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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 15-21

Utilization assessment of radiology information system: Solution to patient safety improvement


1 Department of Health Services Management, Faculty of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Information Technology, Faculty of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication25-Jun-2014

Correspondence Address:
Asghar Ehteshami
Department of Health Information Technology, Faculty of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.135345

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  Abstract 

Introduction: Radiology Information System is responsible for information management tasks typically including readout, storage, analysis and information optional searching. It is generally responsible for administrative and clinical information management tasks in the radiology department. Quality RIS can support software applications in other department such as nuclear medicine, imaging centers, radiation therapy, and endoscopy. Methods: This is an applied cross-sectional study assessing utilization of radiology information system in 12 academic hospitals. The study checklist includes 94 items assessing Radiology Information System input, process and output. Its content and constructed validity were confirmed by research literature and experts opinion. The collected data were analyzed Using SPSS software V. 14. Results: The results indicated that hospital Radiology Information Systems compliance with input, process and output criteria were 54.9%, 55.2% and 37.7%, respectively. The results also showed that the mean input, process, output compliance level in fully electronic and semi electronic radiology information systems were 61% and 44%, respectively. Conclusions: Hospitals with electronically integrated radiology information systems had a more favorable position than other hospitals. They had quality medical staff, were able to provide comprehensive care and services to patients and other consumers and improve patient safety. To achieve their full potentials and close the exiting gaps adoption of international standards is essential and necessary.

Keywords: Digital imaging and communications in medicine, educational hospital, hospital information system, picture archiving and communication system, radiology information system, utilization assessment


How to cite this article:
Raeisi AR, Ehteshami A, Kasai M, Yusofi M. Utilization assessment of radiology information system: Solution to patient safety improvement. Int J Health Syst Disaster Manage 2014;2:15-21

How to cite this URL:
Raeisi AR, Ehteshami A, Kasai M, Yusofi M. Utilization assessment of radiology information system: Solution to patient safety improvement. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2024 Mar 29];2:15-21. Available from: https://www.ijhsdm.org/text.asp?2014/2/1/15/135345


  Introduction Top


In the recent two decades, technological changes and information technology progress have left a deep impact on health care systems. The variation made in the data processing, directs hospitals to rely on information systems increasingly that are tools to receive, transmit, retrieve, store, process and display information. [1] Concepts such as hospital information system and those subsets appeared in the late 1960s with the technology development and computer using in the 1950s, that the most important ones can be mentioned radiology information system (RIS) and played a very effective role in promoting health service quality, increase stakeholder satisfaction, improve treatment economy and finally gain competitive advantage in today's varied environment. [2],[3] Due to the work's complexity, technical and medical of a hospital, hospital information systems cause to improve decision-making in the health care actions and development of organizational performance By providing information and patient records to the service providers, and administrators believe that to make change in hospitals are forced to use it. [4],[5],[6]

Generally, RIS is responsible for administrative and clinical information management task of the radiology department and all of its subsidiaries and support to operations and work processes within a radiology department. If this system is implemented as electronically, it will be able to support and develop from applications software in other special sections such as nuclear medicine, radiation therapy, and endoscopy and like it.

The main features of an information system can be cited in items such as: Functional requirements (e.g., schedules, work lists and digital instructions), control user access and patient satisfaction, Electronically and paper operations File analysis and planning schedule, Support for work lists and files, Details Survey, Reporting and Encodes reports, Tracking pictures and videos, Stock control, Inventories and Requests, Auditing and Billing, managerial and integrated reports of radiology information system.

Digital radiology is consists of two parts of a radiology information system (subsets of Hospital Information System (HIS)) and digital images (picture archiving and communication system (PACS)). One of the most advanced and most applicable information technology innovations in the field of hospital radiology is picture archiving and communication system. In the traditional radiological equipment are used for radiographic films, special papers and stereotype for imaging, images record, storage and display, these are replaced by digital imaging in this system and in turn, all the photos recorded by the full digital sensors, stored with the special standard format and are kept in central servers. Images instead of traditional panels can be observed on screens and monitors for radiology departments or other sectors and pictures' text report attached also to each of them and stored in digital form. [7]

