The decision has been made to ditch the file rooms and hard-copy archives and make the move to a PACS. For most facilities, the initial step to a filmless archive department is putting a team of stakeholders in place to make the critical decisions: what do we need the system to do, which vendor will provide that, and who will take charge of it once it's in place?

Answering the last question requires filling the position of PACS administrator. Not to be taken lightly, breaking down the chore into manageable components can make the process less daunting and provide idyllic results.

1) First things first.

You probably are not looking for a PACS administrator; you are seeking a certified imaging informatics professional, or CIIP.

Only in the world of technology would a job title be around for less than 10 years and be well on its way out of existence.

"I think PACS is an outmoded term; an image archive is a lot more than what a PACS traditionally was," says James Philbin, PhD, director, Radiology Center for Information Systems, Johns Hopkins Medicine (Baltimore). "Everything is communication these days, so 'communication system' is kind of an odd thing to be saying, so we refer to it as a medical image archive."

In fact, the new certification program for imaging informatics professionals being set up by the Society for Imaging Informatics in Medicine (SIIM of Great Falls, Va)—currently in development and slated for debut some time next year—doesn't use the term "PACS administrator" at all. Instead, individuals who complete training will be certified as imaging informatics professionals.

This shift is due to digital archiving's steady progress to virtually every corner of the health care system. A decade ago, any reference to PACS was synonymous with radiology, but today's systems also cover cardiology, endoscopy, and surgery, to name just a few departments seeking to take advantage of the benefits inherent in an electronic imaging archive.

"PACS itself is moving to be an information technology that's a component of the complete electronic health record," says George H. Bowers, principal, Health Care Information Consultants LLC (Baltimore), who also chairs SIIM's Imaging Informatics Administrator education committee. "We also feel that the term 'administrator' implies a supervisory position that does not really describe the role, so we want to certify these individuals as professionals, as opposed to just administrators."

Whatever the designation, a PACS administrator will definitely see expanded job responsibilities. Exactly how vast the scope is depends greatly on the facility, but it is not uncommon for a PACS administrator to take an operational lead role in implementing, managing, and monitoring the system, as well as being involved in projections, usage, infrastructure needs, request-for-proposal creation, and more.

2) Create a list.

Catalog the tasks associated with the ongoing maintenance of a PACS, noting who can and will do what. Once existing staff have staked their claim, look at the orphaned duties and tailor a job description to find the individual who provides the skills required to fill those gaps.

For example, a facility with a robust IT department most likely will not need its PACS administrator to handle hardware, networking, and related infrastructure. Instead, the new-hire's skills can focus more on end-user support. The reverse would be true for clinics without much technical know-how on board. The combinations of skill sets are myriad and demand that adequate time be taken to create a customized job description.

"When you look at various ads, the PACS admin role is inconsistently defined because what one does in that role ranges dramatically from one environment to the next," says Leonard S. Avecilla MS, vice president, SG&A Consulting Inc (Arlington, Tex) and director of Continuing Medical Education for the School of PACS Administration. Variables include the institution's size, the level of IT support available, and the number of areas within the enterprise that will use the health informatics management system. "If you hire based on someone else's position description, I can almost guarantee you that person could not be right for you."

3) Reality check:
Can one person do the job?

Styling the job posting to fit the facility's specific needs also brings a touch of reality to the adventure.

"Through this process you get an idea of whether you're looking for someone who has a technical background and has to learn more about radiology, or you find you need someone who's got a radiology technologist background, who can pick up some of the IT functions," Bowers says. "In some cases, it's not just a single PACS administrator. In many cases, you're looking to hire multiple people."

Exactly how many individuals should be responsible for the PACS system depends on how extensive the list of "wants" is—if it is long and varied, it may be easier for a facility to divide and conquer. Such is the case at the University of Rochester Medical Center (URMC), Strong Memorial Hospital (Rochester, NY), where the department of Imaging Sciences collaborates with IT techs to provide service to the PACS users.

