A major component of putting in a PACS, and one that can easily be underestimated, is training the staff to use the hardware and software that make delivery of soft-copy images possible. At Generations+/Northern Manhattan Health Network in Manhattan, training was given top priority.

"What we did at Harlem Hospital Center," says Roberta Camille Locko, MD, director of radiology, "was to name a clinical person as the PACS trainer. She was an instructor at the School of Radiologic Technology. She showed a tremendous ability with the PACS, and she became our emissary and our liaison with the clinical services to train all the clinicians. She was here practically 24/7."

Locko, who was one of several administrators who oversaw the PACS installation, says about 500 technologists and physicians had to be trained at Harlem Hospital, and close to twice that number in the rest of the Generations+/Northern Manhattan Health Network. "We had training session upon training session," Locko says, adding that the PACS vendor supplied many of the training materials.

When the clinicians and technicians had completed the training seminars, they then had to demonstrate competence. "They had to show that they had mastered what they were supposed to master," says Locko, "and then that certification went into their personnel files." After they had demonstrated competence, they were allowed to use the PACS. "Only when the clinicians had signed off that they knew what they were doing would they get their password," says Locko.

Locko says installing a PACS is "a wonderful opportunity to change systems that are outdated and to use the installation as a performance improvement project." But Generations Plus also used training as a staff bonding exercise. "We had our staff become super-users' and we gave them T-shirts and sweatshirts. We had certificates. We made them feel incredibly involved. We made everyone feel that they were absolutely a part of thisand that's why it has succeeded," Locko says.