The most important achievements of this system include: Increasing capabilities in comparison with radiology film such as (utilizing from digital imaging system and radiology communications in Medical (DICOM) that can be controlled all areas including digital photography, storage, transmission and interpretation of its results) [8] , possibility of transfer all clinical information and patient images quickly and cheaply from underserved areas into specialized centers and counseling centers and country's academic and therefore speed up to the process of patient's diagnostic procedures and work flows of treatment centers. Use of measure to lessen radiation in digital images in comparison with radiology film, removing costs of film radiology, removing physical space for installation emerging and fixing film and unit archive, providing preparations communication network formations of doctors in country and negotiation and providing medical consultation at national and international levels [9] , reinventing and need for re-imaging and thereby saving costs and improving control processes. Increase productivity by eliminating ineffective and additional processes, reduce operating costs by replacing equipments that are capable of doing processes cheaply [10] . Significant contribution to reducing medical errors by providing accurate and detailed information to the physician, increasing ease of working processes in the RIS accurate possibility searching patient records (Demography, images and reports), supports for data transmission in the hospital information system and RIS, Allowing the study of information and pictures of the past and allowing study large amount of images with supporting activities of remote control. [11]

So, on considering the need for establishing the RIS and its benefits role in various aspects such as patient safety, we know it is necessary to set utilization assessment and determine the strengths and weaknesses of the system in Academic hospitals in Isfahan in this study and finally, we provide strategies for improving these systems.


  Materials and Methods Top


This study was applied type and method cross-sectional to assess utilization of RIS Isfahan university of medical sciences hospitals. In this survey, sampling like census and was consisted radiology staff of 12 Isfahan university hospitals from April to March 2011. Checklist of study contained 94 questions in the context of assessment information system's inputs (11 items), outputs (6 questions), processes (77 questions) and the consequences that its validity was confirmed by expert's comments and scientific text review. Data collection was done by referring directly Researcher to study state and the data were analyzed in findings tables by using Statistical Package for the Social Sciences (SPSS) software.

Findings

According to [Table 1], the total RIS's inputs and infrastructures compliance is 54.9%. In this system, all images are transmitted using DICOM standard. Furthermore, all affaires in the system, complied with both Iranian Radiology Association and Atomic Energy Agency regulations and guidelines. All RISs were integrated with HIS; but, only 8.3% of them were integrated with PACS and none was integrated with computerized provider order entry (CPOE). Therefore, according to the study checklist, the radiology departments are equipped with 41.6% of RIS requirements.
Table 1: Radiology information system's inputs& Infrastructures

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The RIS processes compliance was 55.2%. According to [Table 2], centers using electronic RIS and PACS, are fully following the standard DICOM. Planning and scheduling information system processes compliance was 80.8%. The processes based on receiving and doing orders (patient's admission and discharge, sending reports, personnel program's scheduling, preparing reports, make requests, request record, request receive) are fully followed, but the processes based on holding meetings (working sessions, training sessions) have complied lower. Identifying processes of observance rate, matching the demographic characteristics of the patients and gained satisfaction in information system have allocated high percentage. Also the observance rate of Warehousing processes and inventory control and drugs inventory turnover and consumer goods of department completely estimated and equal (100%) and personnel processes of observance rate is (73.9%) in information systems. The observance rate of activities reporting processes and the amount of radiation absorbed by the Film Foundry is completely followed to the International Atomic Energy Agency (IAEA), but does not report to the Association of Radiology. The observance rate of the information confidentiality process is (4.1%) in information systems. Supporting the process of Information Confidentiality and users footprint record (location and time of entry and exit) are not followed in systems and the observance rate of determining amount access process and assigned a password and ID for each authorized person is very low. The observance rate of patient admission and radiology requests and order processes is (69.4%) RIS in studying hospitals are completely complied with the matching order process of patient's identity characteristics and conformation, referring report to applicant received and done instructions. But in terms of matching orders process, clinically and the confirmation of the responsible department (radiologist) and supporting by the confirmed orders have low observance rates.
Table 2: Radiology information system's processes

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The observance rate of processing and interpretation of images and reports in information systems (50%), statistical reports processes about volume orders, client and reporting materials and consumer goods in the sector (95%), accounting and finance process (6.6%) are in the lower level and the main reason is that almost radiology sector financial process were performed by accounting and hospital revenue and the Radiology department individually do not perform significant activities. The findings suggest that the observance rate of study and research process in information systems is (37.9%). Accordingly, the system about the current research process partially meets the needs of learners and researcher, but because access is not allowed for past images and reports for lacking of documents, allowing data process and review records and past studies are very limited.

