The delineation of warranty and maintenance tasks for a system as large and as spread out as a PACS is a complex undertaking. The best method of achieving complete visibility and flexibility is to develop a matrix of tasks vs available resources. A task allocation chart (TAC) is a table of QC, warranty, and maintenance-related tasks with several associated attributes. Each task can be assigned to different departments or organizations for action. The availability and willingness of in-house resources are a large factor in the development of the TAC. All foreseen tasks should be listed in the TAC: PACS system administration, PACS component operation, QC, preventive maintenance, calibration, minor repair, major repair, component replacement, configuration documentation, and record keeping. The enterprise should make the task allocation chart available to all involved facilities and organizations so that proper planning and resource programming can be performed in support of the PACS life cycle.

A task allocation chart is accurate only as long as the attributes for each chart match the real world situation. Changes in equipment inventories, contract specifications, hardware options and test equipment requirements, budget cuts, physics support contracts, and staffing cutbacks are examples of factors that cause task allocation charts to become inaccurate or unusable. Hospitals should review their PACS task allocation chart at least annually to ensure that updates are made as needed.

Figure 1. Task allocation chart development model.

Figure 1 reflects the Task Allocation Chart Development Model. This model depicts the following processes: (1) identify maintenance tasks across the entire enterprise from a combination of technical and administrative sources; (2) identify resources within the enterprise that can be assigned against those tasks; (3) identify vendor-unique resources that must be added to enterprise resources to complete the required coverage of maintenance tasks; and (4) negotiate with all member sites of the enterprise and the vendors for the assignment of resources against all maintenance tasks.

PHASED-IN MAINTENANCE PLAN

Creating task allocation charts that match the planned division of maintenance responsibilities for any point in time can migrate away from complete vendor maintenance toward more in-house tasks. This can be further extended to include an enterprise distribution of tasks. Examples of three task allocation charts are provided below to demonstrate this migration away from vendor services to an increasingly more self-sufficient position.

Vendor-Provided Full Service. Under a full service contract, the vendor provides full-time, on-site personnel for the performance of all required administration and maintenance tasks.

The scope of services provided and requirements for system reliability for full service tasks are the same as required during the warranty period, and include all parts, labor, system hardware, firmware, and software changes. Note the number of cells shaded to indicate the vendor tasks (Table 1, page 62).

Table 3. Shared enterprise task allocation chart

Shared Local Maintenance. Under this type of contract, there is no requirement for a full-time, on-site vendor-provided system administrator. The scope of services provided and requirements for system reliability are modified to provide for locally performed shared maintenance. Reliance upon the vendor is somewhat reduced as reflected in the task allocation chart (Table 2, page 62) and, of course, the cost of the contract.

Shared Enterprise Maintenance. Under an enterprise shared maintenance agreement, reliance upon the vendor is further reduced but the vendor remains directly engaged in the form of full-time systems administrators or engineers being assigned to key locations in the enterprise. They perform higher-level duties and act as backup to the local and enterprise assets. In the case of a

large-scale PACS operation in support of a multi-facility enterprise, this provides an effective mix in vendor expertise and direct system interaction with the more cost-efficient use of in-house resources (Table 3, page 64).

REVISED LIFE-CYCLE PLAN

After developing a set of task allocation charts, which develop a phased reallocation of maintenance activities over a course of years, a forecast of the entire life-cycle maintenance program can be devised for the enterprise PACS. This plan is a key to negotiating strategic maintenance contracts and planning resource requirements across the enterprise. It also serves as an excellent teaching tool for enterprise PACS users and managers to graphically depict the local and enterprise PACS maintenance responsibilities migration plan. Tables 1, 2, and 3 depict an example of a phased maintenance plan that migrates from full vendor service to shared local service to shared enterprise service.

Table 2. Shared local task allocation chart.

The timing of the phases is based on the intended goals for achievement of enterprise PACS support capabilities. It must be mentioned that the cost savings predicted by this migration plan should also be seen as an assumption of increased risk for maintaining PACS-supported clinical services. A sober and realistic assessment should be applied before committing to such a plan.

CONCLUSION

With the demonstrated proliferation of PACS and increases in hospital mergers and partnerships, an increase in enterprise PACS implementations is inevitable. Enterprise shared warranty and maintenance programs present a systematic means of achieving more effective and efficient PACS operations through development of integrated support plans.

The goal of reducing enterprise cost can be fully appreciated only if the clinical utility of a PACS is supported. Inefficient PACS produces not only film, but also more expensive laser film. Furthermore, untrusted and unreliable PACS operations cause reliance on film-based operations, which, in a PACS environment, should be used for backup and specialty printing operations only.

Table 1. Full service task allocation chart. Includes quality control (QC), preventive maintenance (PM), calibration/configuration (Cal/Config), and minor maintenance tasks for vendor system administrator (SA), radiologists, vendor, biomedical staff, clinicians, and radiology department staff.

PACS operations are the culmination of many upstream activities, beginning with a clinical order flowing into a RIS schedule, to an image acquisition, to a diagnostic read, in parallel with the delivery of properly stored and networked bits and bytes of images and patient data onto a properly calibrated display monitor. This sequence of events relies on many service organizations and people, from equipment users to radiology technologists, clinical engineers, and physicists, and to system administrators and network administrators. All of these people and activities come under the umbrella of a PACS operations and maintenance program where everybody knows their job and all organizations are resourced to get the job done. This is why the linkage between operations, quality control, and maintenance is needed. Without communication between the major contributors of PACS operations, effective services are an impossibility.

Additionally, failure to support the allocated maintenance and QC tasks through in-house or contracted means will reduce the efficiency of the maintenance program as well as the effectiveness of PACS operations. Continuous failure to support scheduled QC and maintenance tasks historically leads to more frequent and more expensive repairs with the associated downtime. While a working PACS is a great tool for a hospital or an entire enterprise, a failing PACS is a clinical work-flow nightmare, with serious clinical and business implications.

The task allocation chart is meant to be a dynamic reflection of assignments. It can be used to show current and future program structure. Any transition away from reliance on vendor resources must be met with an equal assignment of tasks to other resources. Each stakeholder in PACS operationsclinicians, technicians, physicists, engineers, and administratorsmust provide constructive effort and feedback to keep the PACS QC and maintenance program effective. The PACS program manager's task is to keep the resources and requirements balanced through the use of the enterprise QC and maintenance program.

John Romlein is vice president, and John C. Weiser, PhD, is chief scientist, Xtria Healthcare Digital Solutions, Frederick, Md.

ADDITIONAL READING

• Norton GS, Romlein J, Lyche DK, Richardson RR. The task allocation chart: quality control of a picture archive and communication system (PACS). In: Blaine G, Horii SC, eds. Medical Imaging 1999: PACS Design and  Evaluation: Engineering and Clinical Issues. SPIE Proceedings. 1999; 3662:409413.

• Romlein J. Reality check: QC in the digital department. Decisions In Imaging Economics. 2002;15(5):18-24.

• Romlein J, Norton GS, Lyche DK, Richardson RR. PACS: acceptance test, quality control, warranty, and maintenance continuum. In: Blaine G, Horii SC, eds. Medical Imaging 1999: PACS Design and Evaluation: Engineering and Clinical Issues. SPIE Proceedings. 1999;3662:111119.

• Staley SD, Romlein JR, Chacko AK, Radvany M. Regional maintenance approach for PACS within the healthcare enterprise. In: Blaine GJ, Siegel EL, eds. Medical Imaging 2000: PACS Design and Evaluation: Engineering and Clinical Issues. SPIE Proceedings. 2000;3980:437-446.