"The technical people are in their own group, and we are the end-user specialists, so we keep a database of users, set users up on the system, and troubleshoot whatever issues we can handle," says Josephine Zanghi-Smith, imaging sciences IT application specialist, Department of Imaging Sciences, URMC, Strong Memorial Hospital. "Anything we can't take care of, we call on IT."

Even when the job duties assigned to the PACS administrator can be managed by one person, establishing a backup is strongly advised, assuming your future employee is human. After all, demands are placed on the PACS admin 24/7/365, and if he or she ever catches a cold or plans a vacation, someone else must be able to step up and keep things humming along smoothly.

"You need a backup, but does that person need to be full-time? Not necessarily," says Stuart Gardner, president and founder, SG&A Consulting Inc, who recommends at minimum 1.5 full-time employees be devoted to maintaining the PACS. "Exactly how many resources are dedicated to it is going to be institution-specific based on what they can afford."

Often, the "half" person can be found in a tech-savvy radiology technologist or an IT tech familiar with the PACS. When hiring multiple individuals, duties can be divided up by expertise.

"If you can afford a couple of people, you need one person who knows about computers, storage, and traditional IT-related topics to focus on managing the archive," Philbin says. "The other person should be focused on the workflow and assisting both physicians and technologists."

Because of the disparate skill sets required to successfully handle all related duties, it is wise to consider what you will settle for initially and how you wish the position to grow before you begin the candidate search.

"The blended sensitivity to the requirements of clinical functioning, the technology, management, and quality control—along with everything else—is something you can only get over time and with experience," Avecilla says. More often than not, one hopeful will meet one set of desired qualities while another person will bring a different set of qualities. "When deciding what you want in the position, creating a category of ‘desirable' experience helps you understand which trade-offs to make to best accommodate the requirements of your facility," Avecilla says.

4) Cover the intangibles.

At this point, the bulk of the work is done. The PACS-specific duties have been outlined, a job description is completed, and the number of—and qualities possessed by—the future PACS administrator has been set.

Before reviewing applications, those responsible for evaluating candidates must also look for essential qualities that do not always show up on a resumé. Sure, "candidate A" may be able to define DICOM without skipping a beat, but can she quell the worries of the hospital's busiest radiologist? Both issues must be given the same weight by a PACS administrator and should be handled with equal ease.

"To be good at this job, you can't get rattled easily—you have to have a sense of humor and not take things personally," Zanghi-Smith advises, and laughingly adds that anyone dealing with a PACS and its end-users should have a "Weeble" quality. "Remember ‘Weebles wobble, but they don't fall down?' You need to be a Weeble, so when you get knocked over, you just kind of pop back up again."

She also emphasizes that the absence of these qualities can have serious consequences. "If you have someone who can't handle the stress or who gets aggravated, agitated, or angry, that really can drag down the rest of the team."

Maintaining an even keel is essential in a position responsible for hearing—and resolving—everyone's grievances and concerns. And as important as it is to not be the resident downer, a PACS administrator must also be adept at keeping everyone up to date and involved.

"The ideal person should be an excellent communicator in training and user-development at all levels, from doctors down to clerks," says Doug Ricci, BSEE, manager of Johns Hopkins Medicine Image Archive, Johns Hopkins Hospital (Baltimore). "You need a well-rounded, even-handed person to be able to look at complaints and suggestions from all over and not be too quick to jump to conclusions."

5) Gentlemen, start your engines.

Once hired, the goal should be to get the new PACS administrator up to speed as quickly as possible.

"The sooner you can get somebody in place as a PACS system administrator, the better off the organization is going to be," Gardner says. "If they are able to be part of the decision-making process, they will understand more about the system they're about to administer."

Any required training should also be attended to promptly. "The majority of facilities hire a single individual who met most—but not all—of the requirements for their vision of what this role should be," Avecilla notes. "At that point they should get that person as much training as they can afford."

Regardless of the specifics of each facility, ultimately the goal is to find someone who understands all the potential pitfalls of the job and wants it for the right reasons.

"Technically, I think it's a very rewarding job, and anyone that's really turned on by a technical challenge will like it," Ricci promises.

Dana Hinesly is a contributing writer for Medical Imaging.