The observance rate of send and received pictures and report process is (25%). It should be noted that the process of sending and receiving images in the sector is acceptable level but in terms of sending and receiving images and reports process in hospital level, between sector in national and international level is located on the lower level due to the lack of use of electronic RIS capabilities. The observance rate of tracing and tracking images and report process is (59.7%). Tracing and tracking images process in the sector and hospitals have allocated largest amount of observance rate But tracing and tracking images and reports have lowest observance rate in between organization level and in national and international level due to the lack of using electronic RIS capabilities.

RIS

According to [Table 3], is observance rate of RIS's output is 37.7%. The findings indicate that data outputs are located in undesirable level (33.3%) the observed rate of archived radiology images and reports is 47.9% and large volumes of images and reports traditionally and only a small amount of them is archived electronically. The observed rate of patient education and their fellows about the conditions and radiology department actions is 33.3% and all training will be done with documented training texts and cannot be used with training aid methods by film and multimedia files. For reporting and images, numbering system numbering method is used based on the patient's clinical file numbers to facilitate the task and other standard methods numbering such as serial and the unit will not be of much use.
Table 3: Radiology information system's outputs

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As can be seen from the results in [Table 4], observance rate of inputs, outputs and processes RIS electronically works more than non-electronic RIS. Accordingly, utilization rate of the electronic RIS is much more than utilization rate of non-electronic RIS.
Table 4: Table of criteria observance rate in electronic and non electronic information systems

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  Discussion Top


Results showed that the status of RIS in Isfahan health care has been unfavorable (2/49%). However, the average of RIS is 61% following criteria of inputs, outputs and process assessment, but non-electronic RIS follow 44% of the criteria. So, it is clear that the electronic RIS has higher efficiency and performance than non-electronic RIS. So requirement of each educational and therapeutic center is one consistent and standardized information system with the ability to meet customer needs care, education, research, executive and administrative that have allowed to classified search and accurate access to information; for that, a hospital and its subsidiaries like a radiology department could be achieved to increase quality and revenue by reducing time and costs simultaneously, which have necessitated to the style and special rules for Imaging, collecting films and reports, reports and Images Processing, clients volume control, receiving and executing processes and other activities and radiology processes.

In [Table 1], total observance rate of RIS inputs has assessed relatively desirable and 54.9%. Also in [Table 4], input observance rate in hospital has an electronic RIS with the average scores 66% has been more desirable than the input observance rate in hospital have non-electronic RIS (40%). By reviewing the status of the applied equipment in sector found that for imaging operations often use modern equipment and older technologies are used less, but older systems have been useful for studying and image processing, yet and in this sense have no desirable condition in the RIS. In a parallel study, Ehteshami and colleagues concluded that using information technology and computer equipment uses to increase facilitate and speed of the file documentation. [12].

The findings suggest that the integration of RIS is a desirable situation with HIS and electronic health files but do not have desirable integration with PACS electronic system and remote electronic request.

In studying Information systems, strong evidence is seen based on following the rules and regulations of regulatory agencies, and therefore, according to the findings of this study, the RIS is assessed desirable about the adherence and following rules.

The findings show that the use of digital radiology systems and PACS, besides improving the quality of diagnosis and treatment, makes dramatically reducing the time of various processes and cost savings of the sector and hospital. In [Table 4], we find that electronic information system will operate which utilizes digital equipment, and follow the highest input standards.

The study is done by Reza Moradi and colleagues about check comparison process between manual systems and HIS in Sheikh Mofid hospital in Mashhad, that showed processes like (length of hospitalization, application process, test answers, A pony and admission process) that has a direct impact on duration of hospitalization. HIS could save considerable time for each patient. In terms of personnel working plan process and set insured patients' list had given rise to significant time reducing. The added value created in the process through the HIS can direct impact on reducing service costs, staffing and increased utilization of hospital resources, which can be cited as evidence of improvement and development in hospital performance. [13] Pare in his study concluded that practitioners and radiologists speak of IT applications in healthcare as a scientific and utilized tool for Medical Diagnostic procedures and have a confidence in the accuracy of its services. [14] Watkins and colleagues found in a study that using the PACS system can up to 25% reduce duration of hospitalization in a hospital and thereby help to reduce the recovery period. [15] Brayan and his colleagues in their study concluded that although PACS systems in hospitals impose a great cost to the hospital, but ultimately that system makes the benefits of hospital financial saving and hence, the establishment of PACS system is appropriate. [16] All studies are compatible with the present study.

