The many faces of PACS administration

What does a PACS administrator need to know to do the job? What roles are the PACS administrator expected to play? What types of background and education are required or even useful in the implementation of a PACS? This is the first in a series exploring the field of the PACS administrator.

PACS administrators have had to blaze their path without much guidance. People entering into PACS typically come from either a radiology technologist or a hospital information technology background. Radiology technologists have a great understanding of the workflow of the department and how applications are used, but they can get into trouble with project management and technical issues. Information systems analysts typically have project management training and are competent with infrastructure and systems administration, but they can have difficulty understanding just how the radiologists and staff use the system.

PACS administration requires a skill set that spans the domains of the radiology technologist, the information systems analyst, and the radiology administrator. Healthcare organizations implementing PACS have a difficult time defining what a PACS administrator should do and an even harder time finding someone qualified to do those tasks. No formal education structure is in place for PACS administration, and no clear standards on what a PACS administrator needs to know exist.

Today, all knowledge about PACS is experiential and can be highly vendor- and site-dependent. The adage about "not knowing what you don't know" being the biggest risk is very true in PACS administration.

PACS at its core is an information system, and staffing should reflect that. The Gartner group provided a framework in a report a couple of years ago on the best practices and structure of highly successful IT organizations. The Gartner model broke competencies into three areas -- behavioral, business, and technical:

• Behavioral competency focuses on workflow and the inner workings of the department. This individual would likely have a background as a radiology technologist who acts as an application specialist. An example of tasks for someone in this role would be designing the reading room, conducting training classes for the physicians, and working with the technologists to help eliminate steps in their workflow using advanced features in the PACS.

• Business competency would more likely be found with an administrator who has an understanding of project management and the strategic vision of the organization. Typical tasks for this administrator would be developing the project implementation plan, establishing benchmarks for measuring performance, developing a return-on-investment analysis, and getting buy-in from the leadership of the organization.

• Technical competency is primarily the role of the systems administrator who understands the technology and supports PACS as a mission-critical information system. Typical tasks for the technical competency would be DICOM and HL7 troubleshooting when integrating new modalities, developing protocols for disaster recovery, monitoring system performance, and continually assessing performance and capacity while planning for future growth. Systems administrators work closely with the service organization of the vendor to ensure the smooth operation of the PACS.

This model implies that a site would need three people to successfully implement their PACS, and this is simply not realistic in smaller community sites. But sites can have other people within the department help fulfill those roles part-time. A department director could help with the business aspects, an analyst from information systems could handle some of the technical components, and a head technologist might be able to help out with the user or behavioral tasks.

In future reports, I will go over in detail each of the competencies and roles of PACS administration.

Dr. Nagy operates Club PACS, a Web-based source of PACS information. He can be reached by e-mail at PNagy@mcw.edu.

For more on PACS administration:

• PACS administration: scrambling to keep up

• What you need to know to be a PACS administrator

• PACS administration: A user's guide for the uninitiated