четверг, 20 сентября 2012 г.

Informatics report: PACS administration--in their own words.(INFORMATICS) - Medical Imaging

At the Thomas Group Ltd (Anaheim, Calif), we conducted a client survey of PACS administrators (PAs) to gather their opinions about the PA hiring process. Here, I will share a summary of the responses and my insight about them.

Q1: When in the PACS process were you hired?

The responses showed no real clear answer. Two answers--'prior to vendor selection' and 'I was not the original PA for our PACS'--generated a response of 25% each. Two other answers--'at committee formation' and 'hired by default'--each generated 17% of responses. The respondents also gave 8% each to the answers of hired 'after financial approval' and 'during implementation.' These results are very reflective of what I have observed and written about in the past--except for the 25% who were not the original PAs. Without interviewing each of these individuals as to why they may have changed jobs, the only thing we can know for certain is that there are many reasons for making a change. Some may have a better opportunity elsewhere with more money; some PAs may move to jobs with PACS vendors; or sometimes, it may just be the wrong position for a person.

Q2: What is your background?

'Radiology' was the answer for 75% of our respondents. (One response was 'biomed,' and I am presuming that he or she supported radiology. I, therefore, included that response in the 75%.) The remaining 25% of the responses were 'IT.' None of the respondents came from a vendor. This, too, reflects what I have observed and would expect to see: This job requires a very strong understanding of radiology workflow and terminology.

Q3: What was your PACS experience prior to hiring?

A dominant 58% responded 'none.' Of the total responses, 17% had either 'worked at another facility that had PACS' or 'was a PA elsewhere.' Another 8% stated that they had completed 'formal PACS training' before being hired. In my experience, it has been very common to hire someone at your current facility with the proper aptitude and a strong, well-known work ethic. Again, talented people with the proper support and skill set are able to understand and comprehend this technology. One question that I am asked all the time is, 'How does someone make themselves attractive as a candidate for one of these positions?' I am fairly certain that the respondents with no experience were all existing employees of the facility with a solid performance track record reflecting the skill set shown in the answer to Q5.

Q4: If a non-health care IT, nonradiology person would like to become a PA, what do you recommend as a precursor?

An overwhelming 75% responded with 'formal training.' This included 58% with 'formal school for radiology or other health care position' and 17% with 'third-party PACS school.' Of the respondents, 17% recommend getting 'vendor experience' (although none of the respondents worked for a vendor), and 8% recommended starting with an 'entry-level health care IT' position to get your foot in the door.

Q5: What do you believe is the most important asset that a PA can bring to the job?

'Radiology knowledge' was selected by 58% as most important. At 17% each were both 'computer, hardware, software, and network knowledge' and 'communication skills.' Of the total respondents, 8% stated 'all of the above' are most important. However, as clearly seen in the responses to Q3, an innate knowledge of radiology is the top criteria to prepare for this position. A PA is going to spend most of his or her days working with technologists and radiologists. Any conversations outside of radiology will focus around radiology image sets, series, views, and the keys to displaying them to best suit users' needs. This would easily be more than 95% of the PA's day-to-day (or night-tonight) activities.

Q6: What are your typical working hours?

As would be expected, the vast majority (83%) responded that they are on-site daily, Monday through Friday. Also, 58% also responded that they provide call support in the evenings and weekend coverage; 50% provide holiday coverage. For those considering PACS administration as a career, these answers are a key insight into the job requirements. PACS is a 24/7 commitment that will always cause problems, issues, or real failures after hours. Therefore, you will be expected to be available and provide support or be a vendor resource to address and manage/fix the inevitable issues. You must have the mentality to deal with these opportunities (issues). In general, when you receive a call, it's because someone has a problem. Your satisfaction will come from helping them; however, sometimes, it will take more effort or longer than the user understands, and you must deal with that situation as well.

Oddly, one respondent selected 'Other' and wrote 'part-time.' I have two thoughts about that: One, there must be two or more people sharing the support responsibility; or, two, if not, I know several hundred PAs who would love to know the secret to a site or system that requires only part-time support.

Q7: Who provides backup coverage, if needed?

Not surprisingly, 75% answered that backup support is provided by IT personnel; several respondents specifically noted RIS support, and one noted clinical analyst, which I added into the IT personnel number. This approach is very common and logical. If any two individuals should know, understand, and live radiology workflow and technology, it should be your PA and the RIS support analyst. In many cases, the PA also provides backup coverage (relief) to the RIS person. On a day-to-day basis, the issues they face are so intertwined that their relationship is very important to a successful support effort. Many times, the after-hours support is directed to the IT help desk as a first line, and many times, the issue is not PACS related; it may be passwords, the network, or other clinical systems creating the problem. Radiology administrators were named in 17% of the responses. My guess is that these are smaller sites that have less of an infrastructure to leverage as backup. Other responses were for biomed or clerical personnel. This is a tough position for these folks to assume, but it might be the only or the most cost-efficient option.

Q8: If you had to choose one thing that would make your job as a PA easier, what would that be and why?

This question really opened a can of worms. First, almost everyone said they would like additional training/support and a second PA to help deal with all the day-to-day issues that need to be managed. The list of things that need to be done each day becomes a juggling act with whatever the next phone call brings. There are concerns about living in a 'reactive' versus a 'proactive' world; in the latter, PAs would be able to perform routine system activities, train referring physicians, and strategically plan. All of these responsibilities quickly can become overwhelming and stressful. Over time, neither of these reactions will be beneficial to the PA or his or her facility.

One respondent mentioned that growing and expanding demands on PAs into other 'ologies,' such as cardiology, pathology, and endoscopy, are going to raise the pressure and time demands on these positions. This question will be answered over time, but PAs must be prepared to expand their horizons, especially in smaller facilities that have the bandwidth.

Michael Mack is president and CEO of the Thomas Group Ltd (Anaheim, Calif). With 20-plus years of experience in medical imaging, Mack now specializes in PACS planning and implementation. For more information, contact mdi@ascendmedia.com.