partnership with Fujifilm partner Availity). 

Rivers says he’s looking forward to building on SDI’s partnership with Fujifilm as the practice continues to excel in optimizing care quality for patients while containing, or even reducing, operating expenses.  

“Like SDI, Fujifilm is interested in continuous improvement,” Rivers says. “We’re working closely with them to improve Synapse RIS’s current and upcoming versions.”

And he cites one key principle of IT leadership that has carried over from his many years in real estate and construction. “Our old RIS’s proprietary format for data and document storage is no longer a frustration,” Rivers says. “We finally have access to the RIS information we need—when and how we need it—to grow our business.”