725 International Journal of Collaborative Research on Internal Medicine & Public Health

Role of HIS and RIS in Improving Quality of Patient

Care
Kanthipriya Lingamallu1 and Shruthi Nayakvadi2*
1 Deapartment of Cellular and Molecular Diagnostics, Manipal University, Manipal, Karnataka
2 Department of Hospital Administration, Nizam’s Institute of Medical Sciences, Hyderabad

* Corresponding authors: Shruthi N, Department of Hospital Administration, Nizam’s Institute

of Medical Sciences, Hyderabad, Tel: 8885356821; E-mail: [email protected]

Abstract
Healthcare providers consider patient care has a foremost aspect to achieve high degree
of patient satisfaction. Use of HIS/RIS plays an active role in improving quality of
patient care in a hospital these days. The benefits of HIS and RIS include reduction of
errors, access of patient information in real time, improvement in clinical decision
making. Hospital information system manages medical and administrative information.
Radiology information system has ability to provide patient scheduling, radiology
reporting, retrieving and storing radiology images from various modalities. In such a
way, HIS and RIS improve quality of patient care by minimizing errors and providing
information in real time.

Keywords Patient care; Hospital information system; Radiology information system;

Quality of patient care; Information system

Abbreviations
Hospital information system-HIS, Radiology information system-RIS, Health layer7-
HL7, Electronic medical record- EMR, Picture Archiving Communication System-
PACS

Introduction
The patient care quality is determined essentially by the quality of infrastructure, quality
of data, competence of personnel and efficiency of operational system.1 The quality of
data in health records is one of the most important factors in improving quality of patient
care.2 Inadequate patient care or poor patient outcomes are due to lack of efficient and
effective information.3
Hospital information technology (HIT) is a fundamental requirement in healthcare
improvement and is a primary strategy for enriching its quality, improving patient
management, expanding research and evolving capabilities in healthcare. Health
Management Information System (HMIS) is an integrated Management Information
System (MIS) that collects management information about on healthcare sector.4 Patient
information allows better understanding of health patterns and can be used not only for
curing diseases but also for preventing them, improving patient safety and preserving
quality of life i.e., it improves overall health outcome and reduces healthcare spending.5
In USA, the quality of healthcare data is focused by American Health Information
Management Association (AHIMA) at a more precise level. The implementation of
HIS/RIS is beneficial to healthcare providers and the patients as it can provide high

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quality service. Quality of HIS indicates attributes such as timeliness and reliability
provide complete and accurate information about patients for physician practice.6
Technology and technological breakthroughs have improved the lives of patients in terms
of diagnosis and the management of serious diseases in the 21st century.7 The patient
health information and education in healthcare is widely expanding with Hospital
information system (HIS), Radiology Information System (RIS), Picture Archiving
Communication System (PACS) and Healthcare apps.8 Conveying quality healthcare to
patients maintains professional pride, increases professional influence, and in turn
achieves organizational goals. Monitoring patient experiences by healthcare
organizations helps in evaluating and improving the quality of care. A patient experience
reflects the quality and services provided by the healthcare organization. More
descriptive information on quality patient care is given by quality assessments and
patient ratings. HIS implementation, main objective is to identify priorities for
managerial intervention based on user evaluations of the performance of the HIS
attributes as well as the relative importance of these attributes to user satisfaction and
productivity outcomes.9
HIS is the core informational system for patient management across the health-care
system and radiology information system (RIS) is considered the core system for the
electronic management of imaging departments.10 Efficient information management
and communication are essential for providing high-quality clinical care.11 RIS/HIS
reduce redundancy in test ordering because clinicians can more readily find past test
results and are alerted to similar tests ordered recently. HIS maintains EMR of patient
which improves patient care by recording patient’s vitals and treatment. RIS is used by
radiologists to edit and report the radiology diagnosis. HIS interfaces with RIS which
communicates through an application layer HL7.

Quality of Patient Care

The effective care coordination of a patient’s health care services is a key component of
high quality and efficient care. Such effective care coordination can be achieved by
HIS/RIS which records patient health information. The healthcare quality across the
continuum depends on the integrity, reliability, and accuracy of health information.12
Collaboration among clinical services and other departments has been limited in the area
of patient care.3 Most of the information transfer is done through medical records which
at often times are poorly documented. All kinds of health information related to
healthcare are produced and managed effectively in order to evaluate the quality of
health services and monitor the health status of Hospital. Providing continuous quality
healthcare to patients are based on fulfilment of the two factors mentioned below:
All healthcare providers and health organizations establish effective relationship among
themselves.
Producing and managing high quality health records to exchange them among
constituent organizations of national health information system.
The patient’s level of satisfaction with the quality of health care services can be
measured through its structure, process and outcome.13 Patient safety, Patient
monitoring, tracking, continuity of care and patient involvement is enhanced by HIS/
RIS. It is a multidisciplinary field which links information technology and healthcare to
provide better quality care to the patients, ensuring patient safety and to safeguard the
information generated is accurate and of good quality.14 It also has a potential use in
medical education, training and issues for research. A personal, professional and
organizational relationship is a quality of Patient-centred care.15 Educating and enthusing
clinicians about information system may improve organizational quality. Empowering

