Defining the PACS Administrator's Role in a Changing Environment

As the market for picture archiving and communications systems (PACS) expands, demand is increasing for skilled PACS administrators. A diverse background and wide-ranging expertise are key attributes to handling PACS duties successfully. But ask 10 different PACS administrators about the most important aspects of their job and you'll likely get 10 different answers.

Because PACS administration is a relatively new field, job descriptions, qualifications and training programs vary among healthcare organizations. So what exactly does a PACS administrator do, and what does it take to do it well? Read on.

JOB RESPONSIBILITIES

Early PACS administrators were seen as little more than technical support people who managed system problems. Things are different now, says Paul Nagy, Ph.D., director of the radiology informatics lab at the Medical College of Wisconsin and an advocate of standardizing the role of the PACS administrator. "What's really needed now is a strategic knowledge worker - not a firefighter," Nagy says.

Without a standard job description, job duties often are determined by a healthcare facility's budget and its PACS management needs.

Once a PACS is operational, an administrator's day-to-day responsibilities also change. The PACS Administrators duties include:

• PACS management, maintenance and troubleshooting
• End-user training
• Workflow management and redesign
• Physician relations
• Administration and integration
• Development of PACS policies and guidelines
• Vendor management
• Expanding the system to new customers and modalities
• Reading room design

If a healthcare facility or clinic is in the process of implementing a PACS, the job responsibilities also likely cover:

• The development of a strategic vision for the PACS
• Vendor selection, negotiation and management
• PACS steering committee development and participation
• Financial assessments and cost estimates
• Management of the project installation
• Intergration of employee training on the system

Lisa Gonsalves' work day is typical of many PACS administrators. In that position for Little Company of Mary Hospital in Torrance, Calif., she spends a great deal of time on PACS maintenance issues, such as daily system checks, handling customer support issues and training new physicians and staff. Gonsalves, who's been Little Co.'s PACS administrator for a year and a half, also coordinates large projects that include the remodeling of the facility's radiology reading room and an outpatient center PACS installation.

A common PACS installation practice is for the vendor to provide an on-site administrator during the first year of operation. Gonsalves manages PACS with another administrator who has been on contract from Little Co.'s PACS vendor (Philips Medical Systems) since the installation was completed nearly a year ago. Gonsalves credits the Philips administrator with helping to educate her on the IT and networking aspects of PACS management. With the first year of the installation nearly over, the Philips administrator is being replaced by a new hospital employee, with whom Gonsalves expects to equally split responsibilities.

Daren Burns, PACS administrator for the 471-bed St. Joseph Medical Center in Burbank, Calif., focuses less on daily maintenance than Gonsalves. Burns says that since implementing Stentor's iSite PACS in March, most of his time is spent in marketing and development. Daily maintenance has become the responsibility of the hospital-employed PACS coordinator. "I keep looking to develop the system outside of radiology," Burns says. "When I come in everyday, I want to make sure a new
clinical person or referring physician is exposed to it and gets [signed up]."

Currently, Burns is working to integrate St. Joseph's echocardiography and cardiac catheterization labs with the PACS. "If you pick the right system, you can transition others [to handle maintenance activities]," he explains. "We took our file room people and transitioned them. You don't need as many [full-time equivalents, or FTEs] and the ones who stay around become more involved in the PACS."

Burns says that getting the right PACS is critical. "Most PACS administrators put out fires all day, because their systems don't work," he says. "What this system allows you to do is to develop it instead of babysit."

The transition from film to digital has been relatively easy and was completed overnight, according to Burns. "The hardest thing about PACS is teaching the techs the new flow of information," he adds. "You need to teach them that the info flow is different now - but that's it."

Ultimately, Burns says, the change in information flow effects workflow as well. "[The radiologic technologists] need to understand that when they hand off the images now, it's not just the physician who sees it. It's the whole hospital," he adds.

CLINICAL & IT

Because of the wide range of job responsibilities, it can be difficult to find a PACS administrator who is completely capable in all areas. "Hospitals don't know what to look for and the combination of skills is unique. It's a hybrid position," says Nagy. "A person should have good IT skills with intimate knowledge of radiology."

For example, says Nagy, a PACS administrator with a clinical background might be a radiologic technologist with administrative experience who understands workflow and knows how to talk to radiology staff, but lacks an understanding of high-level technical issues and project management. Conversely, a PACS administrator with an IT background likely would have thorough knowledge of systems administration and technology issues without the understanding of departmental workflow, imaging technology capabilities and physician needs.

