PACS administrators and enterprise imaging governance

Dr. Christopher Roth, M.D., MMCI

Dr. Christopher Roth serves as the Duke Department of Radiology Vice Chair for Health Information Technology and Clinical Informatics, and also as the Director of Imaging Informatics Strategy for Duke Health. He is also a radiologist in Durham, North Carolina, and is affiliated with Duke University. He received his medical degree from University of Michigan Medical School and has been in practice for 8 years. He is one of 205 doctors at Duke University Hospital who specialize in Radiology. In his unique role as a physician leader for assessing and implementing imaging technologies, clinical decision support, image sharing capabilities across North Carolina, he is working to ensure the usability and integrity of the electronic patient record. He was lead author on the joint HiMSS-SIIM work group collaborative white paper on Imaging Governance. PARCA eNews spoke with Dr. Roth by phone about the role of PACS administrators and analysts in enterprise imaging governance.

How should PACS administrators be involved in governance of enterprise imaging?

Our director of imaging who manages our PACSes, imaging sharing solutions, advanced visualizations platforms, and things like that is absolutely in the middle of everything that is enterprise imaging here at Duke. From a technical side he is the go-to person. He has a number of PACS managers and analysts under him and he is the spearhead to driving actual ground level changes in the various applications and scattered locations all around Duke. There is a critical value for PACS technical staff to be able to participate in the governance either in leadership roles or as subject matter experts because they inevitably will be asked to change something if they are not involved. So good governance will involve them from the beginning.

Are they being involved as much as they need to be in most organizations?

I think they actually are and the reason is it would be a colossal failure if they weren't. Because there is no way you can implement changes like this without changes being communicated to the PACS or VNA or whatever. Those folks have to be there.

As institutions adopt VNAs do PACS go away or get incorporated? What happens to the PACS and the administrators?

We're going through an evolution ourselves. The systems are in many ways complimenting each other and supporting each other along the evolution. We have a VNA and also number of different viewers. We have one PACS that is only able to pull from its own archive. Because of that we are running parallel PACS and VNA. We have prioritized bringing images and content into our VNA that does not have systematic storage today, instead of turning off systems that already are working reasonably okay. Our hope was to solve the most neglected groups first.

All the data in our PACS are duplicating in our vendor neutral archive in addition to data coming in from sites that have no storage or PACS. So what is happening is that the folks who are analysts, ground staff that manage PACS have tremendous knowledge that is particularly useful for those sites that do not have IT or imaging backgrounds. So if you try to teach people how to get scope images, or dermatology images, or even point-of-care ultrasound, those who don't have a lot of background have looked to the PACS analysts, who have become not just analysts but also evangelists talking to various areas about how this is going be done in the future and talking about how it may be done.

When you look at enterprise imaging, there does seem to be overlap between various groups. How do you sort out who "owns" what imaging archives, and the maintenance of those, or is that the wrong way to look at it?

Ownership matters, especially in smaller community centers where turf is important in terms of resource allocation. People need to recognize that there is an economy of scale to leverage. By considering opening up your ownership with some defined processes and policies and expectations around how each is going to be used, then there is a collaboration that grows organically, where it is not as much of a threat as people think it is, as long as there are clear expectations and governance around how archives will be contained and supported long-term. 

If done well, a sharing of resources and brain power, expertise, people power will ensure that ownership is not the limiting factor, and that people are actually keeping their eye on the most important thing, which is using resources correctly, making sure patient care can happen appropriately, and everything is secure.  Ownership should be a very small concern of governance in the enterprise if the culture is favorable.

Does that stem from the imaging strategy? What does the strategy have to be?

In many cases it is more similar, at least in my experience, many of the same expectations that would hold for one specialty applies to another. You have to have a unique identifier; each set of images has to have the right and relatively comprehensive metadata. These are things that you have to have regardless of whether you have a scope image, or a fluoroscopy image, or radiology, it all applies. The strategy needs to call them out as things that have to be addressed, but a collaborative effort should be if not straightforward, at least in the realm of being generally expected that it will be accomplished.

Do you see PACS administrators needing to expand their skill sets to maintain their roles or expand beyond their PACS sphere of skills?

In the setting of enterprise imaging, I think they do to some extent when you are dealing with modalities that may be five or six years old that don't have DICOM licenses or might not even have network capability or short-term storage. They will have to consider things they never had to before. They will also be dealing with many more relatively unsophisticated imaging sources and candidly much more imaging unfamiliar staff. Are there things they'll have to consider, yes absolutely.

Which skills would you identify as having the greatest priority for PACS administrators to acquire?

I think, honestly, the most important skill a PACS administrator would have to face in enterprise imaging culture is taking a role in dealing with end users. I think that is even more important that it is in dealing with imaging specialties like radiology and cardiology, because you are dealing with isolated modalities, dealing with people who don't understand imaging as well, people who need to have their hands held and who have never had to systematize their own processes around imaging the way radiologists have done for the last 20 or 30 years. So I do think the biggest thing folks are going to have to learn is customer service and working with a wide variety of people. 

How would you recommend PACS administrators expand skills, pursuing certifications, teaching classes or workshops?

There are certainly online resources available, which would be a good place to start. Consider a CIIP or PARCA certification. They have different types of values but I think getting your hands dirty in front of a workflow and getting to know your end users, is a qualification that is not often discussed or appreciated. I think there is no substitute for seeing the process with your own eyes. When you do that, sometimes, rather than being on the phone or video chat or teleconferencing, you can’t get a better education than being right there next to the users.

What advice would you give PACS administrators for navigating the change to enterprise imaging?

The first thing that jumps to mind is to be open to volunteering for something new, because that tidal wave is coming and the earlier a PACS analyst gets involved, the better the job security and job growth.