The Quest for the Ideal PACS Administrator

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Herman OosterwijkThe PACS System Administrator (SA) profession is still relatively young. There are many questions about the skill set, experience, and background that are required for the ideal candidate for this job. To determine what the particular background, environment, and experiences are, as well as the need for training and certification, one can simply poll current PACS SAs, which is what we did.

There will be requirements for a PACS SA in the future that are driven by new technologies as well as by the additional domains and specialties that PACS may be responsible for such as mammography, endoscopy, eye care, and so on that are not obvious today. That being said, data derived from current PACS SAs should provide a good starting point for what the core competencies should be. Therefore, we polled PACS professionals during our quarterly e-conferences and solicited feedback via our bi-weekly newsletter.


Institutional background



From my experience with PACS SA professionals, it appears that there are some differences between the competencies required when a SA supports a PACS at a major institution vs. someone who is the “PACS-guy” at a free-standing imaging clinic, orthopedic office, or small rural-based hospital. In many larger institutions, there is strong IT and network support for hardware and technical support, a biomedical department that might take care of monitor calibrations and new modality acceptance and installation, and possibly even a physicist who can assist when there are tricky image quality issues. In smaller institutions and free-standing clinics, the SA has to be much more of an all-round person and take care of these issues. Key for these professionals is the ability to acquire the skills to be able to support a broader area and, more importantly, to be able to develop broad networking skills with other professionals.

The institutional background of the population we polled is as follows:

  • 37 percent of the institutions reported more than 125,000 exams per year
  • 28 percent reported 75,000 to 125,000 exams annually
  • The remaining 35 percent of the institutions log 10,000 to 25,000 exams or  25,000 to 75,000 exams each year
  • 42 percent do not use a formal PACS planning process
  • 33 percent utilize some or complete outsourcing of their radiology reads (nighthawk services or contract radiologists)

PACS SA background



There have been animated and sometimes heated discussions about the ideal background of the PACS SA. Interestingly enough, the arguments heard are often self-serving, for example, an IT person would argue that one needs to have a strong IT background, and an RT would argue that a clinical background is more important. One should not forget that background is often less important than skills: An RT with sharp analytical skills can, with proper training, learn the IT skill set to become a very effective PACS SA. On the other hand, an IT person who takes great interest in the clinical workflow and is willing to learn the “lingo” also can be very effective. Obviously, one needs both IT and clinical skills to perform this job.

Another hot issue is the reporting structure, that is, should a PACS SA report to radiology or IT, and in either case have a dotted line to the other? In my experience, there seems to be a shift by which many SAs are being moved over to IT, something that seems to make sense as PACS is becoming more of an IT strategic tool and an enterprise-wide system. The number of professionals supporting the PACS also is often debated. It seems obvious that a single person is not sufficient, unless that person is some type of a superhero, i.e. never sick, does not need any vacation, always available 24/7, and is not in need of any training off-site. Two full-time persons are required; or as a minimum, one primary person with a second person trained as a back-up.

In our polls, we found that 46 percent of the audience had an IT background, and 38 percent had a clinical background. When asked what they thought would be most important, our audience's opinion was almost equally divided: 40 percent thought a clinical background is more important, while 37 percent found an IT background more desirable (23 percent had no preference). With regard to the reporting structure, 60 percent reported to radiology and 26 percent to IT, and the remainder reported to other departments. One person supports PACS in the majority of the cases (53 percent), which defies common sense. For 25 percent of the institutions, two full-time equivalent (FTE) employees support the PACS, in the remaining 22 percent of the facilities, there are more than two FTEs supporting the PACS.


System environment


One can get a good picture of current responsibilities by looking at the current environment, i.e. what systems are in place. If there is no cardiology integration in place, the support for these systems will not be part of the SA job. However, this might change in the very near future as these systems are being integrated in more institutions. The increasing integration of PACS with various other systems makes its support a complex set of tasks. Speech recognition is a good example. When speech is used as a stand-alone system, with its own computer and well-defined interface to the RIS, it could be supported by another department, such as IT. However, as these applications are integrated with an API to the desktop, it is almost impossible to have strict support boundaries. Also remember that for the user, it is, rightfully so, transparent as well. They will call support because the PACS is down, not knowing to distinguish whether it might be the speech, PACS, or RIS software causing the problem they experience with their workstation.

We found that about one third of the audience uses speech software, 32 percent of the respondents have integrated RIS/PACS, and 14 percent have their cardiology and PACS integrated. Cardiology, if not integrated, uses the PACS archive resources in only 16 percent of the facilities we surveyed, which is somewhat surprising, because that seems to be a no-brainer. Most institutions (68 percent) have some type of integration with the EMR.


Training, certification and the need for policies and procedures


Until very recently, the only method for a PACS SA to acquire the necessary skill set was through on the job training or vendor training. Based on feedback from several SAs, it appears that the vendor training has been improving gradually over the past few years; however, this is very product specific (“how to look at a log file of a device from vendor XYZ”). There are typically no fundamental background and skills taught in these courses (i.e. What does it mean when the log file states: DICOM SOP Class not supported?). The good news is that there are now several venues available in which to acquire these basic skills . In addition, there is a mechanism to get certified as a PACS SA, either via the PARCA  organization, which was established a year ago and already has about 500 members, or via the Society of Imaging Informatics in Medicine (SIIM, formerly SCAR) that is working on a similar certification, due at the end of 2007.

Well-trained professionals should be able to approach issues that might come up in a structured manner. This goes hand-in-hand with having a set of PACS policies and procedures in place, so that, for example, if the system goes down, every one knows how to deal with it and how to recover. As shown from the data, PACS policies and procedures  are still an area that requires a lot of attention.

Our polls showed that only 30 percent of the institutions have a complete set of PACS policies and procedures in place, 26 percent have none at all, and the policies at the remaining 44 percent were rudimentary. It might be questioned how complete these implemented policies indeed are because we found that a key policy, CR/DR reject analysis, was only present at 20 percent of the institutions.

Continuing education also is a requirement for the PACS SA. With regard to training needs, 50 percent of our respondents felt they needed additional IT training and 37 percent desired both clinical and IT training. Should this be conducted on or off-site? About half of our survey poll found a combination of face-to-face and computer-based training to be the most effective method to meet their educational needs. Certification is high on everyone’s list: this question was asked in several of our polls and each time received a 90 percent favorable response, with 83 percent of the audience stating they would consider becoming certified.

I am sure that the quest for the ideal PACS SA is far from over. As with any profession these days, one can be assured that everything you learn today will be obsolete in the next decade. I learned about vacuum tubes in school and had to program in assembly code, something that is foreign to many who are younger than I. However, at that time, this knowledge was very appropriate and needed. Today, the SA professional may not need assembly language skills, but they need to know how to look at a DICOM header to determine whether an Accession Number was sent or not, be able to modify the study description to facilitate the proper hanging protocol, look at an HL7 transaction to see if an Accession Number was sent, and understand the impact of a LUT to display or print a CR image correctly. One only has to follow any of the SA discussion groups to see how much need there is to for a better understanding of these types of issues. There is a good consensus on the background, skills, and environment of the PACS SA; however, the details are still subject to discussion and further refinement.
 


Herman Oosterwijk, MS, MBA, is president of Aubrey, Texas-based OTech Inc. He can be contacted via his company's web site at http://www.otechimg.com for any comments or questions.