Nagy believes that the PACS administrator's role can be successfully treated as a two-person job. "You need to have a redundancy of skills, but at the same time you can have complementary skills," he says. A two-person PACS team makes it easier to cover all shifts, decreases the likelihood of job burnout and allows a hospital to have a full set of clinical and IT skills dedicated to PACS management. It also gives each person a sounding board and enables each to take a worry-free vacation.

PACS consultant Stuart Gardner of SG&A Consulting Inc. sees many of his clients using a two-person approach, but cautions that one of the people should be the lead. "You have to have a clear leader. The second [PACS administrator] should function as backup and support," Gardner says. "From the support standpoint, you need someone in case you're sick, but you should also have a complementary skill set."

Gardner, who adds that he is "not really an advocate of the team approach," says that although some of his clients have IT people in the "lead position," most often the leader is from the clinical side.

Facilities with smaller budgets may not be able to afford the team strategy, Nagy acknowledges. He suggests that a PACS administrator with either clinical or IT experience can be successful as long as he or she is willing to learn and marshal resources. "The only skill a PACS administrator can count on is the ability to learn," he says. "Be able to say that you don't know the answer, but build up a network of resources to find out the answers."

PERSONALITY TRAITS

The ability to manage multiple resources requires excellent communication skills. "The No. 1 skill for me is being a good politician," says Tony Shaner, PACS administrator at Memorial Hospital in Colorado Springs, Colo. "You really have to communicate well, because you work with a lot of different people, and you have to be able to communicate well with all of them."

Nagy says PACS administrators must be willing to take risks and treat mistakes as learning opportunities. With challenges such as the high cost of the technology, fear of change by hospital staff, new workflow procedures, and network glitches, PACS administrators have plenty of opportunities to make errors. "With only 10 percent PACS penetration, there's still risk involved," he says. "You shouldn't take on this project if you're risk-averse." [Editor's note: According to the market research firm Frost and Sullivan, nearly 15 percent of North American hospitals had installed PACS as of 2002. Other market estimates place that figure at up to 30 percent.]

Other important talents are good organizational and facilitation skills. "I have a general idea of what might work, and what I do is bounce ideas off people," says St. Joseph Medical Center's Burns. "I'm kind of like a hub with tons of spokes."

Certainly the PACS administrator must be able to operate well under stress, which can come from juggling multiple tasks and dealing with urgent technical troubleshooting if things go wrong. PACS administrators need to have thick skin, says Nagy. "In the PACS market, PACS equals fundamental change. It's the biggest change in radiology in 100 years," he says. "Change equals risk equals fear in the eyes of many end-users, which may lead them to be overly critical. PACS administrators need to be able to handle criticism effectively."

Nagy likens PACS administrators to dentists. "Part of the treatment is that you have to make people uncomfortable," he said. "It doesn't make you the most popular person, and that can be stressful."

TRAINING OPPORTUNITIES

Currently, a formal PACS administrator college degree program doesn't exist, but most vendors offer training sessions, which can be helpful in explaining the nuts and bolts of specific systems. SG&A's Gardner believes that it is critical for PACS administrators to get what he calls "the bigger picture" of the PACS environment, because many important issues aren't covered in vendor schools. "It is really crucial that the PACS administrator attend some sort of non-vendor school and learn neutral fundamentals, such as DICOM and HL7," Gardner says.

Several PACS training schools - including Gardner's - are attempting to provide these vendor-neutral fundamentals. The sessions, which can last from one or two days to a week, introduce attendees to topics such as security and privacy issues and statutes under HIPAA (Health Insurance Portability and Accountability Act), project management, DICOM, HL7, RIS/PACS integration, IHE, PACS management, workflow re-engineering and quality assurance.

Many PACS administrators rely on self-training, such as books, websites, Internet user groups, and vendor and peer advice in place of formal classroom training. Burns, for example, went to a few digital imaging seminars, but recommends that PACS administrators do their own homework instead of attending training classes. "You're going to have to teach yourself your own system anyway," he adds.

A potential solution to this issue is being developed by the Society for Computer Applications in Radiology (SCAR), according to Nagy, who co-chairs SCAR's PACS administration subcommittee. Nagy and others are working within SCAR to create a formal PACS administration certification process that would provide a job description framework for hospitals and help them identify job candidates who have received appropriate training from a trusted source.

The SCAR PACS administration certification process will include a standard curriculum and testing procedure, says Nagy. He and his fellow committee members hope the certification process will be available in the next two to three years. 

SOUND ADVICE

So what does it take to be a good PACS administrator? Nagy has some final words of advice. "PACS administration can be very frustrating and challenging," he says, "but if you have a thirst for knowledge, a good attitude, and buddies who you can bounce ideas off of, you can be successful."