The many faces of PACS administration: Determining your staffing levels

May 22, 2003

One of the basic rules of PACS administration is that no one can do it all: No individual possesses all the skills required, and no one individual has the time needed to perform all of the required tasks. This article, the fifth in a series, explains

One of the basic rules of PACS administration is that no one can do it all: No individual possesses all the skills required, and no one individual has the time needed to perform all of the required tasks. This article, the fifth in a series, explains what considerations you need to make in deciding how to fill your PACS administration team.

The first article in this series introduced a staffing competency model used in the information technology industry ( This model breaks competencies into technical, behavioral, and business attributes. PACS administration tasks can be sorted into each of these categories, which are covered in the subsequent three articles. These articles are a good place to start if you are planning your staffing requirements for PACS.

When it comes to determining staffing levels, the first question you should ask is, How can one person perform all these tasks? The obvious answer is one person can't. These roles require different people with different interests and competencies. Not only is there way too much work for one person, but it is highly unlikely that one person can possess all three competencies.

Everyone on the PACS team should have a basic proficiency in all areas of PACS administration in order to know what other colleagues do and cover in an emergency. But each person really can own only one competency.

The next question I hope you are asking yourself is, How can I convince hospital administration that we need more than one person? The considerations listed below explain what staffing levels are needed to keep the PACS humming. They should be clearly communicated to the leadership of any hospital contemplating PACS installation.


Enlist the help of the CIO, who understands the staffing requirements of clinical information systems. The numbers can range from one support person per eight users to one support person per a couple hundred users. Calculating support of information systems depends upon several variables:
? complexity of the application
? number of physical computers supported
? geographic distance the team has to cover
? proficiency of the user base
? proficiency of the support team
? degree of responsiveness and coverage required by the team
? level of information system's integration
? level of lockdown on the computers the support team covers
? tools used to conduct systems management, such as remote administration programs


Being on call and not being allowed to go on vacation gets old quickly. A single-person operation is not sustainable over the long run and puts the hospital at great risk. When one person leaves a facility, not only will you lose that person's skills, but you might need to relearn all the knowledge he or she left with.

Hospitals spend all this money and do all this work designing information systems that are fault-tolerant and geographically redundant, but we frequently overlook knowledge redundancy. Most PACS administrators learn their trade on the job, and if they don't have someone to learn from, especially if they are coming into a preexisting PACS, your system is likely to deteriorate.

As an alternative, consider hiring a junior, less expensive, person to act as another pair of hands for the senior people to direct. This provides a method for transferring knowledge and also provides the hospital some redundancy in the staff. It lets your staff get much-needed breaks that will also, in turn, increase your ability to retain personnel.


If the return on investment just doesn't allow for a complete PACS team, consider taking on additional responsibilities such as the cardiology PACS to justify additional staff. This is a synergistic project, and you can justify the additional staff by joining forces. The technology and the skills required are extremely similar. The lessons learned putting one system together often make the implementation of the other system easier.


An understaffed PACS installation makes the vendor look bad. Often clinical information system vendors will have minimum requirements for staffing that the customer agrees to in order to get pricing discounts in the maintenance contracts. Many vendors have a "good install" policy - they provide a discount to a hospital if the hospital dedicates a certain number of people to the project and those individuals go through training and pass tests similar to the program for the vendor's service engineers. This is a very good practice. Sit down with your vendors and have an honest discussion on what staffing levels they recommend and have seen in their installations.

In your presentation to the hospital administration, consider and enumerate all the benefits of a multidisciplinary team. Team members can cover for each other for 24/7 coverage and vacations. A team can brainstorm and solve problems faster because of its members' different backgrounds and perspectives. A well-led team can create an atmosphere for high performance. PACS is a rewarding and exciting field for administrators because of the powerful effect it can have on an institution. Don't allow your PACS administrator to stagnate in isolation.


Assess staff needs with this spreadsheet. TechRepublic Aug 2002.

Developing the right end-user/IT support staff ratio. TechRepublic Oct 2000.

Dr. Nagy is director of the Radiology Informatics Lab at the Medical College of Wisconsin and the editor of ClubPACS, a Web-based source of PACS information. He can be reached by e-mail at

Dr. Paul Nagy's previous articles on PACS administration:

The many faces of PACS administration - an overview

PACS administration: Enter the application specialist - working with and understanding the needs of users

PACS administration: The systems administrator

PACS administration: The PACS manager plays the business role