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clinicians to participate in local and national information management decisions;

exploring how information can be used to improve patient care and outcomes; and
evaluating clinical information systems and helping to realize their benefits.16 The key
component for foundation of decisions at all levels in a health care system is a high
quality patient data. Other important challenges include issues with interoperability with
other systems, medical staff support and usage of HIT, difficulty building a strong
business case for adoption, availability of IT staff, and privacy and security of patient
information.17

Role of HIS and RIS in Patient Care

Patient understanding of information communicated by healthcare providers can lead to
enhanced patient satisfaction, better compliance with treatment instructions, improved
outcomes, and decreased treatment times and costs. Collection, storage and analysis of
health information are the fundamental tools to provide efficient healthcare services and
its importance is increasing by considering the more amounts of health information
collected every day.5 The real time access of clinical data provided by HIS improved
clinical documentation, reduced duplication of health services and also supported better
decision making related to patient care. The recently introduced tools for patient
education and diseases management are mobile health apps.18 It provides access to wide
population at low cost which is helpful in delivering healthcare interventions,
specifically in areas with less health resources without even requiring people to visit
health centers physically.19 Hospital information system implementation significantly
reduces clinician workload and medical errors while saving the healthcare system major
expense. EMR is a clinician based data on diagnosis and treatment.20 Apart from storing
patient information it also keeps a track on diagnosis and its necessary medical
information. HIS is the potential to reduce payment lag and improve health system
performance. However Radiology information system maintains radiology information
of patient and their reports. It is software used by radiologists for analyzing and reporting
the radiology diagnosis by viewing PACS images. RIS allows retrieving and storing of
radiology information, edit reports, patient scheduling, maintaining patient workflow
management within the radiology department. HL7 is a set of international standards for
exchange, integration, sharing, and retrieval of electronic clinical data and administrative
data between hospital information systems. A Comprehensive Health information
System, is a safe and effective communication among the health care providers. It is the
basis of quality and health care development. Factors that increase the complexity of
patient care include multiple chronic or acute physical health problems, the social
vulnerability of the patient, and a large number of providers and settings involved in a
patient’s care.21 The collection and interpretation of patient information from patients
can guide in clinical care. HIS has the potential to improve the health of individuals and
the performance of providers, yielding improved quality, cost savings, and greater
engagement by patients in their own health care.22 Clinical guidelines embedded in the
HIS promote consistent use of evidence-based care, and automated systems help to catch
and prevent errors. The HIS automatically performs numerous tasks done by hospital
staff, enabling them to reduce the number of employees or redirect them to other
responsibilities. The patient data collected are analysed or interpreted and diagnoses are
formulated as the indicators for the patient’s need for care.23 Medical errors may occur in
regard to incorrect diagnosis, wrong prescription of medication, inaccurate interpretation
of laboratory results and incorrect information generated from medical equipment. By
having HIS/RIS such errors can be minimized. Use of the HIS/RIS has been encouraged
by Quality Improvement (QI) program which provides regular reports on selected quality
indicators included on the health maintenance list.24 The successful implementation of
HIS/RIS can be evaluated by the dimension of quality, utilization and satisfaction.

