Medical imaging informatics professionals: How do you advance?

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Medical imaging informatics is evolving as rapidly as medical imaging datasets are growing. Healthcare institutions on the coat-tails of their PACS installations, as well as gearing up for second- or third-generation installs, are relying heavily – if not solely – on the knowledge and skill sets of their IT support staff to keep their PACS and their networks running efficiently, securely and reliably day and night.

Defining the roles of the individuals involved in radiology’s imaging informatics world has been a recurring theme at this year’s Society for Imaging Informatics in Medicine (SIIM, formerly SCAR) show in Austin, Texas, and speakers shared their insight and knowledge on the topic during one of yesterday’s educational sessions titled What’s My Job?

PACS Administrator

As the nighthawk PACS administrator at Imaging Medical Group in Irvine, Calif., Munish Goel says night time can be a problematic time for IT professionals.  
However, PACS administrators who work during the day or at night have universal duties and responsibilities that essentially encompass various roles, including network, workflow and PACS administrator. As network administrators, Goel pointed to tasks involving monitoring network feasibility, setting up the VPNs and establishing routing.
PACS administrators also are workflow managers. “From a business administration standpoint, we have to figure out the proper workflow for the transmission of images, set up protocols for sending the requisitions and images, train people at various facilities to send images and define the lifecycle for a study from the time the study is received until the report is sent and signed by the radiologist,” Goel said.

PACS administrator duties include setting up the modalities to forward images to a DICOM destination, creating or modifying DICOM tags so images can be identified, setting up proper transfer syntax to foster uploads and downloads and check the image quality for diagnostic reading purposes. “Since we use image compression, we want to make sure that we do not lose any diagnostic quality of the image,” Goel explained.

Key issues for PACS administrators who tend to occur at night include: slow image retrieval and upload, lost network connectivity, the DICOM receiver stops responding, reports that do not make it to the hospital and most commonly – studies that are missing images, Goel said.

How can a PACS administrator mitigate the challenges of being a PACS administrator? “Provision proper hardware and software at the hospital, provision proper resources in place before getting contracts, preserve digital driving levels of the images, test workstations calibration prior to fielding and thereafter and use some level of compression,” Goel advised.

In terms of what he likes most about his job, Goel explained that PACS administrators are constantly learning and changing. “The only thing that I don’t like about my job is that you don’t know what you don’t know,” he stated.

How can PACS improve? “I would like to see real time dashboards that PACS Administrators can use to judge the productivity of our radiologists and we are yet to see truly integrated PACS,” Goel said. “We are still lacking in that sort of integration and I know some efforts such as Integrating the Healthcare Enterprise (IHE) are developing standards.”

Application Service Provider

“The term  PACS administrator does not describe what the job entails,” said Lance Ford, PACS administrator for application service provider (ASP) company, Arkansas Medical Imaging of Little Rock. “You are going to find yourself in a highly technical world where you have to know the workings of different systems and explain these workings to various individuals.”
An ASP-configured company is a third-party entity that manages and distributes software-based services and systems to customers across a wide area network (WAN) form a central data server. ASPs are a way for institutions to outsource some or almost all aspects of their IT needs, Ford said, and PACS administration in an ASP environment brings in a unique set of problems to work through.
The biggest advantage to an ASP model is cost, said Ford. “In terms of disadvantages, the client must accept that application as provided and integration with other client’s systems may be problematic,” he explained.
An important component to successful PACS administrating is linguistics. “Linguistics is the scientific study of human language,” said Ford. “You must communicate effectively.” The phrase “the network is down,” could imply a number of things, explained Ford, such as the server is down, the internet is down or the local machine is locked up. PACS administrators must be specific in the language they use to communicate problems and situations or when making requests.
Ford added that PACS administrators must define and know exactly who the customer is. “If you don’t fix the customer, the fact that you fixed the problem will be irrelevant,” said Ford. “If you fix the customers, you fix the problem. And the real customer is the patient.”

Finally, Ford emphasized that PACS administrators must keep up-to-date with what’s new on the market. “You must learn about all different systems, know about routing, computers and the laws regarding healthcare,” Ford explained. “It’s your job to know which systems will accomplish your company’s goals.”

Who else in the healthcare organization will keep afloat with the continual advancements made to PACS, RIS, HIS, DICOM, and HL7, to only name a few?

Radiology Administration

“I am going to talk to you today about radiology administration, insight, perspective and opinion based on my experiences,” said David Fox, CRA, director of radiology, Baptist Health – Little Rock, to audience members.
According to Fox, radiology administrators are responsible for the following list of duties, and probably more:
  • Day-to-day operation
  • Fiscal management
  • Project management
  • Human resource management
  • Communication resources
  • Professional development
  • Marketing
  • Strategic planning
  • Imaging informatics
Fox went on to explain the latter responsibilities in detail. In terms of communication resources, radiology administrators need to know who to rely on for informatics-related issues in the radiology department, such as the CIO, PACS/RIS administrators and IT support. “You must call on them before the problem occurs and when the call comes from administration,” said Fox. “And in order to get things done, you must trust in the abilities of the people you have working for you.”

In terms of strategic planning, Fox said radiology administrators must always plan ahead because it establishes goals and benchmarks for your organization. “In addition, you must build a great support team, involve the team in everyday decisions and nurture the team – provide positive encouragement,” said Fox. “If I am negative, do you think my team well be positive? In addition, you also must listen, perform a look back and make adjustments accordingly.”

Finally, Fox explained the imaging informatics spectrum of radiology administrating, making note that the following are all crucial areas for a radiology administrator when it comes to IT:
  • Modalities are all computer driven
  • Rely on imaging informatics personnel who know informatics and the language, such as DICOM and Hl7
  • Network and programming
  • PACS/UPS – now that you rely solely on computers, a continuous and reliable power supply is critical  
  • Productivity, benchmarking and utilization
  • Financial reimbursement – since radiology is a profit center, radiology administrators must ensure that it remains that way
“Radiology administration is work, but rewarding with the right team,” concluded Fox.