PACS administration: The PACS manager plays the business role

When it comes to big picture thinking, turn to the PACS manager. It is this person who has the business skills needed to run a PACS team and negotiate the thicket of planning and cost issues. The fourth in a series on PACS administration.

This is the fourth in a series of articles exploring the multiple roles of PACS administration. In the first article, I introduced a competency model used in the information technology industry (http://www2.dimag.com/pacsweb/archives/?id=63). The staffing model breaks competencies into technical, behavioral, and business attributes. PACS administration tasks can be sorted into each of these categories. While individuals might need to accomplish tasks from all three competencies, they are typically most comfortable with one. This article will explore the business competency category: who this person is and what he or she does.

PACS is the first hospital-wide initiative coming from within radiology. It takes leadership skills, customer focus, and business savvy to take an enterprise filmless, something that most radiology departments are not accustomed to.(1) An average-sized hospital should hire or dedicate a manager for the PACS team. A significant body of work needs to be done to pull off an enterprise PACS project. In a pinch, some of these tasks can be taken on by the director of radiology in conjunction with an administration-savvy user champion.

As part of the PACS team, the PACS administrator might not have direct responsibility for business roles and tasks, but these tasks are important to ensuring the long-term success of the project. The PACS administrator should be able to speak the language of hospital administration and at least be aware of the CIO perspective.(2)

The tasks of PACS administration begin well before you have a PACS. They starts with understanding the readiness of the institution and setting a strategic vision. The PACS manager will need to build the PACS team and create an environment for the team to succeed.(3) Major responsibilities for the manager include readiness assessment, strategic vision, economics of PACS, vendor selection, and implementation.

READINESS ASSESSMENT

Is your institution ready for PACS? It represents a great deal of change management, and real gains in productivity require significant workflow redesign. Psychology preparedness as well as technical infrastructure preparedness assessment is needed.(4) Adequate staffing is crucial for a successful deployment, support, and training. Part of the assessment phase should be identification of strategic oversight and tactical implementation committee members, who are key stakeholders from administration and IS and the users of PACS.(5)

STRATEGIC VISION

Success metrics could be defined solely as cutting the draconian cost of film, film maintenance, and film room personnel. It could also include the productivity gains or increased business the organization is able to absorb. A clear metric for success should always include end user acceptance and ongoing satisfaction with the system.

Aligning to the goals of the institution is important. Integrating images and reports into the EMR should be the goal of every PACS project. Images are an enterprise resource and need to "escape" the confines of the PACS.

ECONOMICS OF PACS

It's important to understand the complexity of the various business models. Besides the well-touted application service provider model, there is also the software-only model or even outsourcing of the entire film room. Each one comes with its own set of risks and will require a detailed contract negotiation to explore the "what if" scenarios.(6) The cost of PACS is not a one-time event. Workstations will need to be replaced every couple of years, and all the server components should be replaced after three or four years.

VENDOR SELECTION

Choosing a vendor requires a group to know a lot about its own preferences and values. The vendor relationship has to be well understood in terms of service, responsiveness, and technology innovation. A group will have to set its priorities regarding the functionality, architecture, and business relationship, as well as the total cost of ownership. Site visits and onsite demonstrations chew up a lot of your time, but they provide the best proof of how well a system will likely work.

IMPLEMENTATION

Project management means having excellent communication skills to keep the project on schedule and keep everyone aware of what is changing and when. You must work with other departments outside of radiology to forge relationships and understand their needs and concerns about getting rid of film. The PACS project doesn't end on the go-live date.

How do you keep the course on track? How do you create an environment for your PACS staff, who generally behave more like IT professionals than healthcare professionals? It is usually a challenge having the PACS group work alongside radiologists and clinicians and breaking down the culture gap between physicians and IT folk.

Success metrics, workflow redesign, error reduction, and productivity improvements are all terms of quality management. A manager should consider using total quality management processes such as Quest or Six Sigma to help deliver these goals.(7)

In the next and concluding article in the series, I will tie together the three roles that make up the PACS dream team. I will investigate institutions that have used this model and discuss their initial experiences. I will also go over creative ways to justify extra heads to administration.

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 PNagy@mcw.edu.

Paul Nagy's previous articles on PACS administration:

? The many faces of PACS administration - an overview
http://www2.dimag.com/pacsweb/archives/?id=63

? PACS administration: Enter the application specialist - working with
and understanding the needs of users
http://www2.dimag.com/pacsweb/archives/?id=54

? PACS administration: The systems administrator
http://www2.dimag.com/pacsweb/archives/?id=2214

REFERENCES

1. Treister N. Physician acceptance of new medical information systems: the field of dreams. CIO, July 1999, http://www.cio.com/research/healthcare/field_of_dreams.html.
2. Kywi A. "PACS: what your CIO wants you to know. Radiology Management March 2000, http://www.ahra.com/AHRAArticles/AHRAArticles.dll/Show?ID=36.
3. Ivancevich J, Duening T. Managing Einsteins. New York: McGraw-Hill, 2001.
4. Reiner B, Siegel E. Psychological factors affecting the adoption of PACS. Applied Radiology 2002;31(4), http://www.appliedradiology.com/articles/article.asp?Id=618&Mode=.
5. Reed G, Reed D. The PACS committee: the all-important human element. Radiology Management January 2001, http://199.96.2.32/AHRAArticles/AHRAArticles.dll/Show?ID=278.
6. Cannavo M. Trust your mother, but get it in writing. Radiology Management, March 2002, http://www.ahra.com/AHRAArticles/AHRAArticles.dll/Show?ID=300.
7. Barry R, Murcko A, Brubaker C. The six sigma book for healthcare: improving outcomes by reducing errors. Health Administration Press, 2002.