Do We Need to Certify PACS Administrators?

Widespread deployment of new technologies often creates jobs that must accommodate quick growth and new tasks; jobs which must integrate rapid advances and frequent changes in responsibility on a routine basis. These positions are frequently multidisciplinary in nature, often defined ambiguously or at least specified inconsistently. Such new roles are not supported widely by continuing education, and sometimes give rise to concerns about performance proficiency and professional qualification.

The position of PACS System Administrator (PSA) has evolved in response to the volume and breadth of tasks associated with the installation and running of a PACS, even in the relatively smaller and less complex facility settings to which the technology is currently migrating in ever-increasing numbers. Not only are the functions of a PSA varied from setting to setting, but effective performance may require certain knowledge exclusive to one clinical sector vs. another (e.g. radiology or orthopedics, vs. cardiology).

Emerging, multidisciplinary functions are never initially incorporated in academically based, structured educational pathways leading to degrees, or even to certificate awards. Validated, competency based continuing education is not feasible when functional analysis of the occupational role has not been conducted.

These limitations notwithstanding, the need for both continuing education and some evolving form of professional qualification is as needed for the PSA as it was decades ago for other, now-established allied health practitioners, such as radiographers or nurses. IT professionals, a group from which many PSAs originate, are very familiar with certification processes that support in bits, and successive content trainings and evaluations, their constantly-changing knowledge and expertise requirements. In addition, there is no lack of preparatory training and review workshops to support those credentialing processes.

How can those IT professionals in PACS management, or PSAs with a clinical background - often radiographers, CT or MRI technologists and sonographers - satisfy their continuing education needs, or demonstrate proficiency and accomplishment to employers for purposes of advancement or general performance assessment?


The state of things

Years ago, Stuart Gardner initiated one of the first training programs for PSAs. Since then, numerous other workshops and short courses have been created, meeting with varying degrees of success. The content of early programs was based on the real-world expertise of (primarily) PACS consultants and other industry players who routinely witnessed the management requirements that facilities faced following system deployment.

Consistent with the varied nature of the facilities themselves, the relatively gradual stabilization, and standardization of PACS features and capabilities, and the relative lack of consistency in position descriptions and functionality, all programs then, and now, are a best guess at what a PSA needs to know to perform effectively.

The lack to date of a job analysis - and therefore no universally accepted role specification - compromises the design of course content. Many believe that it is difficult for the IT professional to have sufficient understanding of radiology and its various modalities, and for the clinical professional to master adequately the IT concepts required to manage technical issues or communicate with computer and digital imaging specialists. Whilst not always true, disparity in background and preparation usually results in courses being effective for only part of the program, and for only a subset of the participants. One or the other group is compromised by the necessity to accommodate any and all backgrounds. This is the usual bain of continuing education - not very often is it structured with prerequisite requirements, or for successive learning experiences as are traditional degree programs.


The participation of manufacturers

Effectively all PACS vendors offer new-user training in one form or another, of varying duration. It may be in-house and/or on-site at the customer facility. In the current climate of increased expenses, narrowing margins, and overall cost consciousness, these efforts focus on system-specific knowledge. There is neither the time nor the motivation to address the more fundamental, core knowledge. Ironically, these constraints can preclude the effective translation of system operating principles into optimization of PACS performance and trouble-free use of the system. Other outcomes can include increased cost of post-installation customer support, marginalization of service revenues, and compromised effectiveness of application specialists' visits.


Solutions in the worksâ?¦

Already there are colleges developing tracks, or post-graduate specializations in PACS administration. There also are embryonic attempts at credentialing, albeit prematurely launched without the rigor or established conventions for exam development, administration, and security accepted by either the assessment industry, or expert testing organizations in the health professions (e.g. physician board exams, allied health registries, etc.). These efforts do suggest need, and an acknowledgement of the urgency for more formal educational efforts and standardized performance evaluation mechanisms.

Some already conjecture that the next generation of PSAs will be graduates of formal degree programs - associate or even baccalaureate level. And perhaps their salaries will be determined by proficiency as demonstrated by credentialing - rigorously developed certifications, administered by recognized and/or academically based professional organizations and licensing agents.

Few would argue that competency-based curricula of appropriate length, and mechanisms that verify attainment of the requisite knowledge and skills to perform in the critical management role of the PSA, will ultimately improve the standard of patient care. We are observing early steps toward stabilizing and standardizing education and training, as well as toward the establishment of evaluation and credentialing mechanisms.


Solutions in the meantime

Getting continuing education right is never easy. Not that there are not models, each with their associated strengths and weaknesses - there are update, competence, and performance models. There are models that go by other names and classifications, but irrespective of which strategy one supports, there is an immediate need to accommodate one prevailing and major condition. Associated with every existing PACS installation is one, or two, or more individuals - sometimes called PSAs or PACS managers, sometimes teams of individuals across which is distributed the functional role - all in urgent need of education and training solutions. Today, these training opportunities for these many individuals exist only sporadically at best. Currently available training is not necessarily based on principles of content development that are well established and routinely applied in, for example, allied health professional improvement. Moreover, this volume of need doesn't even account for the migration of PACS technology into the very numerous imaging centers, orthopedic environments, and other than radiology settings and clinical applications that we are currently witnessing.

By creating sequenced learning offerings and by objectively qualifying registrants according to formal educational background, experience, and other prerequisite characteristics, targeted attendees can participate over time in content-tiered programs. If these programs are coupled with pre- and post-course testing mechanisms, and web-based examinations following extended, before- and after-course self-study regimens, the accumulated measurement of an individual's proficiencies will be far more than PSAs, employers, and institutions have available now.

Such approaches are now being launched, or are in development. They represent only interim solutions, but can be accessed by PSAs considering formal, supplemental or advanced training. These newer educational offerings also can be utilized by the corporate sector seeking staff development options. Ultimately though, the profession of PACS administration can anticipate the proper and rigorous development of credentialing mechanisms, and another generation of PSAs who may be the graduates of specialization tracks or degree programs.

In the meantime, newly available training programs, and schools of PACS administration, can provide practicing, on-the-job trained professionals a better range of program offerings and meaningful measurement (examination batteries) that validly test knowledge and achievement. Those PSA professionals who wrestle daily with the issues and realities of making PACS work better for better patient care will have a little more to rely on for training, professional development, and some form of validation to employers and the practice community that they know what they're doing.
 

Len Avecilla is director, continuing medical education, at SG&A Consulting, Inc.



References and Readings

Bashook, Philip G.; Best Practices for Assessing Competence and Performance of the Behavioral Health Workforce, University of Illinois at Chicago College of Medicine, Chicago, IL (white paper).

Gardner, Stuart C.; PACS Administrator's Job Requires Patience and a Diverse Skill Set, PACS & IT, Diagnostic Imaging (supplement), 2002.

Leung, Wai-Ching; Competency Based Medical Training: Review, British Medical Journal, 325:696-696, 2002.

Redman, Richard W.; Lenburg, Carrie B.; Walker, Patricia Hinton; Competency Assessment: Methods for Development and Implementation in Nursing Education, Online Journal of Issues in Nursing, http://www.nursingworld.org/ojin/topic10/tpc10_3.htm, 1999.

Shook, G.L.; Neisworth, J.; Ensuring Appropriate Qualifications for Applied Behavior Analyst Professionals: The Behavior Analyst Certification Board, Exceptionality, 13(1), 3-10, 2005.

Wang, Ning; Schnipke, Deborah; Witt, Elizabeth A., Use of Knowledge, Skill, and Ability Statements in Developing Licensure and Certification Examinations, Educational Measurement: Issues and Practice, Spring 2005.