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For other articles and previous issues click here. August 8, 2005 Hybrid
Profession — Neither Technologists Nor IT People Alone Make
the Ideal PACS Administrator Who makes a better PACS administrator: A person with an information technology (IT) background or someone with a clinical background? It’s a question that more hospitals and imaging centers are asking these days as they move from film-based to digital systems and PACS fundamentally changes their operations. Everyone agrees that the selection of an administrator is a critical step in the facility’s successful PACS implementation. Yet many facilities have trouble defining exactly what it is they want their PACS administrator to do. Hybrid Profession The debate over the most advantageous background for the PACS administrator is heating up as the technology advances and the imaging distribution, display, and storage systems can do more. “PACS administration is now a big enough industry and has been around long enough that it should be considered a profession,” says Nagy, who helped lead a one-day educational seminar for PACS administrators prior to the Society for Computer Applications in Radiology (SCAR) annual meeting in Orlando in early June. This was the third year the seminar was offered. When PACS emerged in the 1980s and 1990s in radiology
departments, most administrators were chosen from among the facility’s
radiologic technologists. After all, they knew the department’s
workflow and what a digital system needed to accomplish. When a radiologist stood up at the SCAR meeting and suggested that PACS administrators need to come from an IT background, he was booed. Even Split Because of the way the PACS administrator profession emerged, it does not have a universal skill set or job description. To fill that void, SCAR has formed a committee to develop a certification program for PACS administrators, which will, in the process, better define the skills and knowledge PACS administrators need. SCAR hosted an organizational and information-gathering forum at its recent annual meeting. During the forum, the core skill sets required for a PACS administrator were discussed, a first step in the development of a SCAR certification program. “We probably will have the certification program ready to run in about a year,” says George H. Bowers, MBA, FHIMSS, principal of Health Care Information Consultants LLC in Baltimore. Bowers is serving on the committee with Nagy and SCAR Chair J. Anthony Seibert, PhD, of the University of California, Davis. Nearly 100 professionals, including PACS administrators, vendors, physicians, and educators, have volunteered to assist the committee in developing the certification. Bowers believes developing a PACS administration certification is an appropriate role for SCAR because it is known as the preeminent organization for imaging informatics. “These are exciting times in PACS administration,” Bowers says. The imaging community seems to welcome SCAR’s taking a leading role in this issue because it knows “if SCAR does it, it will accurately reflect the body of knowledge that the majority believes a PACS administrator needs to know,” Bowers says. “I think there is enough need now that the community is willing to accept it.” Many believe the background question for PACS administrators is not an either-or proposition. The ideal PACS administrator is actually a team that includes people from radiology and IT, Nagy says. “You really need to build a multidisciplinary team because I don’t believe this is a one-person job.” New Job Title? Socia has four PACS administrators on his team, which he agrees is ideal. Three have an IT background and Socia, who is the leader, has an RT background. Before becoming a PACS administrator, he was a radiographer for nearly 13 years at Baptist Memorial Medical Center, a 120-bed acute care facility in North Little Rock, Ark. Each member brings a different and needed perspective to the work, he says. The IT people look at the issues that arise from a technical perspective while he has a more clinical view. However, Socia doesn’t believe he could do what he does without his training as an RT. He cites a recent example of how his RT training was critical: One physician using his company’s PACS reads exams for 12 different sites, which are listed alphabetically when he logs onto the system. The site he reads for most often begins with the letter “R” and so he has to scroll down to the bottom of the list to find it. Believing he was wasting valuable time scrolling, the physician asked the IT people what he could do to continue to have access to the dozen sites but have his primary site at the top of his list. “The IT person on my staff came to me and said that he needed to basically change the alphabet so the doctor would be happy,” Socia says. Socia recognized that to an IT person the physician’s request may seem arrogant. “To an IT person, alphabetical order makes perfect sense, and [it seems like] the physician is only refusing to admit that the alphabet starts with ‘A.’” Workflow Knowledge Socia explained the problem to the IT person, who came up with a solution: put a blank space before the name of the facility, which moved it to the top of the list. “Without my clinical knowledge, I wouldn’t have been able to effectively explain the issue to both the IT and physician to reach a common goal,” Socia says. James Barba, MA, RT(R), is a clinical assistant professor in the Department of Allied Health Sciences School of Medicine at the University of North Carolina (UNC) at Chapel Hill. Previously, he had been the PACS administrator/educational coordinator for the radiology department at UNC Hospitals. He agrees that every PACS team needs both RTs and IT personnel. However, he believes it is “a better fit” for the PACS administrator to be an RT for several reasons. Technologists work very closely with information and computer systems as part of their day-to-day tasks, have a comprehensive understanding of radiology workflow from patient visit through billing, and, most importantly, understand the image quality aspects of imaging, he says. “It’s a more efficient process for a registered technologist to learn the basics of PACS and digital’s impact on network traffic, network speed, sizes of files, and so forth,” Barba says. “It is a much steeper learning curve to provide an information technology person with the skill set to evaluate diagnostic images.” Besides the obvious image issues, Barba thinks RTs are also more sensitive to workflow issues that can arise in a filmless department. For example, he says, the RT will know which patients haven’t eaten since the night before and therefore need to come down first for imaging. That’s something an IT PACS person wouldn’t likely know or realize the significance of, he says. In situations where the PACS system is down, RTs are more acutely aware of the impact and can triage during the outage while maintaining dataflow and storage for return of a full function PACS system, he says. “While the IT people are busy bringing the
network up, it’s the PACS person in the radiology department
that needs to know how to get the images off of the system so that
the radiologist can interpret them,” Barba says. “You
can’t say to the patient, ‘Our system for interpreting
your images is temporarily out of service.’” You Need Both Bowers also believes different organizations have different requirements for their PACS administrators. “For example,” he says, “if the organization has a really strong IT department, then the PACS administrator isn’t going to have to be as technical as if the organization had no IT support. The IT department will do some of the more technical functions … if it’s a very small hospital, without a strong IT department, then the PACS administrator may have to do a lot on the technical side.” Nagy believes regardless of their backgrounds, the best PACS administrators have stellar communications skills. “These guys have to be able to work with technologists, nurses, physicians, as well as chief information officers and chief executive officers, and to be able to do that successfully, they need to be really good communicators,” he says. Socia agrees that the biggest part of his job “is making sure all the physicians and employees of the hospitals are happy and understand and can communicate with the IT side of the work.” He also spends a large amount of his time talking to IT people and explaining what they need to know about radiology to do the job. Developing Certification The early PACS administrators knew how to operate the system from their vendor, but their skills weren’t necessarily transferable to another site or hospital, Nagy says. “The job they did was very specific to their vendor.” In today’s world, patients move around a great deal and they need to be able to take their images with them. “When images were recorded on film, they were transferable from location to location, and other than environmental issues such as extreme heat, the quality of the image was permanent,” Barba says. “In a PACS environment, we need systems and personnel that can emulate that ease of transferability.” If PACS administrators and their systems truly spoke a common language, transferring images taken at one site to another would never be an issue, Barba says. “There must be a universality associated with imaging because those images facilitate the diagnosis or treatment of a patient. We must keep our patient focus when discussing these issues,” Barba says. Socia notes that nursing has already developed a master’s level informatics degree. “It is up to the industry leaders in radiology to define the skill set required to be an effective imaging informatics professional.” — Beth W. Orenstein of Northampton, Pa., is a freelance writer and regular contributor to Radiology Today. |
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