One of the last items that many facilities consider during the purchase of a picture archiving and communications system (PACS) is training for those who will become PACS administrators (and, quite often, deciding who will assume that role). As PACS implementations continue to expand into the imaging-center and small-hospital segments of the PACS market, training can smooth the transition. At large hospitals, maintaining a staff of dedicated PACS administrators and technicians (or vendor-supplied on-site personnel) is considered part of the cost of doing business, but smaller hospitals and imaging centers cannot afford a separate staff to maintain a PACS. In this situation, facilities typically choose an already busy technologist or office administrator to perform routine administrative tasks. Although this is not the most desirable situation, it can be, with training, a viable one.

Ideally, an information-technology specialist and a radiologic technologist will share administration responsibilities, with each performing tasks specific to his or her realm of expertise. The information-technology specialist, for example, would manage the day-to-day system-related requirements, and the radiologic technologist would manage patient-related information. In the event that only one or the other is available, management of the system can be performed adequately by either.

Whoever is given the role of PACS administrator must understand that daily maintenance is a fact of life. Every PACS must be monitored. In a large facility with dedicated PACS staff, the task of monitoring can be easily assigned; once trained to understand the requirements of the system, the PACS staff will meet them reliably. An imaging center, however, quite often relies on a technologist to perform daily maintenance. Without proper training for this individual, daily PACS requirements will not be met; the first sign of a problem is likely to be a system failure requiring corrective action, rather than a system message concerning some difficulty that can be corrected before a system failure occurs. Regardless of the size of the facility, reliance on the PACS administrator should not be underestimated.

Training should encompass the normal day-to-day activities required of the administrator and should familiarize trainees with normal system-status messages so that, in the event of a failure, the administrator can take appropriate action (be that rerunning a backup or placing a service call). Regardless of the error, early intervention by trained personnel will minimize the impact of a failure on the enterprise.

Daily Tasks

No matter what size the facility is, there are tasks that need to be performed for any PACS: database backup, image-data archiving, and operational checks of system hardware. If performed as part of a maintenance plan, this routine administration requires only a few minutes per day. An equally important task is the management of demographic data. Inaccuracies in demographic data, such as a misspelled patient name or incorrect identification number, can lead to lost images and can affect the ability to identify and retrieve data quickly. Even in an environment having an integrated radiology information system (RIS), where Digital Imaging and Communications in Medicine (DICOM) Modality Work List is employed, patient demographics will require manual correction at some point. Locating and correcting data on examinations that have been assigned to the wrong patient, or for which the patient information is inaccurate, can affect whether an examination can be found (or slow the reading process while the examination in question is located and verified). Although not considered part of routine system maintenance, these tasks occur daily. Administrators should be familiar with the correction process. Editing patient demographics and reparenting (reassigning examinations from one patient to another) are simple tasks, but can result in lost images if improperly performed. Demographic corrections should be performed as soon as an error is reported in order to keep the data as accurate as possible.

Many facilities overlook the fact that the PACS role encompasses not only the archiving of images, but their distribution, as well. This means that familiarity with diagnostic workstations and distribution systems such as web servers and teleradiology devices will need to be included in the PACS administrator's repertoire. In both smaller and larger facilities where staffing is limited, a good relationship with the manufacturer can provide a source of technical expertise to bolster the existing staff.

Integration

When a PACS is implemented, it is generally with long-term archiving and distribution as primary objectives. With this in mind, determining work flow is critical to configuring the system for each facility. Some questions to consider during this stage are shown in the table below. The answers can then be fleshed out and used to provide a road map for installation and integration. The administrator should be familiar with this map, as it will eventually become the basis of a site profile.

Even with limited resources, a vendor-supplied project manager who is available during the initial planning and installation phases can ask the necessary questions, help provide their answers, and assist the facility in the development of a work-flow plan. Quite often, a project manager will continue to work with the facility and assist it in expanding its PACS long after the initial installation is complete. This is especially valuable when the PACS budget is limited and the system is to be installed incrementally. Planning the growth of a PACS to take place over several years and multiple phases is not uncommon, but if the purchases are not made logically (or if one phase is not completed properly), the results are wasted time and money, along with a work flow that is more hindrance than help. Knowing how to scale the installation, and which steps to take in what order, will contribute greatly to a smoother installation and integration process.

After installation, the training process should include all administrators, both technical and nontechnical. As part of the installation, training should cover the basic requirements necessary to keep the PACS running properly. Later, more advanced training should cover a finer level of detail, providing designated administrators with more advanced tools. These include the ability to configure certain aspects of their systems so that, if a facility opts for a higher level of autonomy, it can manage the details of connectivity, routing, and viewing preferences without having to rely on an outside party.

Procedural Volume

Volume is a significant factor in determining how many people should be involved in the administration of a PACS. A facility performing 300,000 examinations per year obviously will require more administration time than one performing 20,000 examinations will need. Although the larger facility may have a PACS staff of one or two information-technology specialists and one or two technologists whose sole responsibility is the day-to-day management of the system, the smaller facility may have only a single information-technology specialist or technologist to perform the same tasks. This administrator requires the same level of training as the administrators at the large facility. The single administrator may be the only on-site person who has technical familiarity with PACS; since this person may also be filling the role of technologist or may have other responsibilities, the more familiar with the usual tasks he or she is, the more quickly he or she can perform them and return to duties unrelated to PACS.

The impact that training has in the large facility should not be underestimated, however, even if that institution has dedicated personnel to maintain the PACS. If a significant portion of the information received requires correction, having the knowledge and the tools to correct it quickly is critical to keeping pace with examination volume. Whenever possible, integration with the RIS and use of DICOM Modality Work List should be employed as sure ways to reduce inaccuracy and increase performance.

Since a PACS can only manage the information that it has, understanding that data may be sent to the PACS from any number of devices throughout the enterprise is important. Being familiar with site work flow and network topology will greatly increase the administrator's ability to respond to crisis and noncrisis situations alike.

Regardless of the size and procedural volume of a facility, training is a system requirement that is often overlooked. The inability to identify problem examinations quickly or perform daily maintenance can have a negative impact on the ability of a PACS to perform its key function: getting images to the radiologist. Centralized reading, reporting, and distribution are key goals for many facilities. Without trained personnel who understand the management, integration, and maintenance of these different systems, it is unlikely that they will function together smoothly, and this can even be detrimental to the process of reading images. No matter how many administrators an enterprise has or how high its examination volume may be, training is required to get the highest level of performance from PACS.

Bobby Edwards is strategic service engineer/technical trainer, eMed Technologies, Burlington, Mass.