International recognition of PARCA certification adds value

Independent RIS/PACS 

Consultant and Trainer

Clive Daniell is a qualified electrical engineer with more than 30 years of experience in the medical imaging field. He started his career with Siemens Medical where he trained as a CT, MRI and X-ray technician. In 1996 Clive shifted his focus to PACS, RIS and Information Management systems. He was responsible for the implementation of the first digital department in South Africa at Little Company of Mary Hospital in Pretoria.

In 2006 Clive started his own consulting company to offer an independent view on PACS and RIS in Africa. Clive has also been involved in many training initiatives, including organizing the 1st and 2nd African PACS, RIS Edu-conferences held in Cape Town and Johannesburg in 2009 and 2012 respectively. Clive is the founder of In2pacs and the In2pacs Academy. In a recent post on LinkedIn, Daniell explained why he chose to pursue the PARCA certification. PARCA eNews talked with him about that decision to get his perspective of the value of PARCA and certification for PACS administrators and other healthcare IT professionals.

Q. What were the factors you looked for in deciding which PACS certification to pursue?

I always get asked about certification from South Africans pursuing PACS administrator roles. One challenge around that in South Africa is getting a program certified is quite a challenge and time-consuming. You can't just go out and do anything. You have to get the program approved by what we call SETA’s (Skills Education Training Authority). I've been looking at certification for myself in terms of understanding what would improve my career and my understanding.

So essentially there were two that I came across that really did stick out. One was the CIIP, (Certified Imaging Informatics Professional) and the PARCA certification. When I compared them, my gut feeling was that the PARCA covered a lot and seemed like a fairly good certification, but I thought the CIIP might be more valuable. But when I compared the data it was clear the CIIP was mostly in the US, with limited opportunities for writing the exam, you could only do it in the states. When I looked at PARCA there was a much more international flavor to it. If you go to the website, you can see that people all around the world were engaged in doing the PARCA exam. So I thought this must be beneficial. 

Another factor was that I could do the exam remotely, and didn’t need to travel to the states to write it and when doing training in the Middle East, people were all asking me, "What about PARCA? If I do your training, will I get PARCA certification? So I thought, well hold on, this has an international component to it. One of the driving factors, internationally, behind being PARCA certified is that there is nothing else in many countries, so PARCA becomes a good place to go. It’s a good exam, you can do it and if you pass you get a certificate that says you've done something.

Q. Did the exam fully cover the knowledge for a PACS administrator?

When I looked at the PARCA I felt the structure of the PARCA exam is fair. I really did like the components split out with the clinical and IT being key in the beginning and then you can expand out into specializations. I do actually feel that all three certificates under the domain of PACS Administration, are valid. They do cover the material fairly well. But there were areas where, like under the clinical section, I felt a PACS administrator who comes out of an IT background, would struggle with some of the questions often asking, ‘Why would you want to ask that?’ But I could understand the basis of it and I felt it was very fair and it does cover the content of a PACS administrator and the skill set needed very well.

Any areas that could be improved?

I've only done the first certification but probably will take on the others later this year. Not really, I think the big challenge is in understanding what material you need to cover (in preparation). I think a lot of people have a challenge, even with a guideline. The challenge is you don't know to what depths you need to go. But if you write the exam, you get a clear picture of how the questions are structured and what type of questions there are.

Q. Will you change your own curriculum due to the exam?

Oh yes. There are two sections to my training, one is the practical component and the other is the theoretical component. To me, the PARCA certification covers the theoretical component. So some of the things I am changing in my curriculum are to make the components far more modular. The way I had them previously structured wasn’t well aligned with PARCA, so I'm changing that. So if you do my training course, you will be in a better position to write the PARCA exams. That's one side. The other side is the practical side, which I emphasize, and that covers fault finding and troubleshooting, that is an important element of a PACS administrators training program.

Q. Is the role of PACS administrator evolving?

Not yet in South Africa. One of our challenges in South Africa is that actually the PACS administration role has not been embedded in the health industry. So even though PACS have been fairly well deployed, especially in the private sector, the government sector still has a way to go. It is not that PACS is unknown, the technology is known and has been used for a number of years, but the partnership between the PACS vendor and the client has often been vendor dependent. The vendor is expected to do a lot of the functions of PACS administration, especially during deployment, and in many cases, clients often outsource the PACS administration function to the vendors. Many practices select someone that can do the job from inside, but they often also perform other functions like radiography and are not dedicated PACS administrator. 

That too is changing, they are beginning to realize the need for a PACS administrator but they do not yet see the value that person brings to the organization. Essentially radiology practices see the PACS administrator as an IT person or radiographer, fixing problems, whereas actually, the PACS administrator is far more than that. I'm trying to address that issue in the PACS domain and in the world by providing education through the consultancy side of my business, to drive the idea that actually you need an administrator which is a full-time function and the benefits of that are better managed IT function in the practice. That type of PACS administration role I believe is entrenched in the US. 

In South Africa’s public sector there have been one or two provinces that have recognized this and created a PACS administrator post, but the majorities have not. They take a radiographer who has no IT experience and one day, tell them, they are the new PACS administrator. These employees are then trained by the vendor on the vendor's system, but often they never get a generic PACS administrator training.  

Q. Where do you see PACS administration going in South Africa?

The big problem in South Africa is that we have a very fragmented health system, especially from the point of view of data. If you think about the healthcare structure, we have created data silos in all our organizations. The idea of enterprise-wide PACS is struggling to gain momentum because of this. The radiologists own their own PACS, so the question of storing all the other data in the enterprise is of no interest to them.

The big trending interest in South Africa right now is more around mobile technology, smartphone access to images, advanced visualization tools, and your typical tools and distribution within hospitals. There has been some work done on looking at enterprise sharing but it hasn't gained much momentum. The big problem is that lots of people in PACS, such as radiologists, do not actually know how such systems work.

There is a lot to learn, although we do have fairly well positioned radiology-based systems and IT systems. All of the large PACS vendors are present in South Africa. What we haven't broached is the EHR within an enterprise. Even our hospital groups are grappling with this. 

I'm actually involved in a project where we are looking at how to move forward with an EHR strategy. We have an EHR strategy from the government, and in fact, they also have an interoperability framework, which references some IHE profiles, so they've done that work, but there are not a lot of practical examples of implementations or knowledge for how to actually do this. 

Essentially we have two major problems in the EHR space, one, we need to decide how we want to identify the patients, because currently we don't have a standard unique patient identifier and secondly the EHR market is not developed, but this is going to change in the future.

Q. Anything I missed?

You did ask about the direction of PACS administrator's role that I didn't completely answer. I believe it is evolving on a continuous basis, and the next step for PACS administrators is to move up the ladder, maybe moving up the ladder isn’t the right word, but the next step is moving into the data sciences, informatics and data analytics. We're talking about big data and it is all hype at the moment, but in my mind, there is essential value in the data stored, that we’re not using. I think analytics is where PACS administrators will move, and that's where I think there will be growth on the training side as well. 

Whether PARCA is successful as a PACS certification in South Africa comes down to what the actual practices decide to think about it. At this moment there is nothing, and if someone comes to a practice, for a job, and says I've got PARCA certification, people will say, "what’s that?", But if a professional society like the radiology society or the radiographer's society were to spread the word about PARCA as a certification, then that would make a difference and we're trying to get something like that in place. 

There has been a lot done in PARCA and I think it is a very valuable certification to add to your CV. It shows me that you have a baseline of understanding of imaging informatics concepts, which is essential if you are going to be an effective PACS administrator.