Developing processes to implement RIS PACS based Radiology Services

This study describes how we helped a national network of Radiology diagnostic centres to plan how their core working practices should change and to specify the systems requirements for a new ‘RIS PACS’ digital imaging service.

Our Client’s Requirement

Our client, an independent health service provider operates a national network of Acute Hospitals and ISTC’s. There is a Radiology department at each physical location, some of which are supported by in house mobile CT/ MRI services or third party providers.

The company authorised a project to establish a networked RIS PACS (Radiology Information System and Picture Archiving System). An added complication was that the roll out would immediately follow the roll out of a new patient administration and invoicing system.

The project required an end to end future state process model from the point of patient referral to the completion of examination reports, invoicing and fee sharing.

This model was required to

  • Specify vendor RIS PACS system requirements
  • Specify Interface development requirements from the PAS vendor
  • Establish harmonised best practice radiology delivery processes in all units
  • Create a transition plan for each radiology unit in the group
  • Train people in new ways of working

Our Approach
Our client had already established the Xenogenix SMART process management service which enables people in all disciplines to see, understand and develop the best business and information process flows via a web browser.

  • We facilitated a representative group of radiology staff members drawn from different sites to
  • Capture existing process flows for each type of diagnostic referral
  • Create an ideal future state concept model
  • Agree interface requirements and development plans with system vendors
  • Create interim process models that reflected the phased delivery of new functionality of the PAS vendor
  • Track and communicate which activity step would cause potential problems or risks to service delivery


The group originally felt they could quickly define the future state because they had extensive collective experience in delivering radiology services. However each individual had a different perspective of procedures and even used different language to describe the way they did their work. It was therefore essential to create to create a common model of the current processes which revealed the prevailing variances across the group, and to establish the common understanding necessary to begin to decide what the future state should look like.

The RIS system includes considerable patient and referral management workflow functionality which overlapped with the core functionality of the new Patient Administration System.

The model allowed the project team to ask penetrating questions of the competing system providers.   It was used to define the system requirements and critical data sets.

As the winning vendor was selected, the practical system constraints were identified and a scenario of the future state map was created that defined the manual work arounds that would be necessary to establish the pilot system.

The group had assumed collective ownership of the future processes and procedures but needed to get explicit buy in to the changes from a much wider community of radiographers, radiologists and hospital managers. They had also identified issues that required new policy direction.

We ran a validation workshop which involved a wider representative group  examining the detailed processes, inviting them to challenge the proposed solution and correct any misconceptions. This resulted in a revised process model and a range of issues that needed to be resolved. It was important that the workshop was seen to have had the active participation of the people who will do the work.

At the time of writing, this project is entering the pilot roll out stage. The next step will be to use the process models to define the use case tests and to train the pilot users.