Kelly Murphy has been the PACS administrator at Baylor Medical Center at Garland (Tex.) since the hospital installed its GE Centricity PACS in November 2001. Murphy, in conjunction with a host of vendor and professional partners, has truly charted a PACS success story. This month, Health Imaging & IT tracked Murphy to find out just what a day in the life of PACS administrator entails.
EARLY TO RISE
Murphy's day begins early. The former nuclear medicine technologist arrives at the hospital before 7:30 a.m. and starts the day by logging onto the RIS email to check for any problems that occurred during the night or weekend shifts. He spends 15 minutes responding to and repairing PACS users' issues.
"Most days I don't have to spend a lot of time on these early morning problems like exam and patient merges, workstation lockups, peripheral device malfunctions, damaged CR cassettes and error messages because I have a great weekend supervisor and a good night staff," Murphy explains.
At 8:00am, Murphy is entrenched in the PACS database and completely focused on ferreting out errors. Before long, the phone rings. It's a radiologist with an error message in the workflow cycle. Murphy leaves his office to meet with the radiologist and attempt to repeat and solve the error message. Today is a good day. A member of the hospital IT team is able to join Murphy, and the pair duplicates and resolves the error in about an hour and a half. Some days Murphy spends the majority of the day trying to reproduce an intermittent error, without success. Often the errors are linked to corrupt hanging protocols.
At 9:45am, Murphy returns to the database to work on a troublesome CT exam. After some QA checks and a couple of phone calls, Murphy discovers a CT technologist placed images on the wrong radiology order. He spends the next hour working with the RIS manager to generate a new order, credit the incorrect charges and merge the images into the good order.
Murphy is quick to point out that a successful PACS cannot rely on a single individual; some PACS fixes must come from outside the local PACS team. Murphy draws from the experience and expertise of a variety of sources, including the modality and PACS vendors' field support teams. Murphy also scans PACS users websites, such as ClubPACS or Aunt Minnie's bulletin boards and a variety of online PACS user groups, for additional insight into a particular issue. "PACS administrators are a pretty sympathetic bunch," Murphy says. "They're usually willing to help a fellow PACS admin, especially when they've gone through a similar scenario."
It's Wednesday, Murphy's weekly QA day. Before turning to weekly tasks, Murphy strolls down to radiology to put out yet another fire. This call is a quick one; he checks in with a technologist who called about a black box artifact on an image. Murphy resolves the problem by making a cursor configuration change on the workstation that was recommended in the PACS vendor's most recent software release notes.
Murphy confesses, "I have remote access to the entire system from my office, and I could troubleshoot 90 to 95 percent of the problems from my desk. I find it really helpful to listen to and talk with users live; I can get so much more information from a conversation than I can from an email or voicemail. This helps me fix the problems and gives our users confidence that there is someone here to listen to them and take care of problems."
Murphy almost always takes the time to meet with the user if there is an image display issue so he can see what the user sees. Generally, a reboot of the workstation solves the problem, but the user may not report the next problem if he reboots the PC remotely. Murphy sums, "I need to know all of the issues for trending and reporting purposes. I want users to call me about PACS issues."
Murphy trots back to his desk, checks email and finds that he needs to investigate an error message in the Archive Retrieval queue before he can jump into QA. A radiologist has a comparison study stuck in transition from the long-term archive to the short-term, online archive. He logs a call into the PACS vendor's online support center. Within 45 minutes, the exam is back online and ready for the radiologist.
Murphy comes to a good stopping point on the weekly QA with a few minutes to spare before the next meeting. He browses through a couple of PACS and IT journals looking for innovative ideas to improve workflow or troubleshooting. "I'm always looking for new technologies that can be used to improve the system," he explains. Sometimes, these solutions come from journal articles. Currently, he's investigating a unique PACS storage solution to reduce the user's dependence on the long-term archive.
In other cases, an IT colleague will come to Murphy's rescue. For example, all of Baylor's PACS workstations are programmed to log out after 15 minutes of inactivity. This meets HIPAA requirements and works well throughout the enterprise-with the exception of surgery, where the workstations need to remain up and running throughout long procedures. Murphy's first low-tech solution was to purchase kitchen egg timers to remind nurses to click the mouse every 12 minutes; however, the beeping didn't sit too well with clinical staff. By discussing the issue with a visitor from another site, Murphy learned that a simple computer script could solve the problem. The IT guru wrote a script for the Baylor OR. The new script is a dramatic improvement over the egg timer; it keeps OR users logged onto the PACS workstation until they log out of the system.
After a quick lunch and a PACS marketing meeting, Murphy dives into QA again. His weekly QA processes consist of a variety of exam status, RIS error, archive error and Sybase login checks. He begins with STS (short-term storage) analysis, checking on exams that are ready to be archived, dictated and verified, making sure that exams aren't piling up. If a value exceeds its watermark, Murphy logs a call to the PACS online support center. Even if he repairs the problem himself, the call helps the PACS vendor identify and document errors on the system. Next, Murphy completes a RIS error analysis, analyzing RIS exams that aren't recognized by PACS. Often these errors are human, rather than technical, glitches. For example, the RIS manager may build a new radiology procedure but forget to provide Murphy with the new exam information for his build in PACS.
During the RIS error analysis, Murphy is once again called away to troubleshoot a malfunction on a peripheral device. A technologist, after following the PACS Resource Manual to clear a workstation lockup, stares at a blank monitor. After a short discussion with the technologist, Murphy realizes the instructions he produced left out the last step of the reboot process - press the button on the front of the PC to power up the PACS workstation.
The day is winding down, but Murphy decides to tackle one more item on the QA agenda - the reject analysis log. He reviews trends on images rejected by technologists on the PACS. Murphy explains, "I'm looking for teaching and training opportunities. If I notice a particular exam frequently has rejected images, I investigate to find out why. It may be a change in the modality's workflow or a new technologist not familiar with department practices. Our goal for technologists is for them to perform the bulk of their QA prior to sending images to PACS. We only want to see good data on the PACS side."
By 5:00pm, the PACS administrator is ready to go home, well aware that his plate will be equally full tomorrow.
THE ADMIN'S TO-DO LIST
One day is just a taste of the PACS administrator routine, but there are many other duties on the job description. Murphy says, "There are as many PACS administrator job descriptions as there are PACS administrators. The job descriptions are based on the abilities of the individual administrator as well as those in other positions [such as the RIS manager] at the facility. Regardless of what's in the job description, there's definitely enough to keep you busy."
Every day, Murphy's primary duty is to respond to calls from users, which can cover everything from a missing password to damaged CR cassettes. On a weekly basis Murphy also handles CR QA, completes a full database backup on the core system and oversees Sybase log-ins, insuring that users aren't logged in on multiple workstations, tying up licenses unnecessarily.
Murphy also squeezes PACS workflow assessment into the routine, pinpointing and remedying slowdowns. For example, during an early workflow assessment, Murphy realized techs had to cross a busy patient corridor to move from the RIS to the PACS. The first solution was a simple equipment relocation, putting both workstations in a single location. Later, the department added RIS on all technologist workstations.
Murphy's latest workflow challenge comes on the paperless front; Murphy is working with the PACS vendor and a consultant to determine how to eliminate paper in the radiology department.
Other initiatives for Murphy include installing PACS workstations at radiologists' homes and assisting with the PACS implementation at another Baylor site. After three years in the position, Murphy readily confirms that no two days are the same and adds that every day brings new challenges and solutions.