Observance rate of the output RIS has been evaluated 37.7% and undesirable. Also, by looking at the results of [Table 4], output observance rate in electronic RIS hospital with 47% was most desirable that output observance rate in non-electronic RIS hospital is 41%. According to the observed rate of 33.3% recorded output, should be used on regular paper or CD recorded images instead of expensive x-ray film, which it ceases to reduce costs of hospital and expenses of the patients. Neumann in the parallel study with the present study came to the conclusion with establishment IT in hospitals and it is equipped with digital and electronic systems that can be made as economic savings to the hospital costs between 5/0 to 3 billion $. [17]

According to observance rate 47.9% in case of archived Radiology images and reports, we found that the archived status is undesirable in studying information systems and large volumes of archive traditionally and only a small amount of images and reports electronically was archived. According to the findings, images are stored on the electronic drives in hospitals that have electronic RISs, but hospitals that have non-electronic RIS does not have the ability to store and archive images and reports.

According to observance rate 33.3%, in case of education status of patients and their caregivers about the circumstances and actions of the radiology department, we noticed that condition of the patient, education information systems is undesirable and all the training are done by documenting educational texts. Therefore, it is recommended for use of methods of educational assistance as film and multimedia files.

To facilitate for reports and images, more numbering system is used for numbering based on the patient's clinical file number and from other standard methods of numbering are not useful.

Rumball in their study concluded that this system is capable of recording, displaying and storing of continuous data simultaneously. [18] Wagner in his study concluded that the use of computers and information technology in medical science is increasing day by day and replacing digital imaging with old imaging, creating affordablity a lot for hospital in radiology orders, reports and communications and store images. [19]

The observed rate of RIS processes in the study population 55.2% was assessed fairly desirable and by looking at the results in [Table 4], it can be said observance rate in hospital electronic RIS process 71% had been more desirable from the observance rate in hospitals' non-electronic RIS process 53%.

Centers that used Electronic RISs and PACS systems, follow from standard DICOM guidelines, and so standards of the RIS assessed as desirable in these hospitals.

The observed rate of planning and scheduling of the information system process is estimated 80.8% so we found that the RIS of hospitals, follow in the desirable level process working plans and scheduling furthermore should not observe differences between electronic and non-electronic information systems in this issue.

The observed rate of identifying, matching patient's demographic characteristic, getting patient's consent process, had been acceptable level and 96%.

The observed rate of warehousing and inventory control and drug inventory turnover and unit consumer good process is followed fully, therefore, RISs in hospitals have been desirable level in terms of warehousing and inventory control processes and should not be the difference between electronic and non-electronic information system in this issue.

The observed rate of personnel process has been reported 73.9% and these figures show that the RIS in hospitals in terms of observance rate of personnel process had been desirable in the field of documenting of personnel evidences, work experience and education, and report the amount of radiation received by clinical staff but processes related to the staff and other patients, is not an acceptable situation. Meanwhile does not observe difference between electronic and non-electronic information system in this issue.

Processes of activity reporting and the amount of radiation absorbed by the foundry films to competent bodies such as nuclear energy are followed fully. So, the information systems have a desirable and acceptable situation in terms of reporting to this organization. However, it is not capable for sending legal reporting by electronically in an electronic information system, and this process is done entirely by manual.

The observed rate of confidentially process has been 4.1% and in undesirable level. It is necessary for the thought actions for confidentiality of patient information and department process. Electronic information systems which are able to determine the access measure of information and confidentiality for users of different individuals but this process is not observed in non-electronic information system.

The observance rate of admitting process and radiology requests and instructions have been 69% and relatively desirable level. It is recommended approval process instructions performed on the patient, as it is emphasized further by the responsible technical department.

The observed rate of images and reports processing and interpretation processes have been 50% and undesirable level. [Table 4] shows the results that all processes of processing and interpretation images and reports follow in an electronic information system.

Statistical reports processes have been reported 95% acceptable and desirable about the volume of orders, client reporting materials and consumer goods sectors and in this regard, the difference is not found between electronic and non-electronic information systems.

