The Path to PACS Administration

With new technologies come calls for people to implement, maintain and manage those technologies. In healthcare, particularly, the advent and growth of PACS (picture archiving and communications systems) has radiology departments calling for PACS administrators - a position with job responsibilities as numerous and varied as the hospitals looking to fill those positions. Will the person who selects the PACS and supervises its installation be required to train clinical staff, for example? Should the hospital lean toward someone who knows radiology or someone whose expertise is focused on information technology (IT)? And for anyone considering PACS administration as a career change: What combination of education, ability and interest will get you there?

Recruiter Wils Bell, owner of Professional Resources Inc. in Orlando, Fla., suggests that employers are still figuring out what they want in a PACS administrator.

"I've got a client now that has been telling me for the last three months that the facility needs a PACS administrator, but they don't know what they need," he relates. "They're trying to get together with all the people who might be involved, so they can come up with a job description. It's no different than any company trying to come up with a new position: What will this position be? How large a scope of responsibilities will there be?"


FROM PATIENTS TO PACS

Karen Jennings, PACS manager at the University of Utah, Health Sciences Center, Salt Lake City, was a registered nurse with a bachelor's degree running clinical trials for the department of surgery when she began taking courses toward a masters in informatics, originally to boost her research skills. While working on her degree, she was recruited first to help develop a vendor's rules-based decision support system, then to help the university hospital implement its patient medical records system.

In 2001, as director of customer service for the IT Services department, she was anointed PACS manager when radiology expressed concern for its Marconi Medical Systems' PACS running Applicare's RadWorks software: GE Healthcare had acquired RadWorks when it purchased Applicare in 1999, and Philips Medical Systems bought Marconi in 2001. Initially neither company addressed the service component, says Jennings.

"The radiology department approached the CIO and said: 'We do radiology; you do IT. Can you take this over for us?' "

Jennings' first order of business was to attend a weeklong class on PACS administration at SG&A Consulting in Arlington, Texas. Her second was to create a support team consisting of two radiologists, one radiology technologist and a system administrator.

"When I have a radiology-type question, I go to a radiologist. When it's a tech-type question or getting down to the nitty-gritty stuff, I go to the tech. But I handle all communications and integration of everything else."

Jennings' main focus over the last year has been picking a new Philips' Inturis radiology PACS, figuring out how to pay for the new installation, and managing its integration and implementation. That includes interfacing the Allegra HIS (hospital information system) with the IDX Systems' RIS (radiology information system) and then integrating the RIS and the PACS. With the assistance of a Philips trainer on-site, she helps train users on the system.

Additionally, she is selecting PACS equipment for two new ambulatory and cancer centers, and ensuring that the network is in place for those facilities.

"Being a communicator is one of my strengths," Jennings assesses, "and [PACS] offers unlimited potential for career growth. Within a short time as a nurse, I felt I had reached my career cap. I wanted to be more responsible. I wanted to more in charge of what I do."


THE TUG OF TECHNOLOGY

Steve Watkins credits his foresight - and his desire to be part of what he saw as the technological revolution in radiology - with his path to PACS administration.

A registered radiologic technologist since 1978, Watkins had been working at Swedish Medical Center, an HCA-affiliated hospital in Englewood, Colo., for about 14 years when he enrolled in Denver Technical College, graduating in three years with a bachelor's degree in network systems administration. While attending school, he garnered PACS experience at another Denver-area healthcare facility. When Swedish was in the market for a PACS administrator about a year ago, hospital officials asked Watkins to return.

Swedish, meanwhile, had taken its Fuji Synapse Web-based PACS live and ushered in Fuji CR (computed radiography) simultaneously, just prior to Watkins' coming on board as PACS administrator. The network infrastructure had been set up, the Meditech HIS had been brokered, and many of the modalities had been integrated and were able to send images to storage.

That left Watkins to outfit the hospital and four medical office buildings with PCs. Currently he is helping plan a large, HCA-led VPN (virtual private network) for the Denver market.

High on Watkins' list of responsibilities is monitoring. He keeps tabs on the Fuji storage servers; the main controllers, which are Dell computers; the SAN (storage-area network); HIS messages; the database; and a 24-hour, seven-day-a-week computer help line.

He responds to desktop computer issues in the hospital and in the physicians' offices off-site.

He keeps records of network configurations, maintains third-party vendor software installed on workstations, writes PACS policies, makes safety recommendations and manages budgets.

He provides applications training, estimating that, in his year on the job, he has trained more than 300 physicians one-on-one.

"It can be very time-consuming, especially in the beginning," acknowledges Watkins. "In implementation you're going to spend a lot of time, but once you get things going, it does settle down a little bit. But it's always changing every day, and there's new situations every day that you have to deal with."


THROUGH THE RANKS

When things "settle down a little bit" for PACS Administrator Darren Muccioli, he reclaims his "tech hat" and heads for the emergency room (ER) to take x-rays. Most days, however, Muccioli, with Mt. Auburn Hospital in Cambridge, Mass., has plenty to do at his PACS post.

In his 13 years at Mt. Auburn, Muccioli has made the rounds as a transporter, a unit coordinator, a night orderly while attending classes to become an x-ray tech and as a quality control supervisor in charge of ER x-ray. Two-and-a-half years ago he became PACS administrator, accountable for a Sectra-software-based Philips PACS with Oracle database and integrated Meditech HIS and RIS.

"When I was in radiology school, one of our instructors used to tease me: 'Too bad they don't have a job that crossed over x-ray and radiology and computers; you'd be great at it!'" he recalls.

The list of Muccioli's daily monitoring responsibilities reads much like Watkins' list. Muccioli also talks about re-archiving failed attempts, handling disaster recovery and resolving system problems remotely, from his laptop.