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Adverse events in hospitalized patients increase patient morbidity and mortality and are
costly to individuals, hospitals, and society can be effectively observed by EMR.25
Implementation of HIS itself is not patient-centered unless it strengthens the patient-
clinician relationship, promotes communication about things that matter, helps patients
know more about their health, and facilitates their involvement in their own care. HMIS
is a framework that would improve the collection of timely reliable data at all levels in
the system. HIPAA Privacy Rule created the first national standard to protect personal
health information and medical records. HIS is developed in such a manner to secure
patient database and business information. Hospital Information System addresses the
entire major functional areas of modern multi-specialty hospitals. HIS implementation
process is categorized into planning, design, implementation and operation.26 Evidence-
based design and incorporating it into hospital best practices is expected to reduce
medical waste, improve quality outcomes, reduce medical errors, and improve patient
and employee satisfaction while instilling a culture of safety.27 The design and use of
various HIS reports containing information on inpatient utilization and costs, physician
office visits and physician practice patterns, physician productivity, physician referral
patterns and costs, and the health problems of members are presented. HIS activities
include Patient registration, appointment scheduling, billing, order entry, recording vitals
and doctor’s prescription. The integration of electronic patient data records with RIS is
the only way today to provide high-quality clinical services.28 It constitutes the
permanent documentation of patient health, permitting the medical professional to
evaluate symptoms and signs within a broader temporal perspective, contributing to
improvements in making diagnoses and providing treatment.29 This information can be
used in statistical surveys, help with the analysis of procedures, be applied to
preventative medicine, and be utilized for the control of hospital infections. Apart from
the above benefits, clinical and nursing audits can be performed easily by considering
hospital information system. The importance of HIS is to reduce patient waiting time,
billing and dispatching of medicines from pharmacy, easy appointment scheduling and
easy access of statistical data to middle and top level management. It provides online
data on patient statistics, doctor performance and financial data. It also improves patient
care, cost control and security of data. It also helps in streamlining operations, enhanced
administration and control, improved responses, cost control and improved profitability.
Integration of HIS and the radiology information system (RIS) into department workflow
have done much to increase departmental efficiency.30 Embedding RIS and other
imaging systems into the HIS, which should improve the accuracy and efficiency of
patient management while increasing clinician and patient satisfaction via collaboration
and information sharing. Reports are usually stored in the Electronic Patient/Medical
Record (EPR or EMR) of the Hospital Information System (HIS), and particularly in the
Radiology Information System (RIS), which is designed to store, manipulate, and
retrieve information for planning, organizing, directing, and controlling administrative
activities associated with the provision and utilization of radiology services and facilities.
High quality services can only be provided, however, if EPR data is integrated with the
digital images in PACS. Requesting physicians can enter orders directly into the RIS
through an HL-7 HIS via secure Web communications reducing entry tasks and
possibilities for error. It all adds up to a more efficient workflow for the radiology unit
and better service to referring physicians, as well as expanded marketing options. PACS
Fundamentally changed the relationship of radiology to the enterprise, as immediate
availability of images to the enterprise was considered a capability as important as
Distribution of the radiologist’s interpretation. HIS/RIS are expected to improve the
accuracy of patient care information recorded in health records, support clinical decision-
making, and improve accessibility of patients' healthcare information for continuity of
care over space and time.28 HIS have enhanced efficiency by alerting clinicians to

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duplicate orders, enabling faster prescribing and other orders, and reducing transcription,
medical records, and claims expenses. HIS is a massive, integrated system that supports
the comprehensive information requirements of hospitals, including patient, clinical,
ancillary and financial management. HIS/RIS has emerged to improve quality of
healthcare delivery. Hospitals enterprises wield HIS/RIS to provide strategic, connected
information to reduce costs, improve Patient care and increase service levels to their
customers.31 HIS have enhanced efficiency by alerting clinicians to duplicate orders,
enabling faster prescribing and other orders, and reducing transcription, medical records,
and claims expenses. Complete patient record can be stored and retrieved at any point of
time. Links to the fledgling hospital Information systems were also being made
beginning with the computer system that handled admissions, discharges, and transfers
(ADT) so that patient demographic data could be readily accessed.32 The main objectives
of HIS/RIS are to improve patient safety, support effective and efficient health care
delivery and facilitate management of chronic conditions.33 Patient satisfaction is
increasingly the focus of research and evaluation of health care interventions and is
identified as an important quality outcome indicator of health care in the hospital setting.
34

Role of RIS in Radiology Department

There is an increasing interest in use of information and communication technologies to
support health services In health care, patient privacy concerns is important that any
unauthorized individuals should not have any access of clinical records. Nursing staff are
the first pioneers to develop application content that reflects valid hospital staff roles and
to communicate to each practitioner the standards of practice which will guide in
planning and delivery of quality nursing care.35

Hospital Information System / Radiology Information System and its

Efficiency
To promote HIS implementation and optimization process, planning and modifications
are continuously updated to address technological, professional, and organizational
perspectives.36 Electronic medical records help healthcare professionals to see
uncertainties and risks in health care and make possible to solve complex problems. The
fast-growing, tremendous amount of data collected and stored in large and numerous
data repositories has far exceeded human ability for comprehension without powerful
tools Electronic health records, decision support systems, mobile applications,
telemedicine, e-medicine and electronic prescription are just some examples but the list
is much longer.37 Several key indicators for hospital performance are developed has a
benchmark for comparison including reduction in hospital length of stays, reduction in
in-hospital deaths, reduction in or prevention of an increase in the cost of healthcare, and
optimization of the rates of admittance in emergency departments/other hospitals/long
term care.38 Such key indicators can be obtained from hospital information system and
radiology information system. Patient’s access to online health information leads to
increase of its accessibility and credibility. The health care data management systems
provide lifelong records, such as EHR, the electronic part of the health-related
information about a patient includes diagnoses, medications, allergies, lab test results,
and prescription renewals, which can be extracted from multiple sources.39 Optimizing
and experiencing the usage of HIS/RIS improves physician experiences. The tremendous
progress achieved in health care sector, it is an area of never ending experiments which
initially began with controlling mortality and now extends up to improvement in quality
of life. HIS/ RIS can improve the speed and ascertainment completeness of reporting and
also can affect the surveillance work flow and work load.40 Sometimes health records