The observed rate of sectors accounting and finance processes in information systems has been 6.6% and in undesirable level and the main reason is due to more performance of financial processes of the radiology sector by accounting unit and hospital's income. Electronic information enables system that some accounting processes calculate, such as accounting records and the calculation of tariffs health care and patient's consumer but this is not followed in non-electronic information system.

Research processes of information systems are estimated undesirable and unacceptable (37.9%). However, the system about current research processes in non-electronic information system partially meet the needs of learners and scholars, but because there is not possible accessing to last images and reports due to the lack of proper documentation is very limited with the possibility of data process and review records and past studies, but due to archiving information to electronic data warehouse in electronic information system, provides possibility retrospective studies as well as data processors.

The observed rate of Send and received images and report processes in information systems have been 25% and inappropriate and ineffective levels. Of course, process of receiving and sending images in the sector was desired and recommends the capability of sending and receiving images and report process, which should be provided in hospital level, national and international level by using electronic RIS.

The observed rates of tracking and trace images and reports process in information system have been desirable (59.7%). It should be noted that in the process of tracing and tracking images in non-electronic RIS images is desirable at a hospital and sector but the main problem is in organizational, national and international levels that will be removed by using the capability of the electronic RIS.

Research conducted in several countries has shown that placing management of the HIS in the highest level of the organizational hierarchy of health sector can represent important information in strategic planning and policy. Sivala in their study concluded that successful implementation of health programs and IT projects are leading to a positive impact on decision-making at various levels and are associated via development and promotion of health. [20]

Luce in their study also found that technology causes creating economic saving in hospital financial processes and the allocation of resources is done correctly and in a special place because technology has provided the conditions for the system that accurate and comprehensive information available to decision makers to be more quickly and make more accurate decisions. [21]


  Conclusions Top


According to the findings of the study, the hospitals have electronic integrated RISs in more favorable position than other hospitals and are able to provide a more comprehensive and quality service to medical staff, patients and other consumers. To achieve the above goal for hospitals is better than using electronic new technologies in RIS including PACS system and CR (Computed Radiology).

To strengthen the capabilities of the hospital RIS and replacing the inefficient information system with integrated and electronic system are recommended items that should be considered such as: To acquaint the personnel, Doctors and users with capabilities electronic integrated utilization system and the weakness expression of inefficient system, Holding educational classes, Participation of staffs in implementation and its importance to comments and feedback, Reviewing utilization information systems in the world and try to establish system in accordance with hospital environmental conditions. Taking a direct role of the hospital's chairman and chief in project, Project implementation in a specified time range and prevent from continued work with old system for long time and gradual replacement the new system.

According to the findings of a study, the main reasons for offers of researchers for the establishment of an electronic integrated information system in the radiology department of hospital are: Error control in imaging, Increase accuracy and prevent re-imaging, admission error control and providing patient images and reports, control of constant costs, control of current cost, reduce the quality and security the stereotyped and Videos, Increase quality of care, time control, research and teaching facilities, and increasing patient satisfaction, clients, users and providers of medical services.

However, there is a large gap to achieve the full potential of these systems and an effort to achieve international standards is essential and necessary.

 
  References Top

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2.Moradi G. The role of medical record in HIS. Iran Health Inf Manage Assoc Bull 2002;23-9.  Back to cited text no. 2
    
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4.Chuck W. Management: Planning and decision Making, 4 th ed. Washington DC: Thompson Pub; 2006.  Back to cited text no. 4
    
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12.Ehteshami A, Rezaei P, Kasaei M, Rezazadeh E. Awareness and using of medical students about mobile health technology in clinical areas. Acta Inform Med 2013;21:109-12.  Back to cited text no. 12
    
13.Moradi G, Sarbaz M, Kimiafar K, Shafiei N, Setayesh Y. The Role of Hospital Information System (HIS) on Dr Sheikh Hospital Performance Promotion in Mashhad. Health Inf Manage 2008;5:166.  Back to cited text no. 13
    
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15.Watkins JR, Bryan S, Muris N, Buxton MJ. Examining the influence of picture archiving communication systems and other factors upon the length of stay for patients with total hip and total knee replacements. Int J Technol Assess Health Care 1999;15:497-505.  Back to cited text no. 15
    
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18.Rumball-Smith A, MacDonald S. Development and Utilisation of a real-time display of logged in radiology information system users. J Digit Imaging 2011;24:295-9.  Back to cited text no. 18
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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