Like his counterpart in Utah, Muccioli was part of the team that selected the radiology PACS. Unlike Jennings, however, he was not involved in financial negotiations and has no budgetary responsibilities.

Training is a big part of Muccioli's job, especially since Mt. Auburn has a residency program that regularly introduces new users to the PACS. He also serves as an "unofficial" mentor for Philips' customers who wish to "shadow" a PACS administrator for guidance and advice.

Muccioli asserts that his "good sense of humor" helps him maintain his equilibrium in a job that carries round-the-clock, seven-day-a-week responsibilities. It's that same sense of humor, in fact, that inspired him to x-ray the Buzz Lightyear action figure in his office, keep the image on the PACS and print out copies for distribution to young patients awaiting their own imaging exams.


'LIVE AND LEARN'

"I'm looking for someone who is knowledgeable on imaging technology," begins Todd Cipriani, vice president of Professional Services at Newport (R.I.) Hospital, a Lifespan partner. "And I'm looking for someone who has leadership skills, gives me the people part of things, the working-in-teams, the taking-an-ad-hoc-group-and-making-things-happen. Working with directors, doing consensus building. Doing that strategic looking down the road, getting the group to understand where that's going and how to set the tasks so that gets done. It's nice bringing someone in who has worked on PACS because you know he or she has that knowledge base, but that's not the most important thing to me. The most important thing to me is that [the person] understands information systems. Someone who has worked with a RIS can learn PACS pretty well. I'm more interested in the leadership skills."

In contrast to hospital executives who are struggling to define a PACS administrator's role, Cipriani knows exactly what his organization needs. Maybe that's because, as he puts it: "You live and you learn."

Newport Hospital's lessons began three years ago when it moved into a new facility, bringing with it new digital equipment and its first-ever PACS, a Fuji Synapse. At that time, the hospital needed someone who understood technology and computers to ensure the success of the implementation, Cipriani says. Once the PACS was up and running, however, those needs changed.

"The next important piece becomes: How do you integrate that with everything? Not only your RIS, but your other hospital systems? How do you get it into the doctors' offices? Their homes? How do you read from off-site? How do we get it to our other affiliates? So now you've got to start working with others. You need people skills and team skills; getting people to work together becomes much more important. That's a lesson we've lived through. What's more important to us now is distributing an image to a physician who needs it and using technology to make that happen easily for them.

Tips from the PACS Pack

Anyone considering PACS Administration as a career may benefit from some advice from those in the ranks:

• "Good project management skills are essential," offers Karen Jennings, PACS manager at University of Utah, Information Technology Services. "You have to keep so many things organized."
   
• "You are expected to be an expert on everything," comments Steve Watkins, radiologic technologist at Swedish Medical Center. "You have to be able to narrow down the problems pretty fast and have a lot of experience with all the applications to be successful."
   
• "A clinical background isn't a necessity, but it's a benefit," opines Darren Muccioli, PACS administrator at Mt. Auburn Hospital. "If you have no medical background, take some anatomy and physiology or medical terminology courses."
   
• "I look for someone who understands it from a technical side, but also from a functional side," says Wils Bell, recruiter and owner of Professional Resources, Inc., "because it gives them an overall perspective of what the PACS does from a business standpoint, a security standpoint, a user's standpoint."
   
• "The whole people piece in terms of coaching and teaching is becoming more important," notes Todd Cipriani, vice president of Professional Services at Newport (R.I.) Hospital. "In our place, it's becoming [a position with] more and more external contact, and you want them to service those audiences well."

To Get You Started

So you've decided PACS management appeals to you. Now, how do you go about getting a foothold in this new, evolving field? The following is a short list that can help you get started down the PACS administrator career path.

While there does not appear to be a particular degree or degrees needed to be a PACS administrator, successful candidates so far are those who demonstrate an aptitude for computers and network systems. Once you've accepted the job, however, consider a short-term training program - the way Karen Jennings at the University of Utah, Health Sciences Center, did.

Among the businesses offering specialized training programs: SG&A Consulting in Arlington, Texas; OTech, Aubrey, Texas; The Michener Institute for Applied Science, Toronto, Canada; Radiology Consulting Group of Boston, which conducts a course in cooperation with Massachusetts General Hospital; and the Rewards Customer Learning Center, a joint venture of the Institute of Indiana University/Radiology and GE Healthcare (GE) based in Indianapolis. Classes in DICOM also are helpful, such as those offered by Merge eFilm in Milwaukee.

Other training resources are vendors, which offer training on their own PACS to customers, and trade conferences. The University of Rochester School of Medicine and Dentistry is planning a PACS administrator program this month (March 10-13) in San Antonio, Texas, for example.

Wils Bell, a Florida-based recruiter, has begun recruiting for PACS administrators from the information technology (IT) sector, but that's because IT-sector recruitment is his specialty. Meanwhile, many hospitals are looking within their own ranks for potential candidates, with an eye to radiology department physicists and technologists who are computer savvy.

What kind of salary can you expect in the job? In a paper dated April 9, 2001, authored by Massachusetts General's Patricia Whelan, PACS administrator, department of radiology, and Amit Mehta, M.D., medical director, advanced imaging laboratory, report that compensation varies, depending upon candidate backgrounds and on-the-job responsibilities.

"True database administrators and some experienced PACS veterans command salaries above $125,000, whereas internally promoted personnel with little or no systems experience may start at $50,000," according to their paper. "These figures may vary with geographic location as well."

Editor's Note: In the April issue of Health Imaging & IT, we will publish a comprehensive PACS administrator salary survey. To participate in the polling, go to healthimaging.com and click on the salary survey icon.