Why is the PACS administrator wearing a flak jacket?

The phone rings in the PACS support center - an irate user wonders why the workstation is so slow this morning. The PACS administrator has already failed, a SCAR University Productivity and Workflow audience was told Saturday morning.

It's a question of hope versus knowing, said Paul Nagy, Ph.D., an assistant professor of radiology at the Medical College of Wisconsin.

Good systems management philosophy says you know what's going on before the user even knows there's a problem, Nagy said. The alternative is relying on hope that the system is okay when the phone rings.

In order to know, you have to have the right data, which means using the right tools. If you have the right tools the system runs better and has better availability and performance. The PACS administrator can take off the flak jacket.

Several commercial tools are available for this purpose. When Nagy couldn't find one to suit his needs, he built his own. A free, open source triage tool called Radtracker lets any user submit reports describing and prioritizing support issues.

Every incident submitted to Radtracker automatically generates an e-mail to the appropriate support person. If the incident is high enough priority, notification goes directly to the pagers of the people who support that system.

NetSaint is another open source package. When something goes red, indicating a problem or bottleneck has been detected, someone gets an e-mail or a page.

Without tools like these, you have no visibility.

Nagy said PACS administrators should cease depending on physical inspections and stopwatches to isolate problems. These are ineffective ways of troubleshooting.

Availability monitors let you know something is wrong before the customer does.

"You want to be proactive," Nagy said. "It's much less work focusing on the problem instead of on the user and the problem."

How will you hold the vendor to service level agreements if you don't measure availability?

With the performance and availability monitoring tools available today, many of them free, there really is no reason not to know what's going on in any PACS network, he said.

"Everyone wants to make the radiologist more efficient. These tools help the PACS administrator do a better job," Nagy said.