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provide information that can reduce costs and inconvenience of repeating routine
medical tests. Communication systems interface with EHR, patient monitors, and critical
systems are empowering caregivers to be more productive and effective in the healthcare
setting. Challenges for radiology health informatics include refining the systems and user
interfaces, adhering to privacy regulations, and strengthening collaborative relations
among stakeholders, including radiologists and public health officials.41 As the
information age progresses, patients become more health literate and health professionals
will have to ensure they can provide advice as to how their patients can find reliable web
sites among the many misleading and biased sites on the Internet. There is evidence to
support information technology to primary health care in India is cost effective and
ensure accountability of the services and helps in behavior change of the beneficiaries.
The focus of health informatics is the application of electronics health records and
HIS/RIS in clinical care, it uses various other applications to assist with health care
process. Patient peers and health care providers are the expected information users;
however also provide opportunities for policy makers, insurers and health-related
businesses to gather information about patient experience. With the progress of
technology over the last two decades and the diffusion of informatics into the healthcare
field, the role of the physicians to adopt the technology has changed dramatically.42
Healthcare apps and other e-health application tools typically target health promotion,
disease prevention, and informal management of symptoms or problems. Hence, we can
fully accept the beneficiaries from new knowledge about health care and from new and
efficient methods of information technology in healthcare. The healthcare system
involves the flow of patients among service delivery areas. The addition of information
system has confounded the issue of inadequate provider documentation by mandating
providers to adopt complex and time-consuming methods to perform documentation in
healthcare.43
Centralized and distributed databases introduce the possibility to access large volumes of
patient information in a short period.44 The bioinformatics algorithm, analytical methods
in assessment to relationship is the major research directions in health information
analysis. PACS is a distinct and aggressive clinical diagnostic entity which facilitates the
storage and acquisition of large quantities of diverse radiology information, and maintain
the ability to grow in size and diversity. Patient-level, provider-level, system-level,
geographic and cross-sectional data are needed for a wide range of purposes.45 The
challenge for HIS/RIS is to design systems that are powerful enough to handle the
volume of information and the complexity of medical data, but also to support both
patients and professionals in doing their work. Clinical informaticians utilize their
clinical expertise and knowledge of patient care, operational processes, and information
systems to participate in the design, specification, implementation, and evaluation of an
EHR system. It appears that informatics community is a virtual health care database, a
national health care knowledge base, and personal clinical health records would make a
better health system. Health Informatics is a combination of information science and
computer science within the realm of healthcare. Healthcare information systems are
critically acclaimed for their ability to increase legibility, reduce medical errors, shrink
costs and boost the quality of healthcare.46 HITECH (The Health Information
Technology for Economic and Clinical Health Act) act strengthens protections of health
care information. Primary care unit enable the performance of electronic medical
records, and improve the management of the institution.47 Healthcare information
technology had minor role in clinical governance and health care organizations are
improving standardized data sets, reporting forms, and mechanisms for data analysis.
Patient satisfaction and patient outcomes is particularly important to hospital
management. Healthcare organizations intend to prevent and cure disease and to serve
patients with a high quality of care. The Total Quality Management puts them in center

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of all efforts of an organization or an enterprise the level of satisfaction of the customer/

beneficiary satisfaction. The HIS/RIS is strategically placed to manage information
within the public healthcare to unify the fragmented healthcare systems.48

Conclusion
Quality healthcare is the most prominent concern for the patients. Patient might not
judge clinical judgment of physicians hence judge the quality of services provided by
hospitals. Patient satisfaction can be evaluated and identify the opportunities for
improvement in care, reducing costs, monitoring and performance of health plan.
Hospital information system (HIS) and Radiology information system (RIS) is widely
used in many healthcare organizations to improve efficiency and effectiveness of patient
care. HIS stores, manages and captures information related to heath activities of patients
and statistical data of healthcare organizations. Such information is secured as per
HIPAA privacy rule which establishes law related to secure healthcare information. HIS
reduces the burden of day to day operations and streamlines the process flow in hospital
which improves the patient care. RIS is software used by radiologist in a radiology
department to improve the quality of radiology reporting and secures the diagnostic
details of patients over years. It also ensures smooth work flow in a radiology
department and improves quality of reporting. HIS and RIS integration optimizes patient
waiting time and improves patient’s satisfaction. The HIS and RIS communicates
through HL-7 which sets international standards for communication of clinical data of
HIS/RIS.

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Figure 1: Role of HIS and RIS in patient care.

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